ORTC Articles

What issues in recovery are unique to men?

Living up to male stereotypes

Common social expectations hold that men should always be tough, strong, and capable as fathers, brothers, and sons. Growing up male, you may have been taught that giving in to pain, talking about emotions, and crying were all signs of weakness. As a young boy you may have been taught to accept pain and grief without crying or sharing with others. As you grew up you found that the rules were the same: keep your feelings on the inside; don’t show how badly you are hurt; don’t share your emotions with others.

Male stereotypes include:

• Men are always strong and tough.
• Men should be in control.
• Men are competitors.
• Men are not emotionally vulnerable.
• Men don’t know how to express their feelings.
• Men shouldn’t cry.
• Men should be able to “fix” everything.
• Men shouldn’t need help from others.

Of course, qualities such as strength and toughness may serve us well
in some contexts. But trying to always live up to these rigid male stereotypes of conduct can cause us to be self-destructive and can get in the way of our recovery.

Trying to be in control

Control means power. As a man you may have learned early in your development to seek power by controlling yourself and others. You may have problems with Step One, admitting powerlessness, if you feel that it’s a sign of weakness to surrender and accept things you cannot change. However, once you admit that there are aspects of your life that you can’t control, then you can begin to practice acceptance and begin to heal.

Not allowing emotional vulnerability

Because our society tends to view men as protectors, not as emotionally vulnerable, you may feel uncomfortable sharing your feelings with others at first. Drinking alcohol or using other drugs might have been a way to cover up pain or fear. Now that you are in recovery, you may be facing these emotions with clean and sober clarity for the first time in a long time. Remember that everyone feels sadness, fear, loneliness, pain, and grief—these are all normal. Try letting go of controlling your emotions, and focus on naming them and accepting them for what they are—feelings. Fear and sadness are important emotions that alert you to danger and guide you toward intimacy and closeness with others. Real courage can be found in embracing these emotions and finding ways to share them with others who can support and understand you. When you feel strong emotions that you might tend to suppress, practice sharing them with your sponsor or recovery support group. You might also want to share them with your partner, spouse, family, and friends. Telling your personal stories will not only help you, it will help those you share with feel more accepted. They may be more willing to talk to you about their emotions in return.

How can men avoid or overcome these recovery barriers?

Work the Twelve Steps

First and foremost, work your Twelve Step program and rely on the support of a Higher Power and the fellowship. No one can do recovery alone. Start working to understand your specific triggers, develop your communication skills, cultivate new ways of thinking, plan a regular time for meditation and spirituality, associate with sober friends, and make time for health and relaxation. All these elements will help keep your life in balance.

Acknowledge your emotions

If you have been denying your pain and repressing your feelings for years, you may have some unresolved emotional issues that could threaten your recovery if you don’t address them. Denial of your emotions will only give you a false sense of control and waste the precious energy that could be better spent on communing with your Higher Power, working the Steps, and improving relationships with your friends and family.

Share with others

Instead of shutting down when you feel pain or fear, be open to other ways of coping. You might want to talk to your sponsor, your recovery support group, or your partner, spouse, or family members. Counseling might also be beneficial, letting you confidentially discuss emotions such as fear and anxiety, resentments and anger, or sadness.

Work toward balance

Keep your life in balance by keeping needs and wants on an even keel. Prayer and meditation, relaxation routines, and devoting time to health and exercise are good ways to stay centered.

Recovery Action Step

Begin to open up and share the emotional issues in your life.

Write down ways you can develop a greater support network of men who can relate to your issues. Make sure you have a sponsor who understands your specific issues as a man in recovery. Consider getting together with other men in your recovery group before or after meetings.

Practice emotional honesty. Start with very safe topics, then take the risk of opening up and sharing more personal issues.

Remember to work the Steps, utilize your sponsor and sober friends for support, and go to meetings. These practices will help you embrace your emotions, let go of controlling behaviors, receive support, and develop and maintain a healthy, happy outlook that lets you enjoy the freedom and peace of sobriety.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

Substance Abuse and Mental Health Services Administration (SAMHSA): The SAMHSA website provides information and research on men and substance use disorders, as well as on prevention and treatment.

National Institute on Alcohol Abuse and Alcoholism (NIAAA): The NIAAA website offers research on alcoholism in men, information on prevention and treatment, and a list of workshops and meetings.

Can counseling assist your recovery?

The time that you spend in treatment is just the beginning of lifelong recovery. A licensed counselor or therapist with experience in addiction treatment can help you address issues that you didn’t have time to adequately address during treatment. Dealing with issues that may have contributed to your drinking and other drug use will enhance your recovery.

