Recovery Day

When I attended my first Recovery Day celebration in downtown Vancouver I was impressed with the slogan, « I’m in recovery and I vote ».

The history of abuse of the mentally ill but specifically those with addiction and alcoholism has been longstanding.  Being a doctor who works with the mentally ill population and especially with those with addiction I’ve had to literally take all the same abuse that my patients suffer routinely. Being in recovery myself for decades I know intimately the demeaning humiliating behaviours directed to those who have one addiction by those who have another. Closet alcoholics were the worst for the ‘holier than thou’ approaches to the addicts.  Tobacco smokers condemned pot smokers.   

All the while neuroscientific research exposed the  disease of the reward pathways of the brain lambic system with studies showing this not only in man but also in monkeys and rats. 

 No longer do we encounter the offensive name calling and dismissive arrogance that so dominated the social Darwinism of the eighties and beyond but still the neglect is palpable in this field.  Blaming and shaming are the principle approaches to those who suffer from addiction.  It’s no more a moral issue than the colour of one’s hair is a moral issue. It’s a brain disease which develops with exposure no different than the radium sickness that plagued the women who painted the numbers on watch’s with uranium paint so they glowed back in the day when radioactivity was just being understood.. 

A little of something may even be good but a lot is bad for you.  A brief exposure is tolerable but prolonged exposure is deadly.

Each person has a genetically defined level of tolerance for alcohol, for instance.  In genetic studies, 50% of identical twins who develop alcoholism will see their twin develop alcoholism even when raised in a different home. That’s powerful evidence of the disease basis of addiction.  

It’s not just illegal drugs or activities but increasingly with chronic illness people become ‘dependent’ physiologically on the substance that at first saved them. Medications like morphine and clonazepam which can result in dependence can lead to addiction just as food which can save a person can kill them in obesity with diabetes, arthritis, and heart disease. .

Addiction itself is not just the ‘drug’ but rather a characteristic set of behaviours and changes that occur once individuals pass the proverbial cucumber to pickle line of dependence. These changes included spending an inordinate amount of time involved in the seeking and use of the agent, moral and ethical changes associated with obtaining the agent, psychological changes, mood sswings, character lapses, work behaviour change,  relationship changes, all well documented and gloriously evident to observers all the while the actual sufferer is wholly incapable of seeing or doing anything about this, commonly themselves in denial. Most commonly they even react to any external approaches to place  restriction on their aberrant behaviour with mild to severe and outright paranoia.  These behaviours of extreme mental illness are uncharacteristic of the individual and yet those with the chronic disease will despite origins in society and estate end up in jails, institutions or death due directly because of the disease of addiction.  Skid row is well known to politicians, lawyers, professionals and the once very wealthy. It is no surprise that Alcoholics Anonymous was begun by a surgeon, stock broker and lawyer. Yet the average member of society would not likely associate the drunk or addict as one of their own.  

The greatest threat to the addicts and alcoholics are those who capitalize on their disease, the enablers and the outright psychopaths and sociopaths.  In Canada 10 % of the population consume 80% of the alcohol and this figure is the same for each of the most recognized major addictions whether they are mood altering drugs or so called process addiction like gambling and sex.  

A world reknowned addiction researcher declared at an international conference that his research is not funded in the millions to stop addictive behaviours but to identify those who are at risk for persisting in these behaviours which profit others past the point when they no longer have money to pursue their addictions and continue to embarrass the industry that some would say stole their livelihood.  

Today the principle culprit is the government ‘pushers’ who lie outrightly with forked tongue, claiming to want to help addicts while at the same time their salaries are paid for by the avails of this addictive process. So to this day the government approach is lukewarm at best to the purveyors of death, those disgusting members of tobacco boards and their recent cohorts the pushers of marijuana.  It’s all about money and you can’t make a killing of a profitable omelette if you can’t break a few eggs.

A tshirt of the Recovery Movement  is « ‘I’m evidence’.  For so long the lie that addiction was not curable prevailed yet as painful and difficult as it was millions have thrown off their chaîns.  The ‘butt out’ anti smoking movement under taken individually and at a public health level has been so successful that the very air we breathe in the work places and restaurants of advanced countries is no longer second hand smoke.  The evidence is even more powerful in the changes in life expectancy and the survival in lung and heart diseases.  Exercise programs are altering the food addiction obesity that had always plagued the richest of society whether in India, Africa or America. ‘Super size it’ is being challenged by information and exercise.  Just knowing the source of the disease in the compulsive behaviours protects individuals from the fad diets and countless other ineffectual approaches to addiction, a mental and physical illness.

Increasingly the anger so common with interruption of the source of abuse is being identified and the unconscious lies that go with the often psychotic rage that invariably attempts to form allies, and seek rescuers and ‘demand’ changes to ‘achieve’ what is some often simply  ‘ more’ of whatever.  These individuals  enlist those financially and politically themselves addicted or likely to profit from the addiction.  Addicted women are especially so seductive in enlisting men to help them persist in their addictions. 

 Dr. Paul O. , a great leader of the Recovery Movement, himself a recovered addict , paraphrased, said “I could find a problem with a blank wall and if you didn’t see the problem, then it was even a greater problems.”

