Interview with Dr. Mark Ackerman
Psychologist and Addiction Specialist

At MARR, we do not specifically address nicotine dependence as part of our program of treatment, and clients are permitted to smoke cigarettes, though they are not permitted to use e-cigarettes (also referred to as vaping). To get a clinical perspective on the issues of smoking and vaping as they relate to long-term health and recovery, MARR spoke with a psychologist from the community, Dr. Mark Ackerman, who has expertise in treating addictions, including recreational drugs, alcohol, compulsive behavior, and nicotine dependence.

We have all seen commercials that try to scare people into quitting smoking, or maybe we have even tried to scare somebody we love into quitting ourselves. Is trying to scare people into quitting effective?

Research on what works for overcoming addiction, in particular, smoking and nicotine addiction/tobacco use, indicates that scare tactics are not effective for bringing about change. I have learned through my work with individuals that this is correct. Individuals who are nicotine dependent often become resistant when they feel like they’re being pushed too hard.  Addiction counselors are most effective when they strive to meet the individual where they’re at and provide information if they’re asking for it. There’s a technique called “motivational interviewing” that can be very effective in assisting people who are ambivalent or resistant to giving up an unhealthful habit.

There are 3 key components for success with nicotine addiction and addiction in general:  

1. Motivation: You have to want to change. When you have that element of motivation and commitment to change, then you can go to the next level.
2. Technique: Behavior change strategies, attitude changes, and environmental modifications play a significant role in overcoming nicotine dependence.
3. Medication: The medication component can help people feel less uncomfortable while they’re going through the process of giving up tobacco-related products. There are several FDA-approved medication choices that are available which have been very helpful. Speaking with a health care provider is recommended.

How do you address nicotine addiction when you are working with patients who are also trying to stop using alcohol and other drugs of abuse?

We know that people often have the thought that tobacco is less harmful than other drugs, but in fact, tobacco contains nicotine which is a highly addictive drug of abuse. Studies on addictive behavior show tobacco at the top of the list of what leads to chronic disease including lung and cardiovascular disease. There seems to be a myth that says “If you smoke, but you don’t do anything else…well, it’s not a great thing. But you know, if that’s the thing that keeps you away from using other drugs of abuse, well, we’ll kind of accept that.” We’re learning now that’s not the case, and that it is probably best to give up all products that are addictive. If someone continues to smoke, even though they may overcome other addictions, it can lead back to prior addictive behaviors by keeping the pleasure center in the brain responds to certain chemicals.

Do you typically introduce the idea of quitting smoking to somebody who is in early recovery?

I usually want to hear what they have to say and what their motivations are. If someone is motivated to overcome an addiction other than smoking, I might say to them, “Well, we’re going to work on that, and how do you feel about giving up tobacco?  I might suggest that they consider quitting nicotine products, and I let them know that there is help for that as well. Ultimately, being fully successful at overcoming addictive behavior usually means giving up smoking and vaping.

Vaping has been in the news though most people might not know much about it. Could you give us a brief overview of what vaping is and some of the risks associated with it?

The use of e-cigarettes, also called vaping, produces an aerosol by heating a liquid that contains flavorings, chemicals, and quite frequently nicotine and sometimes THC. The user inhales that aerosolized vapor into their lungs. The idea behind e-cigarettes, which became available about 14 years ago, was to help people quit smoking. One of the problems that subsequently developed is that younger people, who often were not smokers beforehand, began vaping and using e-cigarettes because they thought it was “cool”. Vaping was marketed as being a cool sort of a thing to do that was safe. Because it has different kinds of flavorings like mint and strawberry, it became very appealing to young people. Vaping and e-cigarette use has been shown to be potentially helpful for adults who are trying to transition away from more traditional tobacco products like smoking and chewing tobacco. The problem is that it’s turned into a harmful habit for some young people who were not smokers and may lead them down the path into becoming smokers.

Also, there are many different forms of electronic cigarettes with different components to them that are unknown and potentially unhealthy. Most electronic devices are produced overseas thus there is no control over what contaminants may be used in their production.

A couple of months ago there was an outbreak of pneumonia and acute respiratory distress among some people who were using electronic vaping devices. This was well-publicized and is cautionary. Not only is there a risk of breathing in aerosolized chemicals that contain nicotine, but by breathing in chemicals that are harmful, there is also a risk of developing a lung infection.