A counselor can help you with your recovery by:

• teaching you to recognize and re-channel urges to use alcohol or other drugs
• encouraging and motivating you to achieve and sustain abstinence
• holding you accountable, discussing any relapses, and strongly discouraging further use
• helping you identify “sticky situations” where you might be tempted to use alcohol or other drugs to cope with problems
• helping you develop new, more effective problem solving strategies to reduce stress, and helping you deal with anger, frustration, and resentments
• supporting you as you work the Twelve Steps and strongly encouraging participation in meetings
• encouraging you to develop and continue a recovery plan as a lifelong process
• helping you recognize and change problematic attitudes and behaviors that may trigger a relapse
• encouraging you to improve your self-esteem by practicing newly acquired coping skills and problem-solving strategies at home and in the community

Counseling can also help you deal with anxiety, depression, and bipolar or other co-occurring disorders. If you have a co-occurring mental health disorder, seek help and follow your doctor’s recommendations, which may include taking medications as prescribed, attending therapy sessions, or seeking more support in your Twelve Step program. Taking care of your mental health disorder will greatly increase your success with sobriety.

How can you choose a counselor?

If a mental health therapist has been recommended to you as part of your continuing care plan, find one who is a good match for you and who understands addiction recovery.

A good relationship between you and your counselor is necessary for a successful outcome. Your gut feelings are one way to assess this relationship. You should feel that:

• Your therapist is sincere and genuine.
• Your therapist responds to your questions in a thoughtful and considerate manner.
• You are treated with respect and taken seriously.
• You have confidence in your therapist’s skills and training.
• You are given, and will be given, the opportunity to help determine your own program of therapy.
• You trust and feel at ease with your therapist.

It may be necessary to interview several before you find one you feel comfortable with.

Web resource

National Institute of Mental Health This federal website provides information on various mental health disorders and current research on treating them.

© 2014 by Hazelden Foundation. All rights reserved. This publication is not intended as a substitute for the advice of health care professionals.

How serious are thoughts of suicide?

Suicide is a tragic and potentially preventable problem. Suicide deaths out­ number homicide deaths by almost five to three, and there are many more attempted suicides that don’t result in death. The majority of suicide attempts are expressions of extreme distress and not just harmless bids for attention.

Is it normal to feel depressed during recovery?

It’s normal to feel a great sense of loss during recovery. Your addiction may have caused the loss of friends, family, or other important relationships. Some people even lose contact with their children during their active addiction. It’s normal to mourn these losses now that you’re in recovery.

But if you feel consistently unhappy, unusually sad, or depressed for more than two weeks, you might be clinically depressed, which could threaten your life and your recovery. If you suspect that you are clinically depressed, consult your physician or a mental health counselor for an evaluation. Depression is a very treatable illness with proper medical attention.

Personal Recovery Story

“I’m a proud single mother of two great kids. I’ve been working a solid recovery program for more than five years. Staying clean and sober has allowed me to turn my life around. During the last few years I’ve gone to meetings regularly and helped others succeed in their ongoing recovery. But about a year ago I started feeling unhappy and withdrawn from others. I wouldn’t say I was depressed; that would just seem like an excuse. I just knew that I was being very irritable with my family and friends. Over the next few months I began to feel more sadness. I even started to feel that no matter how hard I worked the program, recovery wasn’t working. I started feeling that if I can’t stay sober, I didn’t want to go on living.
“After seeing a therapist recommended by a recovering friend, I identified that I was really coming into a period of personal growth in my life. It was hard. I was facing new truths, making hard decisions, and accepting the responsibility that I could change my life and my family’s life for the better. I put my trust in my Higher Power to help me work the Steps. I relied on the support of my sober friends, my sponsor and my recovery support group. It wasn’t easy, but I eventually made it through that period of sadness. It made it easier to know that if things got really bad, there are doctors and mental health professionals I could call for help.”

—Diane, in recovery for five years.

Thinking about suicide is scary, but it doesn’t mean you’re crazy, hopeless, ungrateful, or worthless. It might mean that you are entering a period of per­sonal growth in your life. You may have come to a crossroads where you have the opportunity to face new truths, make new decisions, and change your life for the better. However, if suicidal thoughts continue to occur, they become more persistent, or you begin to make plans for a suicide, take these signs seriously and get help immediately. Make an appointment to see your physician or mental health counselor, or call 911 for help if you are in immediate danger.

The most important thing to do when you’re in a crisis is to talk with some­ one. If you feel sad, unhappy, or depressed, don’t isolate. Instead seek out re­ sources such as your family, sponsor, sober friends, or self­help meetings. Talking with others who have gone through similar experiences will help.

You may be working a great recovery program, but if you have clinical depression (consistent depressive symptoms that last for two weeks or longer), it won’t go away just because you work the Twelve Steps harder, read more meditations, or attend more meetings. In addition to working your recovery, get professional help to recover from depression.

If you feel that you are depressed, get help; make an appointment to see a phy­ sician or mental health counselor. These professionals will talk with you about your specific circumstances and help you create a recovery plan. Depression is an illness that is treatable. There is no reason to suffer. In fact, ignoring depression could seriously threaten your recovery and your life.