So historically the pressure of the addicts with collusion has seen a variety of addiction issues phrased as civil rights concerns, bars being allowed to be open around the clock, legalization of drugs, man boy love decriminalization for the ‘8 is too late’ crowd, the right to candy bars, one armed bandits , the crack of gambling, showing up everywhere.  

The doctors who work with addicts, like the leper doctors before them are not only shunned but are covertly attacked by legal systems which discourage health care workers in this field and enable the disease while appearing as a rescuer of those who have descended to psychosis and will use any means to kill the messenger who ‘confronts their addiction’ or stands in the way of their disease.

Meanwhile  the overt and covert aggression, the shaming and blaming in the ranks of those who themselves are apart of the drug pushing profiteers continues. 

Originally the Washingtonian spiritual movement and other evangelical movements were the only effective forces against addiction.  Dr. Freud considered addiction worse than schizophrenia and Dr. Carl Jung said that he knew of no cure for addiction but had seen some who had a miraculous recovery. The original 12 step peer support movement was the first reproducible cure with 50 men maintaining  abstinence from alcohol for five years and more. This epidemic of historical proportion saw this ‘cure’ , a true miracle of the 20th century, even as billions moved forward financially and in terms of leisure time to having the means to develop and maintain addictions which in the past were commonly only stopped  by poverty,  disease, or death. Spirituality though not necessarily any religion per se remains a special part of the recovery process.  

Anonymity helped the early movements because of the stigma associated with this ‘behaviour’ labeled a moral failing much like ‘bed wetting’ was until it was found to represent a delayed bladder development.  Even homosexuality, a naturally occurring behaviour throughout the animal kingdom, was considered degeneracy but worst of all were  the alcoholic and addict. The joke might well be that a person could say, “I may be a bed wetting homosexual but at least I’m not an addict.” 

Thanks to the incredible success of the 12 step programs millions of alcoholics and addicts not only recovered but went on to be rich and powerful and influential. The consequence was that all manner of parasitic ‘fad’ approaches latched  onto  the body of recovery. Every charlatan ,now that addicts and alcoholics were no longer impoverished, wanted to get their new earned money for whatever positive or nefarious scheme.  Even the medical community got on board and with the help of governments all claiming the best intentions began to prey on those in recovery . A famous psychologist summed it up by saying that America had become a nation of ‘caregivers and victims’.  It was all about money. 

Now the Recovery Movement began with those who like the ‘friends of schizophrenics’ and the various ‘cancer societies’ was developed by those themselves who had  recovered from addiction or had family and friends who had recovered from addiction.  It takes an addict to know an addict was a saying that helped raise the awareness of many.  This grass roots movment which served not only to raise awareness and get private and government funding to the people and places of greatest need also served to protect fellow sufferers from the often ‘subtle’ abuse of the enablers and profiteers, private and public.   Some of the ‘do gooders’ were addicted to the deceit of political correctness and two faced  countered the real efforts to address addiction with smiling falsehoods and feigned half truths.   The power of the tobacco companies was never appreciated until those in the streets realized how much money influenced the government politicians and government regulation bodies.  The very men and women paid exorbitantly in government regulatory bodies  to protect citizens were themselves profiting by protecting the ‘pushermen’ of various ‘ilks’.  Thankfully those in recovery in their personal journeys had learned to recognize the hidden addicts and those profiteers who claimed to be helping.

The community of recovery was vast and coined  the phrase  “there is shame in addiction but there is dignity in recovery’. Carry the message.

 Recovery Day is an international celebration and coming together of all those who individually and together are working to address the disease of addiction and support those ‘cures’ and those ‘processes’ which truly work.  It’s a wonderful event.  It’s a fabulous day. It’s hope and inspiration in face of a centuries old epidemic.     

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.

IDAA 2017 Snow Bird, UTAH - CME - Science of Recovery - Dr. Ray Baker

Dr. Ray Baker provided insights into the latest research into Recovery.  A lot of research had gone into addiction but this is the beginning of the study of the health after addiction. The research documents the success of recovery. Epidemiological research showed the percent of population serious problems and its significance. The research into what had worked for individuals to achieve recovery showed a variety of tools had been used. The importance of the treatment centres was highlighted as was the value of the 12 step programs.  Dr. Baker went on to discuss the importance of Recovery Capital especially as this related to response to treatment and prevention of relapse.
Even though I’m an addiction psychiatrist working in the field I am amazed at the cutting edge work that Dr. Baker highlights in his presentations. He’s known as a great clinician but his academic credentials, presentation skills and research are often not as well known. This is possibly because if you talk to him personally he’ll be more likely to talk about his family, or his increasing love of running.  I thoroughly enjoyed the presentation and have only poorly given a taste of it with a very few of the slides he used. I trust this will encourage others to catch a future presentation of Dr. Baker’s, watch for his coming book, and follow up on the references he has provided in the area of the Science of Recovery.
I’d personally been interested enough in the commonly misquoted Cochrane study which suggested 12 step programs weren’t beneficial to seek out the chief addiction medicine researchers for those Cochrane Studies at the ISAM presentation in Malaysia.
“We said it couldn’t be studied as a addiction ’treatment ‘ because it wasn’t simply a " treatment." It’s always misquoted.  We ourselves  recommend 12 step programs clinically.”  I remembered that conversation because the chief Cochrane researcher lamented that there wasn’t research to date to support the obvious evidence of the success of 12 step programs especially with regard to long term recovery.  I enjoyed that Dr. Baker had shown that studying Recovery as opposed to  Addiction Treatment supported what we all saw clinically.  Further by looking at the idea of Recovery Capital conceptually there was increasing opportunity to standardize and research aspects which we all know clinically are most relevant to treatment success.  I often have to point out that the Cochrane Studies were originally developed solely for the purpose of comparing one medication treatment to another  and as a tool are best when  limited to this narrow focus. Unfortunately, it’s easiest to show with a short weekly to months  pharmacological trial the benefit of one limited treatment compared with another.  Recovery by contrast is a concept of life change that shows increasingly over years. The cost of research selects in favour of an acute intervention but not so much for chronic conditions as addiction is.  Dr. Baker raised these issues and proposed solutions some of which included paradigmatic shifts in thinking about treatment.  I loved his use of lay persons as recovery coaches and recovery monitors to help get patients to meetings or to doctors appointments and follow up.
All round for me a highlight of the CME presentations this year. I see myself taking some of these ideas back to my clinical practice and changing the questions and recording I do in my continuing care of patients.