How would you summarize the public misconception about vaping?

Using electronic cigarettes with the goal of quitting tobacco products and overcoming dependence on nicotine and staying with that goal can be helpful for some people. However, the caution is that the use of e-cigarettes and vaping are not approved successful treatments for overcoming nicotine dependence or quitting smoking and also incur health and addiction risk. My recommendation would be to use a combination of FDA-approved medications such as Chantix or nicotine replacement (e.g nicotine patch or nicotine gum) combined with behavior change counseling.

What would you suggest for parents who just found out their 16-year-old son or daughter is vaping? What approach would you pass on to them?

I would recommend sitting down with the young adult or teen to find out what’s going on rather than blaming or making accusations or threatening them about consequences. I might want to ask: “How did you get started with this? And why do you think you are using e-cigarettes?” 

And then if there’s a good opportunity, providing helpful information. I would advise being careful about overly aggressive approaches such as scare tactics which we discussed earlier, that are not usually effective as they tend to get tuned out by teens.

If you have one thing to pass on to people who are reading this, what would it be?

There is an enormous amount of evidence showing that tobacco use in any form is highly addictive and extremely harmful to the human body. Second-hand smoke is harmful to those who live with or share space with smokers. Pet health is negatively impacted by the chemicals found in tobacco smoke. Life is short and the human body is very delicate. I would advise the avoidance of all tobacco and nicotine products. If you use, get help to assist you with quitting. Find alternative ways to manage the stress in your life and find other forms of pleasure that would lead to the same sense of relief and enjoyment that nicotine products provide. The majority of people in the U.S., 85%, do not smoke. It is therefore easy to find a friend or neighbor or co-worker who does not smoke and spend time with them. Avoid places where people smoke, as visual and olfactory cues, can be a trigger to use, just like in other addictions.  If you are having difficulty quitting, establish some new relationships with non-smokers, and consider obtaining some professional counseling. Join a support group. Millions of Americans have quit smoking over the past several decades and you can, too. It requires motivation and willingness to make the change.

By Rick McKain, MAC, LPC

As the leader of our Building Better Relationships group at our MARR’s Men’s Program, I have worked with our male clients for over 20 years on intimacy issues. 

Regardless of which issue precedes the other, substance abuse and difficulty in intimate relationships frequently go hand in hand. 

“To treat issues around intimacy and sexuality we need to go beyond the surface behavior to address the underlying emotional, psychological, and spiritual dysfunction.”

The origin of doing intimacy work with men grew out of a need that our clients at our Men’s Center were presenting. We noticed that more and more men who were dealing with substance abuse issues also had sexual addictions that needed to be addressed. There was enough of a need that we decided to establish a group to work with clients specifically on those concerns.

In the early days of that group, we restricted admission to people who met strict criteria for sexual addiction. But as the group evolved, we decided to broaden the parameters so that even if a client did not meet strict criteria for sexual addiction, but wanted to work on addressing issues preventing them from being intimate with their romantic partners, they would be able to participate.

As the group took shape over the years, the curriculum evolved to address the issues that were underlying the sexual addiction or intimacy issues. Just like treating chemical addiction, to treat issues around intimacy and sexuality we need to go beyond the surface behavior to address the underlying emotional, psychological, and spiritual dysfunction.

If we do not go deeper than the problematic behavior, we will only be operating on the level of symptom management, rather than working toward a solution. 

We must work with our clients to start to answer deeper questions, like “What needs are not being met?” and “What emotional wounds are our clients attempting to address with the behaviors that prevent intimacy?”

Listen to “Vulnerability is a Sign of Masculinity”, a podcast featuring Rick McKain and other Men’s Center Staff:

The Real Issue: Do I Have What It Takes? 

For most of our male clients dealing with intimacy issues, we can often trace much of the dysfunction directly to their relationships with their parents, particularly their fathers. 

One of the resources we use to address this is the book You Have What it Takes by counselor and author John Eldredge. In it, he writes that the relationships between fathers and sons are characterized by the son constantly looking to the father for the answer to an important question: “Do I have what it takes?” 

How a father answers this question, with or without words, has enormous power to shape how the son perceives himself. 

