Self-management & recovery training--a SMART humanistic approach to addiction recovery.

Author:Goemans, Deborah June


"The best antidotes to addiction are joy and competence--joy as the capacity to take pleasure in the people, activities, and things that are available to us; competence as the ability to master relevant parts of the environment and the confidence that our actions make a difference for ourselves and others."

--Stanton Peele and Archie Brodsky, Love and Addiction

IN ANCIENT times there was a cruel and unusual capital punishment known as poena cullei (in Latin, "punishment of the sack") that entailed placing the criminal in a sack along with a monkey, a dog, a rooster, and a viper, sewing the sack up, and then tossing it into the ocean. In many ways the pain, heartbreak, and devastation of being caught up in an addiction, or having someone you love caught up in an addiction, feels a lot like being sentenced to that fate.

Given the prevalence of addiction in society today, most people are aware that addiction has no social, racial, religious, or sexual boundaries. It afflicts the actor and the accountant, the doctor and the dockworker, both cis-gender and transgender individuals, atheists and Amish, parents and children. And just as no human being is the same, no addiction experience is completely the same. Yet, according to Michael Werner, one of the founders of SMART Recovery (which stands for Self-Management and Recovery Training), there's one thing people caught up in a substance addiction often have in common: the subconscious belief that if they quit using, they'll die. This is what addiction feels like. As per the analogy of poena cullei--if someone with an addiction is bobbing in the ocean in a sack along with a rooster, a dog, a monkey, and a viper, instead of using the tools at his (or her) disposal to open the sack and set himself free, the addict truly believes the sting of the viper is what's keeping him alive.

"Brian" was a troubled teen who used alcohol to stave off anxiety. As often happens, his anxiety increased over the years along with his drinking, until he found himself in a hospital bed confronting the realization that if he didn't stop drinking, he'd die. For Brian, the fear of giving up alcohol, while scary, was less than the fear of what lay ahead if he didn't. In addiction terms, this experience is known as "bottoming out." Dr. Joe Gerstein, a physician, president of the Greater Boston Humanists, and another founder of SMART Recovery, describes the bottoming out experience as a secular conversion--a moment of clarity that changes everything. For Brian, who now regularly attends SMART Recovery meetings and has been sober for two and a half years, the tools and the support he found at SMART Recovery have helped him stay sober. But it was that moment, when he first realized the way he was living was "utterly unacceptable," that really began to set him free.

The clarity that comes from bottoming out sometimes happens after being fired for drinking or taking illicit drugs on the job, being arrested--or worse, having killed or harmed someone while driving impaired. However, bottoming out often isn't that dramatic or tragic. It comes as a gradual realization that the using is getting out of hand, and most people who realize they need to stop using simply stop. This is true for 75 percent of those who find themselves in this situation, according to the National Epidemiologic Survey on Alcohol and Related Conditions. That lucky 75 percent do not make any declaration of powerlessness, nor do they enter rehab or get any help at all. They simply quit using and continue living their lives--happily, sadly, or however their life experiences happen to unfold.

In many ways, healing from addiction is similar to healing from a broken arm: some fractures are simple and can heal quite well on their own, while others are more complicated and need the attention of a physician. There is substantial evidence that the repeated use of drugs or alcohol damages the release and absorption of certain brain chemicals such as dopamine--the neurotransmitter responsible for the natural euphoria that follows sex or a good meal--and serotonin--dopamines Zen-like sister that brings on the feelings of satiation, calmness, and peace. But, just as a broken arm can heal naturally, the good news about drug-induced changes in the brain is that they too can be healed. With time and abstinence and hearty doses of the good life--music, exercise, love, creativity, and the joy of serving others--delightful dopamine and serene serotonin can be brought back into balance.

The bad news is that sometimes it can't be brought back into balance without help because the urge to use comes from a combination of...

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