Remember Step One, admitting that you are powerless over the disease of addiction, applies to depression as well. No amount of willpower—simply deciding not to feel depressed—will make clinical depression go away. Your brain chemistry may be as powerless against clinical depression as it is against addiction. Diminished levels of the brain chemical serotonin have been found in patients with depression, impulsive disorders, a history of suicide attempts, and also in postmortem brains of suicide victims. The bottom line is that if you have clinical depression, you need to get help. This is not a time for isolation, secrecy, or shame. Just as you learned in Step Two, you need the help of others; you don’t have all the answers.

If you or anyone you know is thinking about committing suicide, seek immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously.

For immediate help, call the Suicide Awareness Voices of Education (SAVE) hotline at 800-273-TALK.

Recovery Action Steps

1. Make a list of people you can talk to if you feel suicidal. Add those contacts (names and phone numbers) to your list of recovery resources, which should include your sponsor, your recovery coach, and supportive family members. Don’t forget to include the Suicide Awareness Voices of Education hotline, 800-273-TALK. Keep this contact list in your wallet in case you need to talk with someone immediately.
2. List any thoughts, feelings, or behaviors you experience that could lead you to feel suicidal. Discuss those thoughts with your sponsor or mental health counselor.

Is there a link between alcohol and other drug use and suicide?

The link between alcohol and other drug use to suicide and suicidal thoughts is strong. A research study found that 37 percent of eighth grade girls who drank heavily reported attempting suicide, compared with only 11 percent who did not drink.

Alcohol or chemical use can lead to depression, hopelessness, mood swings, and feelings of shame and guilt, which can result in suicidal thoughts. If you are thinking about suicide, alcohol or other drug use could give you a false sense of courage that might lead to a suicide attempt. Using substances will impair your good judgment and could leave you vulnerable to suicidal thoughts that you might never have if you were sober.

Is there a link between co-occurring mental health disorders and suicide?

Suicidal behavior is often connected with substance use disorders and a co­ occurring mental disorder, such as depression. Research has shown that more than 90 percent of people who kill themselves have depression or another diagnosable mental or substance use disorder, often in combination with other mental disorders.

If you have a coexisting mental health condition such as bipolar disorder, depression, or even stress, you are at a higher risk of suicide, especially if you return to any level of use.

What are the other suicide risk factors?

Besides substance use disorders and mental illness, other risk factors include previous suicide attempts, a family history of suicide, exposure to suicidal be­ havior in others, access to lethal methods such as guns or poisons, incarceration, and physical or sexual abuse or another stressful life event or loss.

Adverse life events in combination with other risk factors such as depression may lead to suicide. But suicide and suicidal behavior are not normal responses to stress. Many people have one or more risk factors and are not suicidal. Attempts at suicide can occur in clusters, sometimes following the suicide of a friend or a celebrity that received widespread media coverage.

Is age a suicide factor?

Older adults

Older adults are disproportionately more likely to die from suicide, because many of these older adults suffer from a depressive illness. Depression is not a normal part of aging. In contrast to the normal emotional experiences of sadness, grief, loss, or passing mood states, symptoms of depression tend to be persistent and to interfere significantly with a person’s ability to function. If you are an older adult who is experiencing these symptoms, seek help. Make an appointment to see your physician or mental health counselor, or call 911 for help if you are in immediate danger.

Children, teens, and young adults

In the year 2000, suicide was the third leading cause of death among children ages ten to fourteen, and in adolescents fifteen to twenty­four years old, follow­ ing unintentional injuries and homicide. These are shocking statistics, but most youth who commit suicide suffer from a mental or substance use disorder or both. It is important to look for signs of substance use or depression and get professional help for your child if he or she needs it.

Watch for These “Suicide Signals” in children and Teens

Your children may be at risk if they

• complain of being a bad person or feeling “rotten inside”
• give verbal hints, such as “I won’t be a problem for you much longer,” “Nothing matters,” “It’s no use,” and “I won’t see you again”
• put their affairs in order; for example, they give away favorite toys, clean their room, or throw away important belongings
• become suddenly cheerful after a period of depression
• show signs of psychosis (hallucinations or bizarre thoughts)
• show little interest in the future
• act in rash, hostile ways, often expressing rage

What are the signs and symptoms of suicide?

• talking about feeling suicidal or wanting to die
• feeling hopeless, that nothing will ever change or get better
• feeling helpless, that nothing one does makes any difference
• feeling like a burden to family and friends
• putting affairs in order (for example, organizing finances or giving away possessions to prepare for one’s death)
• writing a suicide note
• putting oneself in harm’s way, or in situations where there is a danger of being killed

What should you do if someone tells you that he or she is thinking about suicide?

If someone tells you he or she is thinking about suicide, you should take this person seriously, listen without judgment, and help him or her get to a mental health professional or physician for evaluation and treatment. Don’t ever try to minimize or trivialize a suicidal person’s problems or try to shame the individual into changing his or her mind. Your opinion of a person’s situation is irrelevant. Trying to convince someone that the situation is not that bad, or that he or she has everything in the world to live for, will only increase feelings of guilt and shame. Instead, use this time to reassure him or her that help is available, depression is very treatable, and suicidal feelings are temporary. People con­sider suicide when they are hopeless and unable to see alternative solutions to problems.