When a person has this question answered for them positively, based on a healthy affirming relationship with their parents, they can deeply believe: “Yes, I have what it takes.”  This  knowledge provides them with a solid foundation for their intimate relationships going forward.  They can know that their value is not dependent on another person’s feelings about them, or anything else that may be outside of themselves. This security in their own worth and value provides them with the stability to be open and vulnerable in intimate relationships. They are free to take the emotional risks required to accept others as they are and allow themselves to be seen as they are. 

On the other hand, if a child is told some variation of “you are not enough,” or given no response at all, this leaves the person uncertain whether or not they do have what it takes.

“Often people’s sexual fantasies are attempts to resolve the trauma of not knowing whether they are enough.”

It is not that parents intend to answer this question negatively or intentionally withholding this answer from their children. Oftentimes, parents themselves did not have the question answered for them when they were children, and lack the capacity to answer it for their kids. 

With this essential question unanswered, a person will continue to search for somebody to answer it for them. Many men carry this unanswered question into their adult relationships. Because they are relentlessly searching for somebody to tell them they are enough, they are not emotionally available to be vulnerable and intimate with their partners. 

Often people’s sexual fantasies are attempts to resolve this trauma of not knowing whether they are enough. I was convinced of this by the research and writing of psychologist Mark Laser, Ph.D., who specialized in treating sexual addictions.  

It may sound far-fetched at first, but think about having a psychic wound—a secret belief that you are not enough or that you are fundamentally undesirable. Many of the men I work with carry this wound around with them, and many attempt to relieve the pain by developing the fantasy in which they are sexually desired by a partner or multiple partners. Such a fantasy where one is intensely desired and pursued provides the perfect salve for this wound of feeling unwanted, except it’s the wrong medicine for the wound. 

The problem is that fantasies exist only in the mind, and the relief that they bring is only temporary. Fantasies provide a false and fleeting substitute for the satisfying intimacy that we really desire and are wired to give and receive.  

Failed Attempts to Answer the Question

For a teenager or a young man, the initial jolt of sexual intimacy with their partner provides a sense of closeness and belonging that seems to satisfy their question. For a while, they feel, “Yes, I am enough.” But when the novelty of this relationship wears off, they find themselves returning to their unanswered question. This can lead to a string of superficial sexual encounters, pornography usage, and risky sexual behaviors. In some cases, this pattern develops into sexual addiction and often leads away from satisfying and intimate relationships.

Like any addiction, as time goes by, the subsequent encounters provide a diminishing sense of satisfaction for the person, and compulsive patterns always eventually bring unwanted consequences. However, as with substance abuse, the person can remain caught in the cycle despite the illogical destruction of the process. 

Sexual relationships are not the only places a person will look to answer this question. Their career, personal relationships, athletics, and physical training are other areas I’ve seen our clients look for reassurance that they have what it takes.  How it manifests is less important than the underlying need to be reassured that they are enough. 

“As a result of sharing and listening throughout the 12 weeks of the Building Better Relationships group, many of our clients not only learn about themselves, but actually experience the strength and resilience that comes through intimate relationships.”

The failed attempts to be reassured of this has played out in hundreds of different ways in the life of our clients who struggle with intimacy issues. In our group, each of them writes out these patterns through a trauma exercise, life story, and fantasy exercise, which they eventually share with the other members. Viewed together, these exercises give them a thorough understanding of the wound that they have and how they have tried to unsuccessfully resolve it through behaviors that prevent vulnerability and intimacy with their partners.

Over the course of the 12 weeks of the group, we do not have enough time to work through and resolve all the trauma. However, they are able to identify what their issues are and it lays the groundwork to continue to work on them with an individual counselor and maybe even a trauma therapist.

But perhaps most significantly, as a result of sharing and listening throughout the 12 weeks of the Building Better Relationships group, many of our clients not only learn about themselves, but actually experience the strength and resilience that comes through intimate relationships. The bond formed by men who go through this group together is so strong that frequently they maintain these intimate friendships over the course of a lifetime.

Through the process of being vulnerable and open with one another, they have begun to answer their question. They realize that they do have what it takes, and that the truly satisfying answer to the question cannot come from outside of oneself.

This builds a foundation for them to be able to be open and vulnerable with their romantic partners in a way that they were incapable of before.

Before they complete the group, they also write out their mission statement, answering the questions of what their mission is in life. Along with this, they develop a philosophy paper on inimacy, relationships, and sex. They present both of these papers on the final night of the extended group.

