Is There a Middle Way in 12-Step Programs? (Part I)

One of my Wise friends sent me two links this month. The first was to Bankole A. Johnson's "We're Addicted to Rehab. It Doesn't Even Work" in the Washington Post. We have discussed the addictive personality a lot, my Wise Friend and I, especially mine. She is a medical doctor whose patients have habitually indugled in the excesses that land them in her office. My Wise Friend has either been trying to get a rise out of me or is asking herself if the Alcoholics Anonymous 12-Step prototype part of the best treatment option she can offer her clients.

Johnson questions the sequestering that rehab so expensively enforces and that 12-Step programs out in the world encourage, citing a study that found a 24.4 percent spontaneous sobriety among alcoholics. They cured themselves without the coaxed powerlessness that he despises and that is part of the backbone of 12-Step programs.

I know exactly what he means because each time I lose my abstinence from unlicensed eating, I binge in ways I rarely did before going into the Rooms.

Or is that faulty memory on my part? How did I get to 338 pounds in my early 40s if I wasn't bingeing on a regular basis? Why did I declare bankruptcy in a year that I lost my adjunct teaching job, but managed to save a little money on the same pay of my day job when I was abstinent?

Food addiction is, of course, quite different from most other addictions because, whereas the alcoholic or sex addict doesn't need a beer or a blow job, I still have to eat. In ways, I need the Rooms more than the guy who calls a bar stool home.

So what about my friends who were on the verge of losing everything to alcohol? One turned violent when drunk. Another wrapped a car around a tree. A third holed up every weekend and holiday, emerging only when hallucinations made safe harbor out of family. And what about their lives now that they are centered around meetings, stepwork, their sponsors and their AA friends? They have changed careers and are exuberant about their evolutions as artists. Two have settled into loving relationships and into turning cabins into country retreats.

Very often friends and family want to put the past behind them; they don't want to relive the bad old days. The recovering addict needs the lessons from the bad old days, however. The Rooms are a place apart (a fact -- or symptom, depending on the point of view -- I'll address in a subsequent post). It's good to be safe from the taboos of silence. It's wonderful to be able to laugh at our crimes, to air them out and syphon off the shame of furtiveness and calamity. It's just as good to laugh at the Rooms.

In the interests of fairness, I know who people who have successfully graduated from the Rooms. I also know people who have cleared up without the Rooms or rehab. I think especially of two dearv friends who got clean on their own: a Nickelonian who pulled out of a bad rock habit and a boozer who used the North Pole as a geographic cure. Each relapsed and tried again. The former is doing well now; the latter may stay sober after hospitalization for cardiac problems brought on by booze.

I didn't know them before they started smoking crack or hiding vodka but, when pressed, each friend has talked about a loss of heart, an inability to love beyond a certain safe high wall.

Two people do not make a case study but their shame over their addictions kept them from seeking medical care in the sweating, vomiting, tremorous days of withdrawl. Chemical abusers need medical intervention and sometimes the best facility for that is in the expert care of addiction specialists. So, too, do the grossly obese and the furring anorectic need close medical supervision.

The moment I realized I was addicted to food had some of the same relief of making it to the toilet with cramping bowels. It was that tangible. I have never faced a Monday afternoon's broken resolution since. Even in relapse I know that abstinence is a garbage can away. And I have never been as completely alone as I was before that realization. My family and friends always had a comment or a humiliating you-have-such-a-pretty-face or something else they were physically able to do that I could not. I was always Other. In the Rooms I am One Of.

This puts Dr. Johnson's statement that, "there is simply no need to remove alcoholics from the support of family and friends and shut them away for the customary month in rehab" to a test. Too often "family and friends" are users, too -- I'm sure he knows there is a strong genetic component to addiction. Too often "family and friends" answer a refusal with "can't you have just a glass/bite/hit?" Too often "family and friends" doubt the recovering addict's ability to make a go of it. Too often "family and friends" are furious at the years of misbehavior, insolvency, dependence, abuse and lack of sleep to be properly supportive. Too often "family and friends" want to know if the addict is tempted to drink or how many pounds have been lost or how much "better" s/he feels now that s/he is living straight.

Alcoholism Essential Reads

Are We More Honest When We're Drunk?

Does Alcohol Really Make Us Happier?

There is a saying in Rooms about "family and friends," too. Of course they push your buttons. They're the ones who installed them.

Dr. Johnson can't have it both ways. If he is correct in emphasizing personal power over addiction, then he can't really find fault with

the notion that it is the individual who fails and not the program. For all the neuroscience advances that Dr. Johnson touts, no one has handed addicts a pretty pink pill. Dopamine and serotonin be damned! I still get depressed on maximum-plus doses of sertraline and bupropion.

Dr. Johnson, it should be noted, is on the pharmaceutical payroll, searching for the pill and offering the assurance of a one-quarter spontaneous cure. How many days of sobriety would the 75 percent who fail at will power find without AA? How much hope does detox and living clean, even for a little while, give the relapsed addict that s/he will get it right the next time? How much more authentic life do I have now than I had fifteen years ago, despite years of relapsing?

No one quite knows the recidivism rates in AA, but the true mysteries are in the hope, alertness, self-knowledge and relief that come from time in the Rooms. The failures may be miserable but when I look at the successes and half-successes, I see what was not there before and without.