Addiction in the Pandemic 2

Click here to read the first part of this essay.

So what can you do if you’re struggling with an addiction right now? First and foremost, stop blaming yourself. There are at least two reasons to stop: first that you’re not actually to blame and second that blaming yourself will only make the addiction worse as you add shame over the addiction to all of the other bad feelings you’re trying to drink or shop or masturbate away. And you really aren’t to blame because no one chooses addiction; it’s a normal response to trauma, says Dr. Sumrock, “just like bleeding is a normal response to being stabbed.”[1] In forty years of practice, I have never met anyone struggling with addiction who didn’t have a history of childhood trauma, though I’ve certainly had clients who believed they didn’t, usually because of family myth-making or repression or because the trauma was emotional neglect.  Now, after a year of lockdown, you’re also dealing with the collective trauma of the pandemic, with both traumas reinforcing and amplifying one another, so, for heaven’s sake, try to let yourself off the hook! If it feels impossible, practice lovingkindness meditation for a few days and then try again. Repeat as necessary.

Next, try to look honestly and dispassionately at your “ritualized, compulsive, comfort-seeking.” Consider what it’s costing you and the people around you. Does it threaten your life, health, and safety—or someone else’s? Does it threaten anyone’s mental health, relationships, or financial security? Does it make you feel like a bad person, and, if so, is that because the addiction makes you act dishonorably or because you believe that addiction alone makes people bad? Consider also the benefits of your addiction, alien as that framing may sound. It’s doing something for you, or you wouldn’t be doing it, so what is that something? (Note: it will likely be more than one thing.) Finally, consider the addiction in light of your history and your current situation. Is it a relatively recent development that you think you might be able to give up when the pandemic lifts? Though some on the recovery scene pooh-pooh such ideas, many US soldiers addicted to narcotics in Vietnam had no trouble walking away from them when their tours were over.[2] Or is your addiction a perennial problem that shouldn’t be allowed to reestablish itself and/or worsen?

Having taken as clear-eyed a look as you can at your addiction, you then have to decide whether to let it be, modify it, or give it up, though with some addictions—food and shopping, for example—the impossibility of complete abstinence blurs the line between these options. It’s a decision to make carefully because, in some cases, it’s less dangerous to modify a habit than to quit and relapse over and over. With alcohol, benzodiazepines, and other sedatives, there’s a phenomenon called “kinding,” in which repeated withdrawal damages the brain and increases the severity of withdrawal symptoms, including life-threatening seizures. With opioid addiction, many overdoses happen because users quit for a few weeks, dropping their tolerance for the drug, then resume using at their previous dose, which is now more than their bodies can handle. Though giving up an addiction usually requires multiple attempts, a long string of failures in a short period of time can drive people deeper into their addictions as they medicate the shame of failure and lose confidence in their ability to quit. In other words, depending on your situation, it may be better to set a modest goal, achieve it, then build on that success, so it’s worth giving serious consideration to all of your options, especially while the pandemic lasts.

Some readers might be surprised that I named “let it be” as a legitimate way to handle an addiction, and the truth is that I do it with my heart in my throat because I want you to thrive,  and, in my experience, most people don’t thrive long in the grip of a serious addiction. But you may be one of the rare birds who can, or, more likely, you may be someone whose problem lies near the edge of “normal” behavior. And, for any number of reasons, including the pandemic, you simply may not ready to change yet. Even if you’re none of those things, the decision of what to do about your addiction is yours, and I respect it. If you do make this choice, I urge you to do one thing: pay careful attention to your addiction, not as a judge but as a kindly, interested observer. Notice its rhythms, when it sleeps and when it wakes, how it relates to what’s going on in your environment and in your mind. If you can keep notes, great, but what really matters is the attention, not letting your addiction run on autopilot but staying present and really getting to know it at a deep level. Trust me, such knowledge is invaluable.

Some readers might also be surprised that I named “modification” as a legitimate option because the twelve-step community, to which I proudly belong, is abstinence-based.[3] But, over the past forty years, more and more research has demonstrated that people can and do modify their addictive behavior to improve their lives, and that there’s a wide spectrum of possible modifications with abstinence at one end and addiction at the same level but with added safety precautions at the other. Recently, this graduated approach, which falls under the rubric “harm reduction,” has gained recognition and support from most addiction experts, as well as organizations such as the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse (NIDA) and the World Health Organization (WHO). So I have become convinced that it’s a useful tool.