If someone is in imminent danger of harming himself or herself, do not leave the person alone. When a family member may be at risk for suicide, make sure that firearms or other lethal means of committing suicide are removed from the home. You may need to take emergency steps to get help, such as calling 911. Make sure you follow through and that the person finds a doctor or mental health professional. Don’t assume that your persistence is intrusive. You may feel that you are interfering or being too pushy, but it’s worth it if it results in a life saved.

Web Resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

National Institute of Mental Health (NIMH): NIMH is a U.S. government organization, an agency of the Department of Health and Human Services, dedicated to research and education in the field of mental health. Its website is a great resource of information for specific mental health disorders, eating disorders and suicide prevention.

American Foundation for Suicide Prevention (AFSP): AFSP is a national not­-for­-profit organization exclusively dedicated to funding research, developing prevention initiatives, and offering educational programs and conferences for survivors, mental health professionals, physicians, and the public. This organization’s website offers research on prevention and resources for survivors.

Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA is part of the U.S. Department of Health and Human Services. Its mis­sion is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness as well as suicide prevention.

American Association of Suicidology (AAS): The goal of AAS is to understand and prevent suicide. Founded in 1968, AAS promotes research, public awareness programs, public education, and training for professionals and volunteers. AAS serves as a national clearinghouse for information on suicide.

Suicide Awareness Voices of Education (SAVE): SAVE’s mission is to prevent suicide through public awareness and education, eliminate stigma, and serve as a resource to those touched by suicide. The SAVE site includes tips on prevention, coping with loss, news and events, statistics, and a suicide hotline: 800­273­TALK.

What is denial?

Denial is refusing to admit or acknowledge something that may seem obvious to others. When it comes to substance use disorders, denial occurs when you refuse to accept to acknowledge the problems created as a result of your addiction. You might deny your dependence on a substance, your lack of control over your use, your ability to stop using, and the physical, emotional, and social consequences of your use. Denial takes a number of forms—minimizing, rationalizing, justifying, and blaming are just a few.

Why did we, as substance abusers, deny the facts? We might use denial to sidestep shameful, uncomfortable, or painful events. We might also use denial to minimize our deep feelings of guilt, shame, anxiety, fear, and inadequacy.

Denial is something that happens within us, but also within families and the community at large. Family members often have a stake in denying that someone within the family circle has an out-of-control problem and isn’t behaving like people in other families. A few decades ago, society at large denied that women could abuse alcohol or other drugs. Thus, many women couldn’t get treatment, and by the time they did, their addictions had progressed so far that recovery was far more difficult.

Thoughts of Denial

• When you were using, you may have experienced these thoughts of denial: “Prescription medications won’t cause addiction.”
• “I will stop after having just one.”
• “If I was addicted, I wouldn’t have my high-powered job.”
• “I can quit when I want to—I just don’t feel like it right now.”
• “My family exaggerates when they describe my faults.”

How can denial affect your recovery?

Denial works in many insidious ways to prevent or postpone healthy recovery. Some people are so good at denial that they never get into treatment—an avoidance that can eventually be fatal. Others minimize all aspects of substance use so that, by the time they enter treatment, their physical, mental, and spiritual lives are bankrupt. These people will require longer treatment and sometimes repeat treatment to recover.

Once in treatment, denial can lengthen stays and inhibit people from experiencing all the benefits of the program. Denial at any point along the way can lead to a relapse. Denial, even a little denial, undermines the intent of each of the Steps. Denying addiction affects Step One. Denying your inability to stop on your own undermines Steps Two and Three. Minimizing or rationalizing the effect your addictive behavior has had at home, with friends, or on the job renders your Fourth and Fifth Steps less than honest. It also dilutes the honesty behind your list of shortcomings in Steps Five and Six. And, denial weakens the foundation of any amends you make in Steps Seven and Eight.

Overcoming denial

The best antidote for denial is, of course, rigorous honesty. What are your particular patterns of denial? How can you cut through them and sharpen your focus on the truth about your addiction? Each of the Steps offers an opportunity to keep denial front and center in your recovery.

For example, when taking a daily inventory, ask yourself how you may have minimized the impact of your behavior on others. Repeat Steps Four and Five as often as needed to shine light into areas of your life you haven’t yet addressed with full honesty. Are there amends you can and should make to continue confronting your past actions?

What is recovery?

Recovery is a multi-phase, lifelong journey of growth and development. Detoxification is only the first step on the journey of recovery. But physical detox alone will not help you stay clean and sober. Recovery from your addiction will be a lifelong process that typically requires formal treatment followed by continuing support from a sponsor, counselor, physician, AA members, family, and clean and sober friends. To maintain lifelong abstinence, you’ll need to develop new problem-solving skills to cope with stressful situations and troubles. You’ll also need to be prepared to work hard on your personal development and spirituality to deal with any emotional or physiological triggers that could cause you to re- turn to your old ways of coping—that is, using.

