Addiction is Isolation;Recovery is Participation

When someone is addicted it’s like they have separated themselves from the mainstream by their addiction activities.  Over time they become increasingly absorbed in these  activities, thinking about it, anticipating it, doing it, and recovering from it,  so that the addiction takes over more and more of their life.  At first friends who are not into the addiction are lost or avoided then family, and eventually recreation and jobs.  Normal people, successful people participate in life. They are involved in their family, work, community and their political and  spiritual life.
When doctors ‘fix’ a broken leg they don’t try to ‘set’t the leg according to the way it was previous to the break but rather set it according to the best functional possibility for the leg. This information has been acquired over hundreds of years especially from the studies of olympic athletes and obviously from healthy people.
Addiction isn’t just about the drug, the alcohol, the substance, the process. It’s like a virus that invades the whole body and can indeed be a total epidemic and public health crisis as we see today in many parts of our world.
If you consider addiction socially, really, it’s more like a religion than anything else. The addiction will have ‘no other gods’ before it. The dealer or promoter is like a priest. There are ‘places’ like crackhouses, casinos, bars where the addiction is practiced mostly.  There is a language and a particular way of thinking. “If you had my life, you’d do what I’m doing’ along with other popular cognitive distortions.  To healthy normal people people with addiction often sound like fanatics and sometimes frankly psychotic.
The most successful people in society belong. Freud said mental health is the ability to love and work.  The WHO extended this to what has been summarized as ‘love, work and play’.  In addiction the person finally have only  their addiction.  Addiction has been called the ‘great eraser’. The earlier one can intervene after the ‘it’s fun stage,’ to when it’s fun and trouble, before it’s just trouble, the more successful the outcome. Indeed those with intact family and jobs and still socially active in their communities are most likely to ‘kick the habit’.
In addition to medication, individual psychotherapy and social therapy I encourage people to ‘participate.  Studies have shown repeatedly that those who are abstinent from addiction at 5 years belong to some group that supports their recovery.
Vaillant’s work showed that those 20 years clean and sober were most likely still attending a 12 step program or some other spiritual based program.
But the cornerstone of recovery is participation. It doesn’t have to be a spiritual program.  The loner is at highest risk.  Addiction presents as a ‘friend’ just like the dealer is a ‘friend’.
I had one senior government worker  patient heavily addicted to marijuana and asked her if she had any friends. She insisted she had one friend. That friend was her dealer.  We used to joke in adolescent psychiatry that if your only friend was your social worker you were in trouble. Well, in addiction psychiatry, if your only friend is your dealer you really are in trouble.
When you drive into a town there are usually two large lists of clubs.  One is the so called ‘spiritual club’ so you’ll see a surprisingly long and wide list of churches, synagogues, mosques and temples. Also you will see another list of ‘social’ or ‘community clubs - Elks, Kiwanis, Odd Fellows, Masons etc.  In addition to these emotional and spiritual community clubs there’s a garden variety secular club commonly called a ‘gym’ but also called a dojo, a yoga studio or ‘running club.’  The majority of successful people without addictions belong. Addictions eventually like other major mental illnesses are increasingly isolated and alienated.
12 step programs and spiritual clubs and some physical activities don’t ‘cost’ an arm and a leg.  The Yacht Club or the Jockey Club by contrast are usually well beyond the means of the person in recovery.
12 step clubs and most spiritual clubs welcome people without expectation of any more than a ‘buck’ and please fill a chair.  There are specific recovery ‘clubs’ like the Alano Clubs, a kind of coffeehouse atmosphere hang out, or the similar Recovery Club. The Avalon Society hosts  houses specifically for women. There are a new set of ‘sheds’ for men and a wide variety of ‘drop in’ clubs for mentally ill patients which welcome people in recovery as well. Since addiction is so depressing it is common for people in recovery to come to a realization of their depression and benefit from attendance at the mood disorder clubs or anxiety disorder clubs which are increasingly part of the urban landscape. There are specific support activities commonly, fully or particially funded by government.