Both of these are personal to our clients. Like developing a belief in a higher power, like they do in Step 2, a life mission on intimacy and relationships are not dictated to them. For them to be successful, they need to feel that these statements connect to their deepest held values.  They present their vision for the future of their life and intimate relationships to the group on the final evening. Because of the closeness developed in the 12 weeks of the group, these men usually remain close with each other for years to come. They are able to provide feedback and accountability after the group is over and they continue to strive toward their ideals. 

Like all forms of recovery, community is vitally necessary to continue in the difficult but rewarding work. 

The gap between our unrealistic fantasies and truly intimate relationships can only be crossed through the process of practicing vulnerability. Our clients learn this through first practicing this vulnerability with one another and diminishing shame. In the process they learn—yes, they have what it takes to do the brave and courageous work of carrying that vulnerability home and creating intimacy in their personal lives as well. 

By Alisa Sawyer
Right Side Up Recovery Center for Women and Children

Despite the wider acceptance of the disease model, and a growing understanding of the importance of treatment, alcoholism, and addiction still carry heavy cultural stigmas. 

When somebody is trying to come to terms with their addiction, messages they have heard their whole lives run through their minds on repeat. Addicts and alcoholics are lazy. They don’t have any morals, willpower, or self-control. 

Even though anyone familiar with the facts about addiction and recovery will know these statements to be false, to the person caught in the cycle of addiction, they feel absolutely true. 

Now imagine the double stigma that mothers caught in the cycle of addiction face. Not only do they carry the cultural shame that comes with having an addiction, but they also have to carry the even heavier label of being “a bad mother.” 

Over and over, they hear some version of the following message playing in their minds: What kind of mother puts their children through this? If I loved my children, I would stop drinking and using drugs. I am a terrible person, and I’m a terrible mother.

As one of the Therapeutic Child Care Coordinators at Right Side Up, these are the clients I work with—mothers in recovery who have internalized unfair and untrue biases about themselves and their illness.

The message we work to send to these women over and over again is this:  

“You are not a bad person or a bad mother. You made some bad choices in your addiction, but we are going to work with you on how to implement structure so you can make healthier, safer choices going forward.”

We tell them this in a thousand different ways, through our words and actions, until they can start to believe it. It takes a while to build the trust necessary for them to hear it, but when they do, the recovery they find is something truly powerful to see. 

It is a resilience and a power that inspires me every day and has kept me passionately working at Right Side Up for 15 years. 

The Necessity of Structure

So how do you communicate this message to women who have been hearing the opposite, shame-based messages their whole lives?

While all of our clients work with their individual counselors, take classes, and attend Twelve Step meetings to address the shame that comes with their addiction, the mothers in our program participate in our Therapeutic Child Care (TCC) program to work on the parenting part of the equation. 

Our primary focus in TCC is helping them develop essential parenting skills that many of them missed out on as a result of their addiction. We teach them this through a consistent structure and a routine that we hold them to in a loving, therapeutic way.

Structure, routine, and consistency are always important qualities for people in early recovery, but this is particularly true when children are involved. 

From the day that mothers admit to our program, we start working with them on concrete actions that move them toward a consistency that is healthy for them and their families.  

As soon as mothers admit to our program, our caseworkers start working with them to get them in to see a pediatrician. They also help to get them set up to receive the TANF (Temporary Assistance for Needy Families) benefits and healthcare benefits they are eligible for.   

As far as daily parenting is concerned, we hold them to a strict routine that they can carry on with them once their six months with us is completed. For example, everyday moms pick up their kids from the bus stop. When they get back to RSU, they process what happened that day at school with their children. Later in the evening, moms sit with their children to work with them on their homework for an hour. After six months of practicing with us, our clients have the parenting patterns well established as part of their daily lives. 

We also work with them through parenting classes, where they learn about and practice disciplining children without corporal punishment, using redirection, natural consequences, and overall behavior management techniques. They also learn about different nurturing styles and the various parts of themselves, pleasant and unpleasant, that can come out of all of us when we are dealing with the stress of parenting. 

By focusing our clients’ attention on concrete actions that they can take as parents, they begin to shift their focus away from the unhelpful belief that they don’t love their children enough. Instead, they begin to focus their attention on performing loving acts for their children. 