Anger, Irritability, Moodiness

The trouble with anger, irritability and moodiness is that they may be wholly unrelated to external factors.  Commonly these ‘feelings’ are ‘self generated’  and result in a ‘feeling looking for a reason’.  This is a bomb looking to explode.
That’s why there is a term ‘righteous anger’ because angry people will attack anything simply because it’s in their line of vision.
My mother used to say ‘too often we hurt the ones we love the most only because they’re closest’.
A feeling isn’t ‘truth’.  Anger can be ‘triggered’ by something in one’s past or be an interpretation of something internally causing anxiety. People unused to love and care will get angry with those who are loving and caring.
The natural state of an untreated alcoholic is ‘Restless, Irritable and Discontent”.  This is the RIDS.  It’s what people mean when they say someone is ‘dry’ but they’re not ‘sober’.  Sober people are ‘slow’ to ‘react’.  They’re actually not that ‘reactive’.  That’s what serenity is.  It doesn’t mean that they are dull and cold and unresponsive but rather that they are not ‘hair triggered’.  They don’t have that drama queen quality that dominates the male and female world of addiction.
It’s often called ‘moodiness’ because a lot of people ‘deny’ that they ‘get angry’ but will admit that they can be ‘moody’.  Everyone knows them because everyone walks on egg shells around these people.
I appreciated STEP 4 in the 12 step programs. In the original Big Book of AA a person is encouraged to write down all their fears and resentments.  Anger is often the active form of fear.  Just as we say the alcoholic is an ‘egomaniac with an inferiority complex’ similarly most angry people are really deeply afraid though they problem can’t admit it or don’t even have the emotional depth to realize it.
In Step 4 it says we list people, institutions and/or principles which caused us ‘resentments’.  Unfortunately while I hear that so many people claim to do step 4 their continued shares about their ex, marriages, work or authorities often sound like they missed the part where it says ‘what’s my part in it.’  This is the ‘4 column’  one completes looking at where in any conflict or disturbance was ‘i dishonest, selfish or self serving.’  It doesn’t in any way negate the behaviour of the other.
For instance, a person shoots me in the foot.  They remains the antagonist but if I review my actions truthfully I can see that I probably should have checked if they were packing when I called them a fag or some such thing.  Understanding that one’s life is not a series of punishments or tragedies or sources of self pity and anger empowers one to avoid the pain that led to the desire for anesthesia.
I don’t do a ‘step 4’ in the middle of a war per se. I have to live my life.  But in the process I have to question whether what causes me anger, irritability or moodiness isn’t self generated. Maybe I’ve got the flu coming on and that makes me impatient and irritable and then the post man comes to the door. I explode at him for dropping my mail in the mud and yet it’s me that’s the moody one.
So many people walk around as social terrorists, emotional suicide bombers.
This is often the reason for medication.  Bipolar II disorder and borderline personality disorders commonly appear like this.  Just like the person who with drugs or alcohol has caused their normal ‘self regulating’ emotional controls to be thoroughly broken  Left with little self regulation of the emotional states the person in recovery has to learn a whole new way, other than drugs and alcohol, i dealing with their emotions.
I’m angry with Justin Trudeau  and the Liberal Government right now but given I have friends with cancer and a fellow threatening to kill my dog, frustration with the ever increasing taxes, etc it’s equally possible that there is a feedback loop between my own inner stress and the events of the external world.
I have to be aware and see ‘my part’ in any area of anger and if I can’t see it I really ought to see someone who will enlighten me about this.

