The Space Between

There is a vital space between stopping drinking, using drugs, or over-relying on other unhealthy coping and being in recovery** and healing.

In my last post, I posted about the science of what causes a substance use disorder. This week, I am talking about the science of recovery. Specifically, I am focusing on the space between stopping the drinking, drug use, or process addiction and recovery.

Stopping drinking, using, or repeated unhealthy habits is what allows for recovery to happen or makes space for healing but the stop is not in and of itself recovery. There is a cliche but true statement in the recovery community “if nothing changes, nothing changes.” An even older one from AA is “the same man will drink again.” 

If a person stops the behavior but does not move into thinking, behaving, and operating in ways that have positive brain-changing consequences, the default neural pathways of unhealthy coping return. Even more importantly, that person fails to establish a routine and life that supports a robust and enjoyable sobriety. 

Why Isn’t It Working?

When this happens, that’s when I get clients, family members, or other feedback to say things like “ treatment doesn’t work” or “the relapse rate is so high” or “AA and other mutual help doesn’t work.” 

When substances or behaviors are stopped but healthy positive habits are not initiated, that means that a new brain and new life have not been built; healing can not happen. 

I use the word “built” intentionally here because one of my analogies for successful treatment intervention is toolboxes. It’s important that we understand that drinking, using drugs, and other unhealthy habits are tools. They serve purposes. They are not healthy ways to get needs met, and they usually have short, intermediate, and long term negative consequences but they do have functional benefits. 

As we discussed in the “Why Does A Substance Use Disorder Develop?” entry, people habituate and condition responses to life. Unhealthy coping  are tools people come to rely on. Therefore, in order to successfully change negative habits, people seeking recovery need to equip a new toolbox in order to get needs met in healthy ways. 

My approach to treat this is to leverage the power of the science of positive habits by building a new toolbox. That means, literally, building a new brain.

Build a New Brain

Going back to my mantra of “what is psychological is biological,” what you think about and do, your body follows.

Remember that I support an individual and custom approach to recovery. I am going to use an example from the AA text known as the Big Book. In a section written by a medical doctor offering what was then a progressive view of alcohol use disorder, he wrote: 

“Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable, and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks-”

To put this quote in context, Dr. Silkworth was speaking of people who have an untreated drinking problem but are sober. The feelings of “restless, irritable, and discontent” lead them to resume drinking. The restless, irritable, and discontent represent a not drinking but unrecovered brain.

The key is to put space – filled with the science based recovery habits – between not drinking and the feelings.

Below are representations of healthy and unhealthy toolboxes.

How Mutual Help Helps

I’d like to shift into how mutual support helps with this process?

Here is a summary of the healing habits that are accessible in some of the mutual help or peer support options for recovery. The items I’ve chosen to list come from each organization’s website. I selected them because there is science that supports their efficacy in making sustained change.

AA/12-Step

1. Routine
2. Ritual
3. Social connectedness
4. Sponsorship/accountability
5. Process of transformation of the steps
   1. Daily personal reflection
   2. Prayer/meditation
   3. Repair relationships
   4. Service
   5. Meaning and purpose

Women for Sobriety 

1. Positive reinforcement (approval and encouragement)
2. Cognitive strategies (positive thinking)
3. Letting the body help (relaxation techniques, meditation, nutrition, and physical exercise)
4. Dynamic group involvement

Dharma Recovery

1. Renunciation (abstinence) 
2. Meditation 
3. Meetings (Willingness & Service): Attend meetings, actively participate, and become of service when possible. 
4. The Path (Open-Mindedness & Discipline): Also relates to meaning and purpose. 
5. Inventory (Courage & Awareness): Transcend our addictive habits and heal the root causes of our suffering by writing & sharing in-depth detailed inquiries. 
6. Community (Love & Connection): Cultivate healthy relationships in our recovery community and we check-in with admirable friends to stay on the path. 
7. Growth (Progress is Perfection): We undertake a lifelong journey of growth & awakening. 

SMART Recovery

1. Build and maintain motivation
2. Cope with urges and cravings
3. Manage thoughts, feelings and behaviors
4. Live a balanced life

What Does a Sober Life and New Brain Look Like?

Now, I don’t think clients necessarily have to join any of those groups or others such as Celebrate Recovery, Secular Organizations for Sobriety, or LifeRing. But I do believe that everyone’s sober toolbox needs to include sober specific social connectedness on some level. You can curate that with a contemplative practice of a gratitude journal, cultivating awe in regular nature walks, returning to a creative hobby, and building a science informed robust a.m. and p.m. routine and that might be sufficient for the treatment of a substance use disorder.

Stopping using, drinking, and doing and stopping there is like driving to MD Anderson’s parking lot, never entering the building, and saying “treatment didn’t work.”

For more information, content, support, and tools on how to manage executive stress and enjoy life without drugs, alcohol, or over-relying on unhealthy coping, check my bio for a link to a free workbook on managing stress to help stop drinking.

For more information, content, support, and tools on how to manage executive stress and enjoy life without drugs, alcohol, or over-relying on unhealthy coping, check out my link to a free workbook on managing stress to help stop drinking.

**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.