As they say in the 12 Step rooms, “If you want to improve your self-esteem, start performing esteemable acts.”  

As these women perform the actions of attentive and consistent parents, they begin to have more and more evidence that they love their children and are showing up for them. 

They no longer need to wonder whether or not they are good mothers because they can see evidence every day through the actions that they take that they are. 

We All Need the Same Things

For those of us who work in this field, cultural biases can come up for us as well. In fact, one of my favorite things about my job is getting to see my own biases and growing past them. 

An example of this came to me when I was early on in my career.  I was in my early 30s and one of my clients was the same age, but the differences between us were significant. I was starting my professional career, whereas her whole life centered around drug addiction, and she already had 10 children.  

This shocked me. I wondered, How does someone’s life end up like this? 

It wasn’t that I had never seen families affected by drug abuse. I grew up in a lower-middle-class neighborhood in Queens. Illegal drugs were definitely around, just not in my family or my immediate community. Our house was a hangout house for the neighborhood and was very structured, nurturing, and loving. The worst thing that we saw our parents doing was smoking cigarettes at the cookouts.

So I asked her about when she started using drugs and why. She told me that it started when she was 15 years old. She told me about how she and her friends were at her home where her mother had left crack cocaine out on the table. So they tried it. 

That’s when I had a moment. When my friends and I were 15, rather than sneaking crack, we snuck one of our parents’ cigarettes. That was how we rebelled. 

The differences in our home lives don’t completely explain the course our lives took. As they tell parents who attend Al-Anon about their children’s addiction and alcoholism: “You didn’t cause it, you can’t cure it, and you can’t control it.” 

Many people who grew up in structured homes like mine end up becoming addicted to drugs and many people in homes characterized by the chaos and risks associated with addiction do not become addicted.   

But this woman wasn’t able to grow, fail, learn, try again, and succeed in the same ways that I was as a child because she did not have the structure that I had. To add to that, her psychological development had been hijacked by drug addiction at an early age.

We are all still responsible for our own actions, but our environments play a major role in the courses that our lives can take. I look at what we do at Right Side Up as attempting to provide some of the loving structure that I was fortunate enough to grow up with. 

Just as the shame of addiction is bigger than a single person, lasting recovery needs to be grounded in something bigger than a single person as well. Healthy structure and daily routines, supported by a loving community, can help all of us stick with patterns grounded in something larger than our temporary feelings and false beliefs about ourselves that so easily pull us off track. 

To borrow another helpful phrase from the Twelve Step Rooms: “We are not bad people trying to become good, we are sick people trying to become well.” 

This phrase is one that I think we can all relate to because, at different times in our lives, we can all certainly identify with being sick and acting against our own interests and the interests of those we love, but at the same time wanting to become well. 

Who doesn’t want that? 

We have frequently spoken to people who talk about the immediate sense of warmth and welcome they felt the first time they walked into a 12 Step meeting. And we’ve heard this even from people who have never struggled with substance abuse issues.

What is it in these rooms that is so immediately attractive? Why would there be anything appealing about people assembled to overcome a fatal, chronic, and progressive disease? 

Exuding from a healthy recovery community, there seems to be a sense of joyful acceptance of life as it is. If a visitor or newcomer were able to put it into words it would likely be something along the lines of: You can let down your guard here. You are safe here. You don’t have to compete or impress anyone. 

People that walk into these rooms and feel this are picking up on something real. Here are a group of people who see the world in a unique light. They have learned to see into a deeper reality beyond mere survival. They have tapped into the energy of gratitude rather than competition. They know that they already have what they need.

The Neuroscience of Negativity

This energy of gratitude is unique because neuroscience actually shows that human beings are wired to drift in the opposite direction. Extensive studies in neuroscience have demonstrated that we have a biological tendency to see things in a negative light, commonly referred to as the “negativity bias.” 

For the purposes of continuing the survival of our species, our brains are naturally wired to hold on tightly to frightening experiences from our past to try to avoid repeating them and to scan the horizon for any future threats. Without any sort of corrective action, we drift naturally toward seeing these negative memories and possibilities, rather than remembering the positive experiences or seeking out possible positive outcomes. Studies have shown that this negativity bias develops even in infancy.  

It makes sense that this negativity bias would have benefits for our survival, particularly when you think of our ancestors, who, unaided by the technological advances we take for granted, lived much more exposed to the elements and were more vulnerable to threats by predators.