Turning Point Recovery Society Gala 2016

The 9th Annual Turning Point Gala this year was a great success.  I love the elegance of the Four Season Hotel.  It’s a perfect backdrop for the glamour the lovely ladies in the latest fashion in gowns, dresses and accessories,  bring to this night of nights.   Many of the men mostly in black and grey suits were sporting wide ties again.  Dressed in a brightly flowered spring frock, the delightful Radene Neill was the very best MC. Later she interviewed David Crosby with the charm and wit that makes her warm presence and beauty so appreciated in this city.
The evening opened with a short film of founder Jim Ross talking of the 1982  humble beginnings of Turning Point. From one person saved in a room Turning Point Recovery has grown to several homes throughout the city with the finest reputation for safety recovery and community relationship.  It was good to see all the dignitaries, the Honorable Terry Lake there again this year, and the red serge of the RCMP.
David Crosby, before coming to the gala had sat in a Turning Point Recovery House meeting with those fresh from the downtown streets and addiction sharing his experience, strength and hope.
Brenda Plant, Executive Director welcomed us all there, sharing anecdotes of her meeting Nash then awe at meeting David. She spoke of his humility and compassion while knowing his genius.  Howard Blank was hilarious as the auctioneer who helped to raise a hundred thousand for Turning Point.  Special  thanks are due the generosity of Westjet, Bear Camp at Chilko Lake, Red Rock Casino, Palladino Jewelries, the Okanagan wineries, 54-40, Fairmount and Four Seasons Hotel. Those bidding were  competitive  for the best of causes.
David Crosby shared that his recovery from drugs and alcohol, in a Texas State prison, was the hardest thing he’d done in his life.  His loving partner was his greatest gift of recovery.  He’d sailed oceans, scuba dived for the sheer joy and beauty of the sea, ridden motorcycles despite the dangers and contributed the world over with the unforgettable music of the Byrds, Crosby Still Nash and Young, and now his songs, solo, or with his son and CPR.  He said that his greatest regret was the people he’d hurt and the time he’d lost.  His creativity was harmed by his drug and alcohol abuse.  Sitting in that Texas jail he found that the poetry he’d thought he’d lost through his addiction came back in his recovery.  Having  just completed a new acoustic album, he described the joy he finds with music.  His preference these days is for the intimacy of audiences he can see compared to the nights playing to  stadiums with tens of thousands.
Yes he spoke of Woodstock but the special significance of Turning Point Galas is that those invited are there to speak about the personal not the iconic.  He shared his deepest sorrow as one day he wrote the names of those who he’d known as dearest friends but were killed by drug addiction.  It went on for two yellow foolscap sheets single spaced. " They were my friends,” He said.   “Think of what music Janis would be making today.  Think of what Jimmy’s guitar playing would be like today.”  "When someone says that alcohol or drugs is needed for creativity,  I say no….  Alcohol and drugs are a scourge that destroys creativity."  At 74, two heart attacks and a liver transplant later he is grateful for his continued creativity  so thankful for the  life that recovery has given him.
When he ended speaking, when Radene had asked her last question, when the audience had put their last question to him. When he spoke of anxiety he had for America today, what remained for me was that wonderful line he shared, as memorable as countless others his gift has given us for so many decades.  Paraphrased,  ‘war brings us down, music lifts us up. I’m so thankful to have had a life of making music. Thanks to recovery I'm still  making music."
He was a beautiful man.  As a teen I learned  guitar to play and sing his songs. It was the late sixties and early 70’s  when his music harmonized with an era.  Tonight his humour,  humility, depth and sincerity enthralled us still.
We all stood to applaud, thankful to have been apart of something rare and beautiful and intimate.
I felt truly blessed.
Thank you, David Crosby.  Thank you Turning Point Recovery Society.

Social Recovery and Abstinence

This was truly one of the very best presentations that I have ever heard. It was given as part of the CME  at the IDAA 2013 conference in Denver, Colorado. The presenter was truly inspiring and a great presenter. I apologize for these rough notes and have recommended to friends that I'd encourage anyone who wants some cutting edge research and a terrific presentation to get in touch with Dr. David McCartney……Despite being from Scotland he spoke the English language with great clarity.
I was further impressed to learn of the great work being done by Bill White whose original papers I'll definitely be obtaining.

National Health Service UK LEAP

Lothians and Edinburgh Abstinence Program

 

Recovery and Social Factors

 

Dr. David McCartney

 

Scottish Context (or whit ye need tae ken)

1.Do People Get Better

2.What is recovery?

3.What is the evidence?

4.How Does Recovery Happen?

5.Social influence, visibility and contageon

 

1. “Scotland - we are a small country with a big problem”

Pop 5.3 million

54,000 problem heroin users

Twice rate of England and 5 x that of US

22,000 on methadone

584 drug related deaths in 20011

Costs 3.5 billion pounds ($5.4 billion)

 

34% of men and 23% of women drinking to excess (self report)

5% of pop dependent on drink

Cirrhosis rates have doubled

 

Vast majority of liver cirrhosis deaths are related to alcohol

 

Enormous increase in alcohol related mortality

 

Alcohol related deaths - high related to neighbours.

 

It’s multifactorial causation

 

Change in perception - unacceptable to be seen drunk in public in my granny’s day where as today any weekend night you’d see lots of people drunk in street

Supermarket spirits

Price of alcohol falls and alcoholism rises

 

1. Do people get better?

“Saw administrator in Scottish harm reduction facility and told that if you want to succed in this work you have to believe no one will get better.”

“I decided not to work there.”