With harm reduction, you continue the addictive behavior but find ways to reduce the negative impact on your health and well-being, which may or may not mean cutting down. It’s best known as the philosophy of many programs that treat narcotic addiction, but it has lately begun to spread to other types of addiction as well. Harm reduction can be an end in itself or a step toward abstinence—and it’s important to know that you don’t have to make that decision right away or all at once. If you have an alcohol or drug use disorder, harm reduction might involve switching to a less dangerous drug or using medication to help you consume less.[4] For all addictions, it involves planning when and how you will engage in the problematic behavior as well as creating systems to reinforce those plans and, over time, create new habits. For some of you, it might involve finding peer support for your harm reduction efforts in groups such as Moderation Management and HAMS, which help with alcohol dependence.  You can also find useful information by Googling ” _____ addiction AND harm reduction” or by searching those phrases on social media.

For some readers, the best option will be quitting, even during a pandemic. You don’t have to “hit bottom” to choose this option; you just have to decide that the cost of your addiction is greater than its benefits and that now is a good time to give it up. If you think that might be true but you’re not sure, you can try an experiment: quit for a month and see how that goes.[5] Whether you succeed or struggle (or both), you will learn much that can help you decide what to do in the longer term.

If your decision is quitting, there’s a lot of help available, from inpatient addiction treatment (curtailed by the pandemic but still available) to Zoom therapy with a practitioner knowledgeable about addiction to emerging online programs to twelve-step meetings and other free peer support, also still virtual. Inpatient treatment can be invaluable, especially with long-term addictions or shorter-term addictions tied to acute environmental stresses. Some people simply need to step away from the demands and triggers of normal life in order to get some perspective on themselves and begin to establish healthy new habits, so if you’re one of those people and have access to inpatient treatment, go for it. Unfortunately, inpatient treatment programs vary significantly in quality, and some may be harmful for survivors of childhood trauma. Look for programs that identify themselves as trauma-sensitive” or “trauma-informed” and/or who are equipped to treat people with a dual diagnosis of addiction and one or more mental health problems. I benefitted from such a program long ago and would recommend it to anyone who has the desire and means to go.[6]

That said, in my forty-plus years of recovery, I have met many, many people who recovered from addiction without inpatient treatment. And, in fact, some people fare better when they remain in place and assemble their own recovery program, one they can stay with long-term. In my experience, such a program—any program, actually—needs four elements:

  1. education
  2. peer support
  3. therapy or other trauma work
  4. replacement activities

Education means learning about your addiction, how to deal with it, and how to live without it. Some people educate themselves via independent reading, and you’re obviously in that category, given what you’re doing right now. But there are also recovery programs with a strong informational component, and I’ll list a few of those at the end of this post.

Peer support is vital, even if, for now, it has to be virtual. Addiction feeds on alienation and, in turn, feeds alienation, making people with addiction some of the most isolated people in the world, if not physically, then emotionally. The antidote is connection, whether through a treatment program with a peer support community or a Zoom twelve-step meeting or a subreddit such as /r/stopdrinking or any one of the thousands of other groups out there, a few of which I’ll list at the end of the post.

Let me pause to say a word or two about twelve-step groups. If you spend any time researching addiction online, you’ll see that they have passionate defenders who believe they have saved millions of lives, as well as passionate critics who believe they promote harmful ideas about addiction. Both are true: they have saved countless lives, and, having originated with AA in 1935, they do have, in their seminal texts, some obsolete and potentially harmful ideas. But here’s the thing: twelve-step groups are independent, self-governing collections of individuals, and they differ from one another profoundly. One group may be full of people quoting the seminal texts I’ve just mentioned and speaking in the vocabulary of those texts, which can sound a bit, well, cultish, especially to a newcomer. The next group may be completely different, just ordinary people talking about their lives in ordinary language but with extraordinary candor. Some groups are more or less religious, more or less friendly, more or less diverse, more or less open-minded, the list goes on and on. So, in the end, almost anything you say about twelve-step meetings is true, including that they represent the world’s most widely-available support for addiction recovery and a great place to make friends who understand and share your struggles.

And there’s always SMART Recovery, for people who prefer a more scientific approach.

One last thing I’d like to add about peer support: challenging as it is that meetings have to be virtual right now, there’s also one great benefit: you can try out lots of different meetings without having to travel all over the place, making it easier to find meetings that feel like a good fit for you. You can even participate in meetings thousands of miles away, and, in fact, it can be rather wonderful to feel connected to people in distant places through your shared struggle with addiction.

Therapy or trauma work is important because, to give up an addiction long-term, you have to grapple with its causes, not necessarily right away, but eventually. Some people may tell you that the only cause is “the disease of alcoholism” or “the disease of gambling addiction,” but that explanation, though revolutionary in the 1930s or the 1950s or even the 1970s, is far too simplistic for the 2020s. As I mentioned in my last post, both individual and collective trauma play a large role in addiction, so, at some point, try to dedicate some time and energy to excavating the history that helped shape yours.