With this negativity bias wired into us, left on our own, without some sort of active reorientation, we will end up focusing on the hostile and scary possibilities for our lives, while missing key parts of the picture.  

The Lens of Gratitude

When discussing the therapeutic benefits of a gratitude practice, psychologists Phil Stutz and Barry Michels articulate it in the following way in their book The Tools: 

“What if, on a level we can’t see, the universe is interested in our welfare, supporting us in ways large and small? It’s not that much of a stretch to be able to perceive this. Start with your physical body. It extracts oxygen from the air, it digests complex foods, it allows you the miracle of sight and hearing. All these things work amazingly well without your even understanding how.”

All of these helpful processes—breathing, digestion, sight, and hearing—are taking place whether we notice them or not. Gratitude is what allows us to appreciate this. It is not about generating a false narrative of naive optimism for things that are not there. It is a way of perceiving the world in a more complete light. 

Stutz and Michels go on to state that gratitude isn’t just an activity, it is a means of perception. “With practice, you’ll find that gratefulness perceives the spiritual world just as clearly as your eyes and ears perceive the physical world.”  

The 12 Steps walk people through the process of being able to see the world through the lens of gratitude. As a result, laughter, joy, and connection become the natural companions of an active and healthy recovery community. 

The Steps undo the burdensome myth of individual self-sufficiency and having to fight our way through a world that is out to get us. Rather, the person in active recovery learns to see through the eyes of gratitude. They can begin to see all the small and large ways that they have been taken care of all along. The gifts that they begin to appreciate are often not anything new, but in active recovery people now have the ability to see what was always there. 

Gratitude is a key to access the benevolent forces at work around us that we are often unable to see without it.

A Different Universe

When a new person walks into a room full of people who are committed to this vision of the world, the effect can be powerful. It can even be powerful enough to convince him or her to go through the ego-deflating process of the 12 Steps. And in that process, he or she gains the ability to see all the ways that the universe is on their side as well. 

There is something about working the 12 Steps that gives people the ability to see the world in this way. It allows people to gain access to a more complete picture that includes the less obvious ways that life is working in our favor, rather than only seeing our problems. 

Bill Wilson articulated this perception of a new world in a piece of beautiful writing at the conclusion of Step 11 in Twelve Steps and Twelve Traditions.

“Perhaps one of the greatest rewards of meditation and prayer is the sense of belonging that comes to us. We no longer live in a completely hostile world. We are no longer lost and frightened and purposeless. The moment we catch even a glimpse of God’s will, the moment we begin to see truth, justice, and love as the real and eternal things in life, we are no longer deeply disturbed by all the seeming evidence to the contrary that surrounds us in purely human affairs. We know that God lovingly watches over us. We know that when we turn to Him, all will be well with us, here and hereafter.”

Having worked through the steps, the individual finds a way to access a connection with a Higher Power. Entering into prayer and meditation, he or she is able to see with the eyes of gratitude. 

The primary difference between a hostile universe and a benevolent one is whether or not we have access to the power of gratitude.  

Sources:

Amrisha Vaish, Tobias Grossmann, and Amanda Woodward, “Not All Emotions Are Created Equal: The Negativity Bias in Social-Emotional Development,” Psychological Bulletin, 134(3) (May 2008): 383-403. 

“Step Eleven.” Twelve Steps and Twelve Tradition, 96-105. New York: Alcoholics Anonymous World Service, 2004. 

Phil Stutz and Barry Michels, The Tools. New York: Penguin Random House, 2012. 

By Matt Shedd

Those unfamiliar with the language used in 12 Step communities may have never heard the term “emotional sobriety.” But this, perhaps more than anything else, is the goal we have for our clients at MARR.  

The term comes from the founder of Alcoholics Anonymous, Bill Wilson, who refers to emotional sobriety as going beyond mere abstinence from alcohol. In emotional sobriety the person begins to cultivate what he describes as “real maturity and balance…in our relations with ourselves, with our fellows, and with God.”

Like most processes of spiritual growth, the path to emotional sobriety is one of letting go: letting go of our ideas of who we think we are, what we deserve, who we think others think we are, and anything else that blocks our acceptance of our lives as they are. 