 

Desistance (crime)

Belief nothing works

-85% of repeat offends desist from criminality by the age of 28 (Blumstein and Cohen 1987)

Recovery rates

-CSAT (2009)  58% of life course dependent users of substance will achieve lasting recovery

-Bill White (2012 50.3%

-Welsh workers estimate 7% (Best)  - asked the addiction workers and this was their idea - this is the “Clinical Fallacy”.  Major gap between reality and belief

 

Outcomes (US) physicicians

80% pluse sustained abstinence

70% return successfully to work

High expectation

Intensive treatment

Monitoring

 

Outcomes (UK) physicians

79% abstinence (at 3 years)

Most return to work

Most avoiding GMC (Boards)

Unlike their patients most opiate addictied physicians don not end up on opiate replacement therapy

 

Lothians and Edinburgh Abstinence Programme

• positive residential treatment program, medical and social, 3 months
• funded at point of contact through NHS

 

Seven Pillars of LEAP

-medical

-therapeutic

-housing (safe, supported)

-education/employability

-mutual aid/recovery community

-family programs

-aftercare  (2 years)

 

This is fairly new in United Kingdom

 

300 referrals/year

 112 admissions/year

62% completion

52% graduates maintain abstinence (one year)

 

Do people get better?

YES

 

Duration of Recovery

(Bill White 2013)

 

When does recovery today predict recovery for life

Point of durability seems to be reached by 4-5 years of recovery -stay sober and clean for life

 

What is Recovery?

-voluntarily sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society - UK Drug Police Commission - 2008 p6

 

-Recovery is a process through which an individual is enabled to move on from their problem of drug abuse towards a drug free life and become an active and contributing citizen -
Scotland

 

Betty Ford - sobriety, personal heallth and citizenship.

 

You are in recovery if you say you are - valentine - abtinence alone is not recovery

 

Evidence Review

There is little UK based research and international evidence base on recovery is limitted by 3 factors

1. dated 

2. much is based on alcohol and not illict drugs

1. much of it was US

 

But

Sustatined recovery ‘is the norm”

Recovery is related to the 12 step process

-

-

 

Study of workers in the field in recovery from heroin addiction (108)

‘tired of lifestyle, found rock bottom, 

why did they stay stopped

-moved away from using networks

-found treatment not that important

 

Mapping the recovery journeys of former drinkers (Hibbert and Best (2011) Drug and Alcohol Review)

-graphs

• physical health
• psychological health
• environment
• evidence - in early recovery - first 2 years a little lower than society norms
• “BETTER THAN WELL RESEARCH” after 5 years appear to do better than the population norm. 

 

Post Traumatic Growth

-from natural disasters like tornadoes, plane crashes murders( McMillan 1997) , sexual assault (Frazier 2004) 

-pain touchstone of spiritual recovery and growth

 

How does recovery happens

Several models

1. Social control
2. Social Learning
3. Stress and Coping
4. Behavioural economics 

 

Structural equation modelling results

over 2000 patients

Self help movement involvement - active coping, motivation to change, friendship - all contribute to substance reduction.

 

"Getting you plugged in makes you well"

Holt-Lunstad & Colleagues (2010)

Grella and colleagues (2008)

Best and Laudet (2010)

 

*Number and quality of social relationships predicted long and healthy life

 

 

People who relapsed were less likely to use self help movement

 

Community benefit - increased non using relationships

 

Lit et al “changing network support for drinking (2009)

-one abstinent person in network decreased risk of relapse by 27%

 

Recovery studies in Birmingham and Glasgow (n=205)

-more time with other people in recovery

more time in activities.

 

Recovery Capital

-breath and depth of internal and external resources that can be drawn on to resist alcohol and drug abuse

• can increase ‘recovery capital’ 
• clean housing, friends, family ,health, volunteering, peer support, work
• new concept in UK - assertive referral to mutual aid
• - mostly getting people on to AA/NA
• -find out what meetings are available
• hard to get professionals to believe this and do this despite all the evidence that this work
• less than 5% will respond with just a brochure
• need to have someone meet them and go with them and ask about the meeting in follow up
• 1,200 groups weekly
• various family and servicers groups

 

How are we doing in Edinburgh (The Gap)

Do you or have you ever used AA/Na

AA- .8%

NA - .4%

 Part of it is the misperception about the success  - self help recovery is very successful

Clinical fallacy exists that recovery isn't successful mainly because - we don’t see those who get well

Misperception it’s an religious group

 

Alcoholic Anonymous in UK

• all the mutual aid groups are growing and some very rapidly

 

Social Influence and Contagion

-"hang around recovery people long enough and you might catch a dose of recovery"

• same is true with addiction

 

Framingham Heart Study - Christakis and Fowler

-person’s odds of becoming obese increased by 57%

(similar research with smoking -if your partner stops smoking 67% increased chance you will)

-Conclusion ‘your friends can make you fat’

Obesity Epidemic

64.3% Scots obesid

 

“obesity is catching’

 

Social learning and Social Control

 

Social Network and quality of life

-Holt-Lunstad - 2010 - individuls with good social networks 50% greater likelihood of survival

 

12 step affiliation versus involvement

• **attendance at 12 is not likely to be as helpful as becoming actively involved
• ***getting a sponsor at 6 months 4 fold likelihood of not relapsing

 

“My recovery gave me a new life”

-recovery from addiction makes Scotland stronger”

-visibility important

 

Recovery communities 

outside mutual help

UK Recovery Walk

 

relationship between treatment and recovery

• treatment can be a part of recovery ‘initiation’
• gives the client the tools - managing your own recovery
• -self efficacy and enduring recovery (recovery maintenance)
• a journey, not a destination
• eg diabetes and emphysema - movement to training patient to manage their own 

illness from original management plan of solely seeing speciality

 

Contagion

• have treatment providers got it the wrong way round?
• Recovery is contagious
• Reocvery champions

 

What does it all mean?