The self help or community based services usually have a higher functioning capacity.  The average synagogue, church, or temple or YMCA/YMHA/YWCA will have a wide spread of highly successful to marginal individuals. This is like the 12 step programs where those who have long term recovery and ‘are’ back on their feet again are encouraged to hang around to help the next person.
Society is generally set up like a membrane with only a few ‘gateways’ where the addict or alcoholic in recovery can ‘mix’ with those who don’t suffer.  Part of the function of the health care system has been ‘quarantine’.  The local golf club doesn’t advertise, ‘heroin addicts welcome’.  It may not be right but it is real.
So Im forever encouraging patients to participate. To this end I encourage all the standard ‘health care based resources ‘but then encourage what was part of the patients life before the addiction kicked in.  Just as the addiction stopped a person from working and contributing and in recovery we encourage a person to return to work I encourage a person to return to those activities that they did before the addiction isolated them.  Not those activities which contributed to their addiction but the other ones.
Over many decades of work I’ve been pleased to be a part of  real success stories. Patients who were in school but dropped out have returned to school, often starting with a night school course and often going on to completing trades, bachelors, master’s or phd programs.  Recovery is that amazing.  So many of my patients have joined gyms and this has been the take off to their return to health and self esteem.  Yoga, Tai chi, martial arts programs, swimming, YMCA are all amazing places for increasing what has been increasingly called ‘recovery capital’.  There’s a lot to be said for ‘healthy body, healthy mind’
Actual human longevity has been associated with ‘relationships’ , the more connections one has the better off one is. What a contrast to the crack addict sitting alone with pornography in a single room with the curtains drawn. What a contrast to the grossly obese person who sits alone at the smorgasbord.  Or consider the addicts whose only contact with a neighbour is sharing a needle or the alcoholic  nursing their bottle in the lonely drinking bar.
Many of my patients have benefitted most from going to AA or NA or CA (Cocaine anonymous) or OA,  Overeaters Anonymous, or GA, Gamblers Anonymous, or Debtors Anonymous or Sexaholics Anonymous, Codepents Anonymous or Sex and Love Addicts Anonymous.   There are literally millions involved in the 12 step (or anonymous ) recovery programs. And now increasingly SMART another cognitive behavioural pseudo self help program is increasingly available.
Churches, temples, mosques and synagogues are a cornerstone for recovery. If you ever attended or your parents attended any then you’re really welcome back  Besides that being a ‘club tourists’ is always welcome and I encourage people to simply ‘drop in’ a few times to these ‘clubs’ in their neighbourhood, and put a ‘buck’ in the basket and go a few times to see if it ‘fits’. Anything is better for recovery and depression than being with ones self or one’s dealer.  We joke by saying that ‘I may not be much but I’m all I think about’ and “my brain is a bad neighbourhood, I shouldn’t go their alone.” It’s equally important to consider ‘volunteer activities’ and become involved in the countless volunteer clubs and activities increasingly available to get one outside of themselves. It’s old adage that if you haven’t shoes then you can still help a person without feet. So much of recovery is ‘perspective’.
I’ve had countless patients benefit from returning to the spiritual organizations that they attended as a child. Commonly addiction makes one critical of all those activities that don’t promoted addiction. These spiritual organizations are themselves reaching out to the recovery community with a local synagogue having a weekly group for people in recovery, countless churches of all denominations having weekly dinners and services and the various HIndu, Sikh and Muslim temples encouraging people to forsake their addictions and participate in community. In Malaysia the mosques have methadone clinics situated in their buildings with a combination of spiritual and medical personal available for people seeking help with addictions.  The local indigenous community has a variety of native healing communities involving sweat lodges, drumming societies and smudging.
A lot of my patients have been welcomed back open armed into the HIndu and Sikh temples where their extended families are so happy to see them engaging in their communities. Yoga is especially helpful in recovery while mindfulness meditation is increasingly recommended.  The taoist tai chi organizations are further ‘clubs’ where people can get healthy and learn a wholistic approach to their recovery.