When people first begin the journey of recovery, they often think that it is all about staying sober, but it is really so much more than that. Sobriety is how the journey starts, but if we work an active Twelve Step program we find that recovery is actually more about a spiritual transformation and becoming the person we were always meant to be.

In recovery we learn new ways of thinking, acting, feeling, and being. We learn about the wonderful truth that a Higher Power is active and working in our lives, and that it is through this power that we are changed

Why is it important to realize that recovery is a lifelong process?

The Minnesota Model of addiction treatment effectively combines the best of the medical and social/behavioral treatment models with spirituality. It is based on the idea that recovery is a lifelong process that takes place over time, in specific stages. Each stage has tasks to be accomplished and skills to be developed. If a recovering person is unaware of this progression, unable to accomplish the tasks and gain the skills, or lacks adequate treatment, he or she will probably return to use.

What are the seven habits of successful sobriety?

1. Forget willpower—embrace your Higher Power. Accept the fact that addiction is a disease. You can’t use willpower to control even limited use of alcohol or drugs. Abstinence is the only solution.

2. Use the problem-solving skills you learned in treatment to stabilize your emotions as you go through life’s crises.

3. Learn to identify and manage stress or any co-occurring disorders like anxiety or depression.

4. Build a sobriety-based lifestyle. Embrace clean and sober friends and engage in healthy recreation.

5. Learn to let go of self-defeating behaviors. Identify and snuff out stinking thinking. Know that you deserve to be happy and healthy.

6. Be prepared for the lifelong process of continued personal growth and development. Continually examine your goals and values, and make improvements that will give you more life satisfaction.

7. Don’t get lazy with your recovery—it takes focus to abstain for a lifetime. Remember that any use of alcohol or drugs will reactivate the progression of the disease of addiction. Stay focused. It’s your life.

What are the stages of recovery?

Transition stage

The transition stage begins the first time a person acknowledges an alcohol or drug-related problem. As a person’s addiction progresses, he or she tries a series of strategies aiming to control use. This ends when the person realizes that safe use of alcohol and/or drugs is no longer possible for him or her—not ever.

The struggle for control is a symptom of an identity conflict. Alcoholics and drug addicts enter this phase of recovery believing they are normal drinkers and drug users capable of controlled use. As the progression of addiction causes more severe loss of control, they must face the fact that they are addictive users who are not capable of controlled use.

During the transition stage, addicted people typically attempt to control their use or stop using. They are usually trying to prove to themselves and others that they can use safely. This never works for very long.

Stabilization period

After going into treatment, you probably experienced physical withdrawal and other medical problems. This began your stabilization period. During treatment you probably began working to break the psychological conditioning that increased your urge to use. You began to stabilize the crisis that motivated you to seek treatment, and started learning to identify and manage symptoms from co-occurring disorders such as anxiety or depression. This prepared you for the long-term processes of rehabilitation. A recovering person typically takes six weeks to six months to master these symptoms with the correct therapy.

Early recovery period

Early recovery is marked by the need to establish a chemical-free lifestyle. To do this you must learn about the addiction and recovery process. You must begin immediately to build relationships with sober and recovering people who will support your desire and efforts for long-term recovery. We also need to separate from friends who use because when we are around them when they use, we are unable to keep from using. This may be very difficult if you have never had relationships with people who maintain sobriety-based lifestyles. We may feel alone during this time, and it is important to find healthy support. Going to AA meetings, meeting with your sponsor, and finding healthy recreation opportunities will help expose you to clean and sober people who will offer you support and friendship as you focus on lifelong recovery.

You will also need to develop recovery-based values, thinking, feelings, and behaviors to replace the stinking thinking you formed in addiction. This period typically lasts one to two years or more.

Middle recovery period

Middle recovery is marked by the development of a balanced lifestyle. During this stage you will learn to repair the damage done to your life during use. You will need time to reestablish healthy relationships with your family, set new vocational goals, and expand your social circles. During this time we may try to move out of the protected environment of a recovery support group to assume a more mainstream and normal lifestyle—and sometimes we mistakenly believe that we can now drink normally. Either way, this stage may bring us stress as we begin applying basic recovery skills to real-life problems.

Late recovery period

During late recovery, you should take proactive steps to make progress on any ongoing personality issues that still interfere with your life satisfaction. In traditional psychotherapy, this is referred to as self-actualization. It is a process of examining the values and goals that you have adopted from family, peers, and the culture you live in. You’ll start to evaluate whether you want to keep these values or discard them, and you’ll start forming new ones. In normal growth and development, this process occurs in a person’s mid-twenties. Among recovering people, it does not usually occur until three to five years into the recovery process, no matter when recovery begins.