1. Recovery is a reality - evidence - recovery narratives
2. Recovery is social - takes place in 12 step groups
3. Recovery is contagious - attraction, power of example
4. Worldwide evidence base needs to develop a  bit - 12 step evidence is strong and growing
5. We can actively connect people to recovery resources ( 

 

 

 

 

Resentment and Forgiveness

In the 12 step programs there is great emphasis on addressing one's own 'resentments' and attempting to 'let go' of these and move on to 'forgiveness'. It was explained to me early that 'forgiving' didn't mean I 'condoned' what I perceived as the other person's behaviour. Further it was also explained to me that in the 'heat of the moment' I was supposed to be defending myself directly and surviving and leaving the forgiving till a later time. Even the Dalai Lama has said that if a person is pointing a gun at you and shooting you are right to defend yourself.

However, holding onto resentments has been described as 'taking poison and hoping the other person dies'. We are what we think. Cognitive behavioural therapy says specifically that our thoughts create our emotions and we also tend to attract and be drawn to what we feel, sometimes in a viscious circle kind of way.

The key to addressing our 'resentments' in the 12 step program was to make an inventory of all those who we felt had hurt us and then list what the hurt was. This hurt was described as being less complex and more specific than most of us are willing to do. Indeed we tend to think of ourselves as 'terminally' unique but when we actually list our resentments and see the pattern is rather basic we realize that we're not that special or different from anyone else.

The experience of resentment is associated with a threat to the following:

1) Money - it's utterly amazing how much resentment people hold to anyone who interferes with their money 'supply'.
2) Sexual life - it's equally amazing how much resentment people hold to anyone who interferes with their sexual life.
3) Security - this refers to whatever we believe protects us and keeps us safe in what we believe is an unsafe world. It probably should be at the top of the list because certainly I still have fleeting negative thoughts of the careless irresponsible drivers who drove through lights and hit me with their vehicles leaving me today with some rather serious pain issues where joints were damaged. That's an example of a 'security' issue. The failure of the insurance company to compensate me for my loss is another resentment issue that goes with money.
4) Self esteem or status or personal relationships - we have a 'social image' of ourselves. I have had a serious resentment to a compulsive liar and pervert who falsely accused me of being attracted to them, as a form of extortion for money. In then end I had to pay them off because the courts are only about money and no longer care for 'justice' or 'right and wrong'. Indeed the courts are a source of resentment to me because as a dead lawyer friend said, the middle class of Canada can no longer afford them. The legal system no longer protects me from thieves and criminals and all I have is insurance which costs me more and more to the point where I'd think the insurance and legal system and criminals were in league against the law abiding citizens. Of course after the 'status' issue, where the 'false allegation' impugned my 'reputation' and rewarded the liar and criminal, I had a resentment about the money issue. At the same time I worried that my family and friends would think there was some truth in this even though I knew that anyone who knew me knew me as a good man. I worried that these days people don't want to associate with anyone in any kind of trouble for fear 'bad luck' is infectious. I know the love of my family and close friends wouldn't be affected by these consequences of my working within a corrupt government with the most dangerous and disturbed people but I still worried and had resentments about what these negative experiences would do for my relationships in general.
5) Ambition - I wanted to buy another house having lost two to divorces and the punishment that is institutionalized there. I hoped to work less with later years and more pain. I wanted to be safer and be surrounded by friends who accepted me as I am after all the sacrifice and work I'd done. I worried about health care and cosmetic care and safety in old age and worried indeed I'd be pushing a cart on the street or dying painfully of a treatable medical condition but not having the insurance or money to pay for this. I have resentments against those who have interfered with my attempts to 'get ahead', to 'be the best person I can be', to 'love and not hate', to be 'fearless' and to do those things I wanted to do on my bucket list, like sail around the world, learn the bagpipes, right the great Canadian novel, serve as missionary doctor, make love, sky dive, para sail, take a trip into outerspace and meet aliens, any of those things. I can develop a resentment against anyone who gets between me and where I see myself in the future, even in the future a day or two from now, like recently when a slow moving arrogant Heathrow security guy held us all up so we missed our flight and I'd been hoping to get home and to bed but instead was delayed a day and didn't sleep till 3 am. Expectations have been described as "pre formed resentments'. Consequently we try to have 'good intentions' leaving the outcome in God's hands. That's the Christian thing but I was trained in science and medicine that I'm responsible not only for intentions but for outcomes and I have a resentment for 12 steppers and Christians who abdicate responsibility for poor outcome saying it's in 'god's hands' whereas as a rifle marksman I also know that most poor outcome is a product on lack of training, practice or taking into account the wind. So I'm learning how to coordinate my expectations and time frames with the limits of others and the environment rather than having 'great ideas' without realization of how much is involved in the actual translation of idea into finished product. I'm also very appreciative of those who are successful at this and less likely to criticize effective people than many whose lives are less so and they rarely seem to really look where the need for change is, not with the external world but rather with themselves.