Each ethnic and cultural group has it’s own ‘community’ clubs.  Where a person might have rejected their ‘catholic roots’ they might well find ‘participation’  and extended friendship in the local ‘buddhist’ temple.  The key is ‘participation’ .  Going from isolation to ‘participation’ is what works and where it begins isn’t necessarily where it ends. A number of my patients have gone on to leadership in community organizations that are at variance with where they began. A United Church minister left aetheism by joining the vaguely theistic unitarian church  to move onto anglicanism and eventually becoming a united church minister.  The key is movement.  Get out.   I have patients who have done exceptionally well in organizations like Kiwanis and Masons.  A number of women I had as patients in the country gave up drinking wine alone by joining the local quilting society.
The ‘meet up.com’ app is an amazing resource for activities for people to participate in.
I am also encouraging people to join political parties. To date 99% of those who have followed this advice have joined ones other than my own. The key is that political parties in Canada at least are ‘cheap’ to join and have a wide variety of community interests and activities.  It’s uplifting for people who once were the greatest ‘critics’ to be seen voting and participating in the political process.
Some of my patients have stayed sober in Toastmasters, others have overcome depressions and gained a whole variety of skills theres. Still others have joined a variety of dance organizations, including Salsa International, Arthur Murray’s, Fred Astaire, and all the different ethiic dance organizations including square dancing and high land dancing.  As much as we like to demonize leaders of the different parties individually they are truly amazingly accomplish social individuals.
Addiction is isolation.  It carries a large component of shame.  Recovery is participation.  Rather than a ‘phoney’ or ‘fake relationship’ with one’s substance of choice or addiction of choice, one moves out of being a mental wanker to being a part of community and participating in all the wide variety of activities that people do where addiction is frowned on and certainly isn’t a selling feature.
Some ‘clubs’ require ‘caution’.  For a while some Legions were glorified drinking clubs dominated by alcoholics though increasingly I hear that these organizations and other veterans organizations are working actively to identify and counter addictions that not surprisingly  follow combat experience. A third of those with ptsd and no other history of addiction vulnerability developed addiction. Underlying all addiction it can be said is anxiety, most commonly social anxiety and sadly ‘if you don’t use it you lose it’.  However, there's also a lot of 'yes, but' in addiction. Prochaska encouraged maximum resource input into those who were willing to be 'active' in their recovery. "Show me, don't tell me."  Many patients are indeed looking for someone to blame rather than wanting to 'change'.  It's not surprising that the phrase 'If you talk the talk, walk the walk' is so prevalent in treatment centres.  Many addicts want to say they are seeing a therapist only to 'appear' to be 'participating' and of course will get very angry if you don't 'collude' with their outright 'refusal to change'.  Not surprisingly 'drug testing' is common place in early recovery for those returning to work.
Dr. Paul O., famous for recovery, said “I can find a problem with a white wall and if you don’t see the problem, it’s an even greater problem.”  Addicts who would shoot up in a church basement without concern or get drunk at any church wedding or funeral would suddenly say they couldn’t attend AA or whatever because of the ‘god’ stuff. Thankfully SMART was developed and atheists can as well join ‘philosopher’s corner’ or ‘political parties’. Most commonly the ‘criticism’ reflects’ lack of willingness to change.  This is sadly indicative of high risk for relapse since commonly people’s previous life is adapted to support the addiction and people feel most comfortable with what they know. All change is anxiety provoking and initially discomforting. The obese are, in my experience, least likely to jump at the suggestion to join a gym.
It’s not rocket science.  It’s really very simple. Yet it’s not easy.  Those who want to change most will eventually make the effort or sadly die or end up in jails or hospitals as a consequence of their persisting addiction and isolation.  Now of course there are ‘exceptions’ and not all people with addiction are ‘isolated’ in this way. Some are merely ‘isolated’ in themselves . But that’s a specific sub group.  The generalization addiction is isolation and recovery is participation is just garden variety main stream.