This is the time when you will learn to change self-defeating behaviors that can trigger a relapse. These self-defeating behaviors often come from psychological issues that started in childhood, such as childhood physical or sexual abuse, abandonment, or cultural barriers to personal growth.

Maintenance stage

The physiology of your addiction will last for the rest of your life. The maintenance stage of your recovery is a lifelong process of continued personal growth and development. Here you will cope with adult life transitions, manage routine life problems, and guard against relapse. Any use of alcohol or drugs will re-activate the physiological, psychological, and social progression of the disease.

Could you encounter roadblocks during recovery?

Although some patients progress through the stages of recovery without complications, most addicted people do not. They typically get stuck somewhere. A “stuck point” can occur during any period of recovery. Usually it is caused either by lack of skills or lack of confidence in one’s ability to complete a recovery task. Other problems occur when the recovering person encounters a problem— physical, psychological, or social—that interferes with his or her ability to use recovery supports such as AA meetings, sponsorship, and counseling.

When recovering people encounter stuck points, they either recognize they have a problem and take action, or they lapse into a familiar coping mechanism: denying the problem. Without specific relapse prevention skills to identify and interrupt denial, stress begins to build. Eventually the stress will cause them to cope less and less well. This very often results in return to use. If you use your relapse prevention skills, you’ll be able to moderate the emotional and psychological effects of crisis in your life, which will help you maintain lifetime abstinence.

What is insanity?

The Big Book defines insanity this way:

“He had much knowledge about himself as an alcoholic. Yet all reasons for not drinking were easily pushed aside in favor of the foolish idea that he could take whiskey if only he mixed it with milk! Whatever the precise definition of the word may be, we call this plain insanity. How can such a lack of proportion, of the ability to think straight, be called anything else?”

How can the Twelve Steps return you to sanity?

In Step One you learned to define the problem of addiction as

• You have a body that can’t handle alcohol or other drugs.
• You have a mind that can’t give them up.
• You have a spiritual condition that can’t do anything about it!

You also learned that the solution to this awful dilemma is that you need the help of a Power greater than yourself to restore you to sanity.

Step One advises us to accept that we are powerless over drugs and alcohol. This is not to put us down. Instead, Step One guides us toward a new way of thinking and gives meaning to our struggle. Once we understand our illness, we’re no longer baffled by the “insanity” of our using. We can become more comfortable with ourselves and with others. We can let go of shame and guilt and start to work toward our ongoing recovery from the disease. When we admit powerlessness, we admit that we can’t control everything in our lives. But we are responsible for the effort we make.

It’s not easy to accept that we are powerless. But it’s the first step to recovery. Once we accept our disease, we can then get down to the work of recovery.

What are inhalants?

Inhalants and solvents are chemicals found in household products such as glue, dry cleaning fluids, gasoline, and others. The fumes or vapors are inhaled (or “huffed”) for their mood-altering effects. Sometimes they are sprayed in a paper bag or soaked in a rag that is then placed over the mouth and nose. These chemicals are not meant to be intentionally inhaled and the packaging often contains warnings. They can cause serious damage to the body and organs, and inhalant use can even lead to death with just one use.

There are four main categories of inhalants:

• Volatile solvents: These include paint thinners and removers, dry-cleaning fluids, gasoline, glues, correction fluids, and felt-tip marker fluids.
• Aerosols: These are found in spray paints, deodorant and hair sprays, vegetable oil sprays for cooking, and fabric protector sprays.
• Gases: Medical anesthetic gases include ether, chloroform, and nitrous oxide (or “laughing gas”). Other products containing gases include butane lighters, propane tanks, whipped cream dispensers, and refrigerants.
• Nitrites: These are often considered a special class of inhalants and are known as “poppers” or “snappers.” Various types of nitrites are still legally sold for recreational use, while others are illegally manufactured, or only available by prescription.

How does inhalant use affect the brain?

The effects of inhalants are similar to those of alcohol, including slurred speech, lack of coordination, euphoria, and dizziness. Inhalant users may also experience lightheadedness, hallucinations, and delusions. Inhalants deprive the body of oxygen, a condition known as hypoxia. Hypoxia can damage cells throughout the body, but the cells of the brain are especially sensitive to it. Someone who repeatedly uses inhalants may loose the ability to learn new things or may have a hard time carrying on simple conversations. Other effects from inhalants can be lethal or irreversible.

Because inhalants can be found in everyday household products, many people don’t consider them to be dangerous. However, most inhalants are toxic and can cause long-lasting damage or death.

The American Psychiatric Association (APA) uses the term “inhalant use disorder” to define a pattern of inhalant use that leads to significant physical, interpersonal, medical, or work problems. Inhalant use disorder is rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with inhalant use disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Those with inhalant use disorder should receive treatment, and those who identify themselves as addicts often find the skills and support to stay sober through peer support groups like Narcotics Anonymous.