Of course I have to address resentments I have to myself, ie the person I was yesterday rather than today. Most of what occurs in my life is a product of the desires I had yesterday. I can see the outcomes of my prayers and ambitions when I was younger. I can also see the effects of 'karma' or 'divine retribution' the older I get. So I have joint that's painful not so much because of the injury but more because of the lack of care I took and my unwillingness to follow medical advice at the time of the injury. So much of what I deal with today is a product of my 'knowing better' and not taking 'good advice' or 'listening to my superiors, parents etc".

So I have to recognise that my happiness is subtracted by my resentments. It's like the hard drive of a computer that's full of spam. I have to forgive if only to stop thinking of the old shit.

Now I've got to go back to work right now.



- Posted using BlogPress from my iPad

Progressive Nature of Alcoholism and Addiction

In meetings of Alcoholics Anonymous people who relapse describe their descent into the abyss of addiction by saying "when I was in the rooms of AA, my disease was in the parking lot doing push ups."  Returning to the struggle with alcohol they went from the plan of 'drinking like a gentleman" or 'drinking like a lady" to the all consuming animalistic life of serving the god of the bottle.
Millions of people come to AA but don't stay, simply using the success of AA to initiate their recovery in some other form.  AA showed the world in the 1930's that Alcoholism and Addiction could be 'cured' through abstinence and 'one drunk helping another'.  The 'self help movement of 12 step programs with the essential spirituality of a 'god of your understanding' ie no longer making yourself and your own desire God but rather joining group and community for a consensus reality, has served countless others with compulsions of wide variety. The recognition was the Aristotelian idea that one couldn't 'think themselves into new action but rather needed to act themselves into new thinking".  The cognitive behavioural therapy of the 12 step program as opposed to the 12 step fellowship showed individuals through action that their belief in the benefits of alcohol were cognitive distortions induced by the insaniety of addiction.
Untreated alcoholism progressed to institutions or death.  Once a person passed a certain point the so called up elevator or down elevator place, the future was either a slow or fast descent depending on how one 'controlled' the drinking, all paths downward being at best 'harm reduction' .  The only cure to date in chemical addictions remains the abstinence which causes so many addicts to say "I don't like AA because......."  Those who themselves achieve abstinence by any means see the value of AA and don't disparage it. Those who don't achieve abstinence will likely condemn all programs which come between them and their drug of choice with the passion which most recognise when we say, "the lady protesteth too much."
A tenet of AA is that once an alcoholic, always an alcoholic.  This is certainly evidenced by scienttfic research which to date has not be able to identify those who won't relapse to previous levels and worse.  Vaillant's research showed that relative to the general population, an alcoholic 5 years sober was 'statistically' no greater risk of drinking dangerously than a person who never drank. This is important in the work place but on an individual basis no one sober knows if he or she could pick up a drink "safely".  A Montreal study of 'controlled drinking' showed that despite 5 years of abstinence of those who returned to drinking 50% within the year drank alcoholically.  I believe it was a Dutch study that showed that 30% of those 15 years abstinent returned to drinking alcoholically.
The research suggests that there is a decreasing risk after 3 years of abstinence of people returning to their previous behaviour but that the risk of this even at 15 years sobriety is that a third risk death or institutions for the sake of a drink.  The World Health Organization designates only 'abstinence' as a cure and requires all other programs be called 'harm reduction".  Further it recommends that 'harm reduction' programs only be used in the context of a stepping stone towards abstinence not as an 'end in themselves' .
This suggests that the insaniety itself persists.  People with simple 'allergies' don't decide I'll try taking something that once caused a horrible rash, again.  Yet people who broke out in police and divorces seem to somehow figure 15 years of good living later that picking up alcohol is again a good thing.
The progressive nature of alcoholism has been the principle reason for people explaining that with relapse a person returns to previous level of abuse much more quickly than the first time. People who drank 'normally' for 20 years then drank abusively for 2 abstain only to relapse and find themselves drinking abusively either immediately or a year or so later.
Personally I remember smoking an occasional pipe or cigar for 10 years before becoming a pack a day cigarette smoker for a year.  Quitting somking on 2 separate occasions with the intent of just having a weekend smoke or at most one or two a day I was back to smoking a pack a day within six months.  Quitting again then I found the next time at six months in the week before I quit I was smoking 2 packs a day, a truly exponential increase. It's almost 15 years since my last smoke and still I occasionally 'romanticize' an 'occasional' cigarette.
Functional MRI studies of gamblers have shown that the addiction is not driven by reward associated with the 'win' but rather by the 'dice' being in the air 'just before the 'decision' of 'win or lose'.  The 'thrill' for the brain is that moment of uncertainty.  Psychoanalytically the addict has been seen as having failure in primary relationships and seeking to re enact that 'moment of abandonment'. Melanie Klein described this as the 'good breast, bad breast' moment for the infant.  The infant wants food and the 'good breast' is the one that delivers it. The 'bad breast' is the breast that doesn't appear 'on time'. The longer the delay in a child having basic needs met, ie the period of neglect, the greater the division between the good breast and bad breast.'  This explains to some extent those who are at greater risk for addiction though to date no one appears to be immune to addiction. As one cocaine researcher said "some of us might not sell our grandmother's for crack in the first week of addiction but all of us would after a few years." Addiction itself causes reversible or permanent brain injury with increasingly loss of the more human motivational structures seen in Maslow's research with the devolution over time to the 'animal' and finally 'lizard' brain of the McLean triune brain model.
