September is Recovery Month, a time to celebrate the fact that recovery from substance use disorders is not only possible, it’s probable. In the United States, 9.1% of the population (or 22.35 million adults) have resolved a substance use problem. Compared to many other medical and psychiatric illnesses, substance use disorder is one with a good prognosis. It is estimated that between 42%-66% of people with substance use disorder achieve full remission, although it can take time to reach that point. (https://www.recoveryanswers.org/recovery-101/fast-facts/)
For all the advances in science and all of the advocacy rallies, though, I still wonder about the countless others who never show up in the statistics or at the marches. It’s hard to quantify or extrapolate percentages from people who would qualify, yet are in denial or too ashamed to admit that they suffer from substance use problems. How can they appropriately respond to a survey when they are still not admitting the truth to themselves?
The other day I had a phone call with someone who continues to drink despite many obvious problematic episodes. We tiptoed around his drinking, but he eventually admitted that he drinks too much quickly adding that he hasn’t lost his job and hasn’t hit “bottom.” I shook my head in amazement and didn’t bring up the fact that I knew his marriage is on life support and he hasn’t slept well in over 5 years. A part of my wanted to scream, “what are you waiting for?” but I remained silent because another part of me totally understood.
For years I continued drinking even when problems began to arise, in a mix of fear and denial. I couldn’t imagine a life without alcohol, yet I was becoming increasingly ashamed about things I would do when I drank. Looking back, my rationalizations were laughable: “I am a Deputy Bureau Chief in the Manhattan DA’s office! How can I be an alcoholic?” or my personal favorite, “I haven’t had a DWI!” (yet failed to acknowledge that I didn’t own a car in NYC!) My denial, just like his, can be both heartbreaking and mind-boggling at the same time.
The idea of “hitting bottom” became popular during the early days of Alcoholics Anonymous since most of the original members had truly lost it all or were on the verge of losing it all. The belief was that in order to make the drastic decision to stop using drugs or alcohol, a great willingness was necessary, willingness propelled by extreme negative consequences. But as the years have passed, many people are now addressing their substance use problems before things get that bad. Over the past several years, groups like “Young People in Recovery” and collegiate recovery programs have literally smashed the illusion that you have to wait to be a ‘bum’ on the Bowery before asking for help.
The decision is still a big one (no matter how old you are) and still almost always initiated by a consequence. I have yet to meet anyone who got clean and/or sober because life was going great. No one I’ve ever encountered has said that they woke up one bright and sunny morning and jumped out of bed thinking, “It’s a great day to get sober!” The reality is that most people will not change their behavior unless and until it causes problems.
But experiencing consequences does not have to equate with losing everything (even though in the end, everything you lose may include your life). In fact, the good news is that you can decide which consequence will serve as the “straw that breaks the camel’s back”.
Even the common language contributes to the problem, with the phrase “alcoholic” or “addict” conjuring up images of destitute individuals with nothing left in their lives. Individuals may look at the fact that they are still employed, haven’t lost their homes, and are still “functioning” as proof that they do not have a problem. If they can show up at the office or make their “tee time,”, how could they possibly be an alcoholic or an addict? The reality is that addiction is insidious and can progress in severity even while the paycheck is coming in and you are on the ninth hole of golf.
The bottom line is that “functioning,” does not mean that there isn’t a problem. Functioning means that things are “operating”, but that doesn’t equate with operating at maximum capacity. Instead of asking “Have I hit bottom?,” perhaps the better to question is “is my use interfering with achieving my full potential?” Back in the DA’s office, I never drank in the morning or even during the day, but I was hungover a lot and I know that I could have been a much more focused and efficient prosecutor had I been at the top of my game.
Given that addiction is a progressive condition, those who are “functioning” will inevitably experience a decline in their quality of life. It can be a very slow and painful process, where remorse and regret replace joy and delight. That process is often aided by the fallacy that things are not “that bad” because they are grasping on to any part of their life that hasn’t yet been destroyed to justify their continued use. Sadly, there are no happy endings in these scenarios.
Since getting sober, I have met some of the most accomplished professionals across the world who are in recovery. Addiction is an equal opportunity destroyer that can devastate any- and everyone. It has no regard for what you do for a living or how much money you make. I was lucky that I didn’t wait until I lost everything. I still had a great job, a loving family and a great social network. My “bottom” was a loss of self-respect and the realization that I was not the woman I dreamt of becoming when I was a little girl. I knew that it was the alcohol that was causing the pain and I finally said “Enough!”
Over the past twenty years, there have been significant strides in our understanding of addiction. As with any other chronic condition, the earlier the intervention, the better the prognosis. As both a breast cancer survivor and a woman in long-term recovery, I am incredibly lucky that both were caught in the early stages. My breast cancer was stage one and while I had a recurrence, the cancer never spread beyond the breast. I didn’t wait for the cancer to progress before seeking help. I have never met a cancer patient who said, “I’ll just ride this out until it metastasizes and things get really bad (hit a bottom)!”
Yet, that is exactly what happens with many people suffering from substance use disorders. Instead of seeking help when they first realize there is a problem, they continue to use substances in a harmful manner because they aren’t at “stage 4” yet.
While substance use disorder is a chronic condition, it is also unique in many respects. It is not only treatable, but remission can start immediately. The minute someone decides to put down the drink or the drug can mark an immediate turning point in his or her life. While relapse may occur, many are able to maintain continuous sobriety from the beginning. Unlike other diseases or disorders, you can determine your turning point..
The other unique feature of recovery from substance use disorders is that it can often be resolved without resort to formal treatment. A recent national study found that over half of those in recovery had used no formal services whatsoever. (Kelly, 2018) Kelly, J. F., Bergman, B. G., Hoeppner, B. B., Vilsaint, C. L., & White, W. L. (2017). Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181(Supplement C), 162-169. doi: https://doi.org/10.1016/j.drugalcdep.2017.09.028
Not only that, but unlike other diseases, where the goal is to get back to “well”, with recovery people actually transcend and get “better than well.” Studies conducted in both the US and UK confirm that this concept of ‘better than well’ offers a model of hope and change to populations and suggests that the goal of recovery is not a narrowly constrained model of symptom reduction, but a quality of life process of ongoing growth. Hibbert and Best (2010) Scottish Drugs Recovery Consortium.
For a very long time I was amazed at the fact that I was able to stop drinking on July 15, 2001. I did not have to go away to treatment and I was able to make some major changes in my life through making some personal decisions and connecting with others in recovery. But the truth remains that I spent years struggling before I was able to admit I had a problem. The excuses and justifications were illusory and pretty much based on a combination of fear and stubbornness. I was scared of a life without alcohol and I also clung to the notion that I somehow couldn’t function without it.
So, during Recovery Month we need to shine a light on the fact that your “bottom” can be whatever you want it to be. The earlier you address that nagging issue in your soul, the faster you will get better and truly find meaning and purpose in your life. Seeking help is not a sign of weakness, it is quite frankly one of the bravest things a person can do. Hopefully next year we will have even more Recovery warriors joining in our celebration.