Addiction is considered a brain-based disease characterized by abnormal drug-seeking behavior that leads to impaired control over one’s drug use. Addiction means a person will continue using drugs like inhalants despite the harm it does to their health, family, work or school, and relationships. An addict may experience withdrawal symptoms (physical pain, fatigue, depression, trouble sleeping, irritability) if he or she stops using, and may need to keep using just to feel normal. “Curing” addiction is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, addiction is considered a chronic disease which is beyond one’s control and fatal if left untreated.

How does inhalant use affect a co-occurring mental health disorder?

Co-occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co-occurring disorders should be part of any good assessment or treatment plan.

Many people with a mental health problem turn to substances to feel better. For example, a person who is depressed may turn to inhalants to feel better. Because the euphoria is brief, the person will probably repeat the usage, increasing the risk for addiction, overdose, and even death. What’s more, the symptoms of inhalant use can mask and mimic mental health symptoms. Inhalant-induced hallucinations, for example, might be mistaken for signs of schizophrenia— resulting in ineffective treatment.

Is addiction to inhalants widespread?

Addiction to inhalants is rare, but can happen with frequent use. In a 2008 study, 0.1 percent of individuals admitted to substance abuse treatment reported addiction to inhalants as their primary substance of abuse. However, most individuals who report inhalant use as their primary substance were ages 12 to 15. Although not necessarily a “gateway” drug, inhalants are found in household products, which are more available and tend to be the first drugs young people are exposed to.

Addiction won’t go away, like a cold or the flu. It is a chronic disease, meaning you have it all your life. However, by staying sober and getting ongoing support, recovering people live normal, healthy, productive lives.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

National Institute on Drug Abuse (NIDA): This government organization is dedicated to addiction research and education. Through its website you can access up-to-date publications about many different drugs of abuse as well as emerging trends.

Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA is part of the U.S. Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness.

How does loneliness affect recovery?

Can you remember feeling isolated or different, even when you were among lots of people at parties or celebrations? You may have used alcohol or other drugs to fit in and feel more like part of the crowd, but found that the relief from loneliness was only temporary. As your addiction progressed you may have felt guilty or ashamed, which left you feeling more lonely and isolated than ever.

Now that you are in recovery, you may think those feelings of loneliness should disappear. But the choice to abstain from alcohol and other drugs means that you must isolate yourself from your using friends—perhaps the only friends you had during your addiction. It is not uncommon to feel lonely during this time. Look at it as a temporary transition and a symptom of positive growth. You are moving from an unhealthy network of friends to a life-giving, supportive network of friends. Make an effort to create connections with new people in recovery, and make sure you attend Twelve Step meetings.

Remember that you don’t have to go it alone. Any time you go to a meeting you will find a room full of understanding people who have experienced the same feelings of isolation. Talking with them will help you regain your sense of humor and belonging. You need help from others, from your Higher Power, your sponsor, and your recovery support group. Keep in close contact with these people. They will form your support network. They can understand what you’re going through and hold you accountable to keep working on your recovery.

Remember that deep, lasting relationships take time to develop. They will grow as you grow in your sobriety. In the meantime, practice being at peace when you are alone. People who are content and at peace with themselves can spend time alone without feeling lonely. You can learn to be at peace by practicing meditation and serenity.

If during active addiction you tended to isolate yourself or be a loner, take care not to isolate yourself while working on recovery. Balance your alone time with time engaged in positive relationships with others.

What is alcohol?

Alcohol is a liquid obtained by fermenting carbohydrates using yeast or a distillation process. Beer, wine, and distilled spirits are the major types of alcoholic beverages. Despite being legal, alcohol is classified as a drug along with illegal drugs such as heroin, cocaine, or improperly used prescription drugs.

How do I know if I have a problem with alcohol?

Start with a simple four-question test called CAGE. Among clinicians, CAGE is the most widely used test to determine if a problem with alcohol exists. Here are the questions:

• Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt Guilty about your drinking?
• Have you ever had a drink first thing in the morning as an Eye opener to steady your nerves or get rid of a hangover?

If you answered yes to at least two questions, you are at risk of having a problem with alcohol. Other diagnostic tools are available to help you further assess your use of alcohol or other drugs. Your physician can help you determine if a problem exists.

What is alcoholism?

Alcoholism is an addiction to alcohol. It is considered a brain-based disease characterized by abnormal alcohol-seeking behavior that leads to impaired control over drinking. Alcoholism means a person will continue using alcohol despite the harm it does to their health, family, work or school, and relationships. “Curing” alcoholism is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, alcoholism is considered a chronic disease which is beyond one’s control and fatal if left untreated.

The American Psychiatric Association (APA) uses the term “alcohol use disorder” to define a pattern of alcohol use that leads to significant physical, interpersonal, medical, or work problems. Alcohol use disorder is rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with alcohol use disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Through treatment, some with mild alcohol use disorder are able to learn how to better manage their drinking. Those with moderate or severe alcohol use disorder, who identify themselves as alcoholics, are advised to abstain from alcohol completely, and often find the skills and support to do so through peer support groups like Alcoholics Anonymous.