Finally, replacement activities are crucial, and they should be replacement activities that offer some of what you seek in your addiction, such as distraction, relaxation, excitement, self-forgetting, feelings of power, or a break from ordinary perception. Be honest with yourself about what you get from your addiction and creative in looking for replacements; for example, if your addiction is risky and part of you is attracted to that, then look for an activity that offers an element of risk (note: I said “element,” not “truckload”). For our friend Richard, the danger of hunting sexual adventure in high-crime areas had been part of his addiction, and, in recovery, he got a similar thrill from kayaking across open ocean where he could feel a thousand feet of water and a unknown universe beneath his tiny craft. Having that almost-physical sensation was important to his sobriety, and losing it to the pandemic may well have contributed to his relapse. The same could be said of Sunny, who found a different kind of risk on the stage.

Both Richard and Sunny, I’m glad to report, are back in recovery. They went through the process I’ve just described, starting with the all-important first step: they stopped blaming themselves for relapsing and started learning from the experience. If you’re struggling with addiction during this pandemic, try to follow their lead in abandoning a shame spiral for a virtuous circle of self-knowledge. And, above all, reach out your virtual hand, and you’ll be amazed at how many hands reach back.

Image: “Freedom from Addiction” by Candy Aaron. Ms. Aaron’s work forms part of the Addiction and Art Exhibition and is covered by a Creative Commons license.

[1] I already mentioned (and hotlinked) the article in which this quotation appears, an interview with Dr. Daniel Sumrock by Jane Ellen Stevens, but I don’t believe you can have too many links to a good article, so here’s another one. In making the analogy to bleeding, Dr. Sumrock is talking specifically about childhood trauma, but his understanding of childhood trauma was based on his research on Vietnam War veterans, so I doubt he’ll mind the expansion.

[2] This historical phenomenon is famous and is well-covered online and in recent books, including Atomic Habits: An Easy, Proven Way to Build Good Habits and Break Bad Ones by James Clear and Chasing the Scream: The First and Last Days of the War on Drugs by Johan Hari. This excerpt from Clear’s book gives a brief overview and its relevance.

[3] Abstinence doesn’t always mean completely avoiding whatever is causing you problems. No one has to gamble, watch porn, play video games, or use drugs, including alcohol, but it’s pretty hard to give up food, shopping, sex, love, work, and the internet. In these cases, abstinence means distinguishing between healthy and unhealthy use and avoiding the latter, and the line between abstinence and harm reduction quickly blurs.

[4] Those interested in harm reduction for alcohol use disorder should start with this essay by a well-informed colleague. There are two other essays in the series (linked in the original essay) that are also worth reading. Harm reduction for opioid use disorder is better-established and better-known, at least in the form of needle exchange and methadone. Buprenorphine, a newer drug, is also very effective and is becoming more widely available, as is kratom. Medications for stimulant addiction aren’t as effective, though recent research reports modest success with a drug also used for alcohol and opioid addiction.

[5] If you are physically addicted to alcohol or other sedatives, abruptly quitting can be life-threatening, so speak to your physician before trying this experiment. In addition, consider asking a friend to check in regularly to make sure you don’t develop acute withdrawal symptoms, such as seizures.

[6] If you lack the means to go to rehab, know that 90 percent of all residential treatment in the US is based on the first five steps of the AA program and staffed by counselors with minimal training. In other words, inpatient treatment is a little like AA boot camp, which means that you can get many of its benefits for free on the outside (keep reading because I’m going to talk about AA in a moment). Yes, it’s still wrong that not everyone who needs rehab can have it because the breathing room and the focus enabled by residential treatment can be very helpful. But they’re no magic bullet—and, in truth, there’s an argument to be made for grappling with your addiction where you live.

Resources: virtual peer support
Alcoholics Anonymous Meeting Guide, also available via iOS App and Google Play App.
Cocaine Anonymous Online Meetings
Food Addicts Anonymous Virtual Meetings Guide
Gamblers Anonymous Virtual Meetings
HAMS (Harm Reduction, Abstinence, and Moderation Support for alcohol, peer-led, free, has links to limited online support, including the HAMS Forum)
Hello Sunday Morning (alcohol, harm reduction, free for Australians)
Internet and Technology Addicts Anonymous Phone and Online Meetings
Marijuana Anonymous Meeting Directory (online, phone, and in-person meetings)
Moderation Management Meetings (alcohol, harm reduction, includes phone and video meetings)
Refuge Recovery Online Meeting Guide (Buddhist, abstinence-based, all addictions, free)
Sex Addicts Anonymous Online
Sex and Love Addicts Anonymous Online Meetings
SMART Recovery (science-based, all addictions, works toward abstinence but also supports people who aren’t there yet, free, includes links to Zoom meetings and an online forum)
Tempest Sobriety School (woman-centered, alcohol, costs money, online)
Virtual NA (Narcotics Anonymous online and phone meetings)

Resources: active, supportive subreddits
See also the entries under the heading “Trauma, Treatment, and Other Help” on my Vital Links page.

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