All research to date on persons who develop alcoholism or addiction shows them as being inherrently 'immature' psychologically especaily around the issue of  'gratification'.  Despite this the head of the Supreme Court of Canada's alcoholism was a serious concern for the high court only decades past.  No doubt some of the early work of Beverly McLaughlin, present supreme court head of Canada was undoing that 'wreckage of the past'.
The more 'instant' a substance has for providing 'gratification' the greater the risk of addiction. This is shown in the 'addictive' potential of crack which smoked or injected has greater addictive potential than coke which is 'snorted'.  The addictive potential of injected and inhaled substance is greater than that which is ingested. This is one of the distinctions which separate the marihaua or cannibis addict from those who want cannibis for 'medicinal' purposes. The addict must smoke the cannibis whereas the healing benefits of cannibis are equal and more medicinal if taken as a tea.  Those wanting it for medicinal purposes, a highly significant minority, despite the eupheminism of "medical marijuana' the precurser of 'medical prostitution', are therefore not those who insist it only 'works' for them if it is 'smoked'.
Following on this progressive disease of addiction it's been said that the sex addict who has made a life of orgies,   doesn't truly thereafter, want to hold just hands with a nun.
The brain of the addict is demonstrably changed on a whole range of neurochemical measures. Dopamine pathways associated with the nucleus accumbens, the pleasure centre of the brain, are changed and the change persists.  Frontal lobe utilization of sugars, the food of the brain, is altered on MRI studies for 3 months after the last use of cocaine.  Marijuana remains detectable and active in the system for 6 weeks and possibly 3 months.  Alcohol influence on the liver is detectable days and weeks later.  The minimum true test of abstinence and once a diagnostic test of addiction was the abstinence from a substance or behaviour for 4 seasons or one year.  If a person couldn't stop gambling despite negative consequences, or drinking despite dui's, this was pathognomic of inherrent addiction.  Marijuana smokers who say they can go a days or weeks without a 'toke' are akin to alcoholics or  who say they can go a few hours without a drink.
There is permanent organ damage with addiction as well.  Women are much more susceptible to the physical deterioration of addiction which is a kind of poisoning of the system physically and obviously spiritually.  Spirituality is likened to Freud's 'eros' or life drive as opposed to his 'thanatos' or death wish.  The dice in the air or really 'playing with death' seen in the 'adrenaline junkie' and 'compulsive risk taker'.
The definition of addiction is that it is unhealthy and hastens risk of death whereas a behaviour such as AA attendance, normal work or church or sports or any recreation moderately followed is by definition not an 'addiction'.  The term addiction is used for 'unhealthy' substances and endeavours.
The other factor which obviously plays a role in the apparent progressive nature of alocoholism is the aging of the host.  A person will drink to a steady state they may maintain at a younger age but this drinking behaviour is 'hard' on the 'body'.  When a person abstains or takes a break it's a bit like an athlete who leaves and returns to the sport.  The alcoholic now has an older liver, older lungs, and older brain.  Addiction is a burden at the best of times.  A common time for 'relapse' is with early retirement when one has means, loss of life  structure and there's just so much golf one can play. These executives who stopped drinking often 20 years earlier begin to drink excessively in their late 60's. Alcoholism is a principal cause then for the heart disease and illness and death seen specifically in this population.  It's not so much that the 'disease' is 'stronger' it's that the 'host' is older.
The neurochemical explanation for the apparent 'progressive' nature of the disease and the high risk of return to previous level then worse for addiction is that the addiction has established an information 'highway' in the brain.  Not using the highway results in the development of other 'tracks' for neurochemical communication. However the 'highway' remains and can quickly be brought back into use. Much like we say about learning to 'ride a bicycle' .  Once one 'learns to be a drunk or addict' it's like 'riding a bicycle', the learning is always there to return to and build on.
Further if the 'thrill' or 'adrenaline rush' is of the 'dice in the air' then the death wish of addiction is to go further than one's worst last drunk.  So if a person crashed a motorcycle drunk at 70 mph  and lived maybe this time one's unconscious wish would be to 'crash a motorcycle drunker at 80 mph" and see if one lives..
Certainly that's the picture that the sex addicts give in their simply 'pleasure' driven experience so well described in  the snuff movie 9mm starring Nicholas Cage.   Only increasing risk and degradation gives the same 'high' so more and more of a thing is sought in the ancient adage of heroin addiction when one is forever 'chasing the tail of the dragon.'
Thankfully abstinence resolves this issue if the alcoholic or addict can 'surrender' to the notion that this is not their 'war' and there are countless alternatives in life worthy of such intense endeavour.  Addicts and alcoholics not surprisingly when they change their focus from death resulting activities to life enhancing ones commonly go on to great contribution and amazing success and altruism.
 It's well recognised  today that one doesn't need to take the elevator to very bottom of society but rather can get off any at any basement floor.   That then can  become one's'personal bottom' and  the basis for the springboard into a life that has been called for may 'the 4th dimension'.  Peace, bliss,  joy, happiness,  love and meaning  are  far different from the frenzied withdrawal and driven  pleasure lust of addiction.