The spiritual maturity that Bill described is not typically achieved by the means that we anticipate. It is not usually found through the heroic fantasy we may have envisioned of helping to “save the world” and showing everyone how wonderful we are. It is found through heartbreak, failure, and loss–a shattering of the false ideas of who we think we are. The good news is that if we trust the path, the losses and failures that we thought would destroy us become the firm foundation of a new identity that is not subject to constant change.

The path to emotional sobriety can seem like quite the opposite for the person who is on it. It can feel like a path to emotional chaos.  It usually starts with the feeling that the whole world is falling apart. All the firm grips and footholds we used to have on our lives are no longer there. That is why the mentorship and guidance of a sponsor and others further along in the 12 Step process is so essential. This support provides the connection outside of one’s own feelings that can sustain us through these emotional rough patches. 

External Crisis

An external crisis often precipitates the process of getting into recovery. With our clients coming into MARR, they are often facing the consequences of years of substance abuse. These consequences can take many forms: ultimatums from family members, legal consequences from the court, the threat of losing a job or professional license, or the possibility of losing custody of a child, to name just a few possibilities. 

These consequences are often dramatic, urgent, and loud. They are circumstances that demand immediate attention. The consequences are so disruptive to “business as usual” that they can summon an uncommon willingness from our clients to take the dramatic step of checking into long-term treatment.

Although painful and shocking, this external crisis is usually only the preface to a more significant internal crisis where lasting recovery can actually begin. 

Internal Crisis 

The external consequences are often necessary to get people to the place where they have a genuine spiritual crisis forcing them to question their identity. 

Once they are in treatment, MARR clients are no longer able to rely on things outside of themselves to give them a sense of their identity. Separated from their jobs, houses, families, and daily routines, they no longer have easily ready answers for who they are.  Although not as dramatic as the chaotic circumstances that usually cause people to check into treatment, this crisis can sometimes be even more painful. 

The person at this stage of their recovery can begin to see the discontentedness that has been underneath the alcoholism or addiction.  

In the treatment environment at MARR, the client no longer has the constant activity of drinking, using, and cleaning up of consequences. The causes underneath the continued substance use can now be exposed. 

Normal life is now the problem, and the client gets the opportunity to see this up close. The person in early recovery can now see what Bill Wilson calls the “false dependencies,” which get in the way of emotional sobriety, specifically “a demand for the possession and control of the people and the conditions surrounding me.” 

When these dependencies on being able to control people and conditions were threatened previously, drugs or alcohol served as an effective balm to cover over the pain of not having these expectations met. Now, without the temporary distraction of substances, clients can see how frequently these attempts to control people and circumstances undermine peaceful, contented living. 

Unrealistic expectations make it impossible for one to stay emotionally balanced and weather the ups and downs of daily living. For this reason, much of the treatment at MARR focuses on the daily emotions our clients encounter in the small things: grocery shopping, negotiating car rides, making weekend plans as a community, to name a few. 

Our clients practice negotiating these situations in a protected environment where the stakes are lower, so when they leave they are better prepared to handle weightier matters.

Outgoing Love

Bill Wilson describes the basis to longstanding emotional sobriety in the following way, 

“This seems to be the primary healing circuit: an outgoing love of God’s creation and His people, by means of which we avail ourselves of His love for us.”

This may sound more “religious” than some of our clients might feel comfortable with, but what this looks like in practice does not have to be “religious” at all.  The general sentiment of emotional sobriety happening through “outgoing love” begins to show up in the relationships they have with the therapeutic community they are living with here at MARR.

The power of community provides the possibility of basing one’s identity on something bigger and more stable than one’s own constantly changing feelings. 

Life is no longer about having to figure things out on one’s own, which is an emotionally volatile situation to be in. They are now able to rely on the protection of the community. 

With the shift in focus to thinking of the wellbeing of others, the individual starts to experience a sense of their own wellbeing on a deeper experiential level. They are no longer simply doing damage control around the consequences of their own actions, but are actually looking out for the welfare of others, who are in turn looking out for them. 

It is in the practice of daily life with the therapeutic community at MARR that our clients experience what Bill was talking about when he stated, “My stability came out of trying to give, not out of demanding that I receive.”

Source: 

Bill Wilson, “Emotional Sobriety: The Last Frontier.” The Grapevine, January 1958. Accessible at http://silkworth.net/pages/aahistory/general/emotionalsobriety.php