Why does alcohol affect different people in different ways?

People with a family history of alcoholism are genetically predisposed to the disease. A person’s environment also plays a role in alcoholism. Alcohol has different effects from person to person because of body size, hormones, and metabolism. This is particularly true with women, who typically become inebriated faster, progress to addiction more quickly, and develop diseases related to substance use sooner. One person might drink and even abuse alcohol but never become an alcoholic, while someone with the right biological and other factors can develop symptoms of alcoholism after just one drink. Others may find that their problems with alcohol grow over time.

How much alcohol is too much?

Here are the guidelines established by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for adults up to age sixty-five:

Moderate drinking: For men, four drinks a day and no more than fourteen drinks per week; for women, three drinks a day, and no more than seven drinks per week. Drinking more than these amounts is considered heavy or “at-risk” drinking.

Binge drinking: Binge drinking is considered to be any amount of drinking that raises one’s blood alcohol concentration (BAC) to 0.08 within two hours. For men, this usually means five drinks in two hours; for women, this usually means four drinks in two hours. Binge drinking is a serious problem among high school and college students, as well as many adults. Those who binge drink are at a higher risk for health problems, car crashes, and injuries.

Among men and women older than age sixty-five, more than seven drinks per week or more than three drinks per occasion is considered too much.

A drink is considered 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

The U.S. Department of Agriculture’s recommendations are more restrictive, at one drink per day for women and two drinks per day for men. Alcohol can affect people in different ways based on weight, body chemistry, medications, and how recently they’ve eaten. These recommendations are estimates based on average conditions.

NIAAA researchers found that the younger someone starts drinking, the more likely that person is to develop an alcohol use disorder. Among respondents who began drinking before age fifteen, more than 40 percent had a problem with alcohol at some point in their lifetimes.

What are co-occurring disorders?

Co-occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co-occurring disorders should be part of any good assessment or treatment plan.

Of people who have been diagnosed as alcoholics, 60 to 75 percent have or have had a mental health disorder. Abuse of alcohol, which is a central nervous system depressant, can mask or mimic symptoms of depression or an anxiety disorder. What’s more, people with a mental illness require less alcohol use to experience alcohol-related problems, compared to people who don’t have a mental illness.

Among clients with co-occurring disorders, alcohol use disorder can lead to a number of problems, such as a recurrence of their mental illness, use of other drugs, homelessness, violence, victimization, incarceration, suicidal behaviors, and hospitalization.

How does alcohol use affect the brain?

The human brain is made of billions of nerve cells, or neurons. Every time you feel something, including the effects of a drug, neurons are “firing” messages to and from one another. This “conversation” is known as neurotransmission. In a chemically dependent person, the conversation has gone awry. The role of brain chemistry in substance use disorders is a relatively new finding in the treatment field, but a rapidly growing body of evidence supports it.

While specific drugs affect the actions of specific neurotransmitters, alcohol affects the actions of multiple neurotransmitters and is the only drug to do so. Alcohol has been proven to negatively affect mood, memory, reaction time, concentration, and many other critical brain functions.

Is alcoholism treatable?

Yes. Treatment usually involves detoxification, medications, and outpatient, hospital, or residential therapy. Withdrawal from heavy alcohol use can be an uncomfortable process, and dangerous to your health. It is not advised that you try to quit on your own without medical supervision.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

A branch of the National Institutes of Health, the NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. Its website offers many articles about alcohol, addiction, treatment, and co-occurring disorders.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is part of the U.S. Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness.

What is obsession?

In 1934 Dr. William Duncan Silkworth described alcoholism as an obsession of the mind and an allergy of the body. Bill Wilson would later take this description of the illness and use it as the basis of the Alcoholics Anonymous approach. This obsession to use substances against all practical wisdom is often called insanity.

The Big Book (pages 36–37) explains insanity this way:

He had much knowledge about himself as an alcoholic. Yet all reasons for not drinking were easily pushed aside in favor of the foolish idea that he could take whiskey if only he mixed it with milk! Whatever the precise definition of the word may be, we call this plain insanity. How can such a lack of proportion, of the ability to think straight, be called anything else?

How does obsession affect your recovery?

When you start to realize the depth of your obsession with substances and how it has negatively affected your life, you experience what is often called “hitting bottom.” At this low point you see that you no longer have control over the things that you value most—your health, your family, your sanity. In Step Two you are learning to define the problem of insanity—to see addiction as the by-product of a spiritual problem that requires a spiritual solution. This means you need the help of others; you don’t have all the answers. To live an ongoing lifetime of recovery, you will need to find a loving, guiding power you can really trust. This is your Higher Power.

If you’re like many people in early recovery, you haven’t defined your Higher Power yet. That’s okay; you don’t have to know who or what your Higher Power is right now—you just need to know that you aren’t it.