A physician story of addiction and recovery

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober.  I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple.  It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either.  I know this will instantly raise the “denial” flag among the 12 steppers, and that is fine.

I hope it does because I want your attention and ear on this matter as well.  I am not in any denial about my addiction, but I flatly reject the notion that this is a terminal disease with but one cure: surrender and step work.  It’s such a complex issue that conveniently wrapping addiction into this package is ultimately fatal for some and may be leading to more relapse than “recovery” in others.

I don’t have data to prove it, and no one ever will, but I have seen firsthand examples of fatal failure and relapse while “working the steps.”  Sure, it could happen in any form of treatment, secular or otherwise.  And therein lies the crux of this conundrum for me: forcing and coercion of a unilateral mindset of treatment onto such a complex, misunderstood, and potentially fatal condition is at best bad medicine and at worst unethical and anti-Hippocratic.

However, as most things in life and (sadly) medicine, it comes down to the dollar.  Rehab is a multimillion dollar industry with the world’s most captive audience.  Usually professionals with no choice but to complete treatment at an approved facility or face public humiliation, loss of job and licensing, and potentially loss of career.  Over 90% of treatment facilities are 12 step based.  Most would argue, “well, it must work.”  I will counter with, “no, but it is a cookbook treatment that guarantees participation and hence profit.”  No one wants to be the first to criticize or go against conventional wisdom in such matters.  That would be financial suicide.

My journey into the world of rehab, recovery philosophies, and public perception has left me truly aghast.  Yes, I am a drug addict.  I became addicted to opiates and used them sporadically, then heavily, the last 3 years of a 15 year hellish trip.  When I was finally caught, I was grateful, though it was delayed.  I self-reported and started outpatient counseling and voluntary drug screens immediately and remained sober the entire time.  I was sent for an assessment at a well-known facility after meeting with my state board.  This is where the disillusion started.

There is basically no way a physician presenting for assessment will be told they don’t need inpatient care.  They have a truly captive audience and know it.  Admittedly, inpatient treatment was good for me, but for reasons cited below.  Through the months that followed I witnessed coercion and forced rehab more than once in substance abusers, not addicts.  I say I needed treatment, but retrospectively it was really the down time with fellow doctors that was therapeutic.  I never bought into their 12 step preachings.  It was so disappointing that an esteemed facility was basing it’s treatment on a mystical book of chants and simpleton sayings rooted in dogmatic preachings and faith healing with no science to support it.  It would be like getting into Harvard and finding your first textbook was a Dr. Suess story.

I also was, and am, incredibly disappointed in the lack of flexibility afforded physicians or even the general public when it comes to rehab.  It appears to be 12 step or nothing, and personally I think nothing is the better option between the two.  I was bombarded with the 12 step dogma, and it is a psychological beatdown designed to steal any control or free thinking one may have and force you into a program of pure religiosity dressed down as “spirituality”.  Submission is critical to their cause.  When agnostics are told their higher power can be a tree, I knew right away this had no basis in any science or fact and hence no merit.  I think tailoring treatment to the individual and not railroading all into the one size fits all treatment would be life saving.

Problem is, state boards don’t care.  They rubber stamp their approval on 12 steps because it’s cheap and easy.  If any other disease or behavior were treated this way the public backlash would be without precedent.  Addiction is a complex blend of behaviors and perhaps disease, but it in no way is a “terminal, fatal disease”.  That’s basically oversimplifying the workings of the most complex organ in the world.  Recent breakthroughs in neuroplasticity research are rewriting the books on how the brain can recover, rewire, and relearn.  Addiction may, in fact, be curable with the right treatment.  The right treatment is not blindly working some mystical Oxfordian steps that a couple of laymen came up with 80 years ago.  Why can we not be open minded and explore other options?

Personally, I do my own program of reading, some secular recovery, some SMART recovery, and mostly discussion with others.   I am mandated to 12 step meetings.  They are a huge waste of time, but I do write and think about alternative treatments during these meetings.  Anything to pass the time without being dumbed down and defeated.  When I was released from rehab, I was asked to do 90 meetings in 90 days.  I made it to around 70.

Retrospectively, I’m not sure how I ever did this other than to say I truly understand the Stockholm syndrome after being held as a 12 step captive for 3 months.  Now I like to say I am sober despite AA.  I also attend a monthly Caduceus group which is decent as it is colleagues,  but reality is it is just watered down AA.  What I believe is that my narcissistic and avoidant personality got a lot of pathologic positive feedback from a bad behavior and ultimately lead to addiction.  I think I have a minute, if any, amount of disease at work.  Once caught and shamed and then sentenced to 3 months of rehab, I had had enough negative feedback for a lifetime.  I had time to analyze this while in treatment and realized that the drug use had to be eliminated in order to never experience this again.  It was that simple.

Selfish endeavors had lead me to addiction, and if I was to ever be functional again, I had to eliminate the option to use, no matter what.  I am not in denial.  I know I can never use or drink again, even though I’m not an alcoholic because I am an addict and I don’t do any mind or mood altering substances in moderation.  I know that will never change, but it will also never be an issue because I am committed to lifelong sobriety.  I choose not to use because life is better without it.  I don’t have any using dreams, euphoric recall, cravings, compulsions, etc.  I have a great life now on the other side of my meltdown and that is all the positive feedback I’ll ever need to remain clean.  I have had several extreme marital and financial stressors  during and post rehab, and not once did I even entertain the idea to use.  I am also at least 30% more productive at work and that is huge for my positive feedback bank.

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  • pao

    Thank You for your perspective ,which as a Spouse of a Addict agrees with many of your points.While the Steps have been saved countless lives invaluable as an approach to a difficult series of cascading physical,emotional and spiritual defecits at the individual,family and community level. I ,too have witnessed and experienced the limitations. With addiction of various types and presentations reaching epidemic proportions ;It is frustrating so little of options are available or the measureable outcomes studied. I havegained much from a invaluable wealth of information and support at a site called :Recoverynation.com founded by now deceased Jon Marsh who pionerred a wellness based workshop based approachs. It truely was invaluable self-exploration into the willingness for honest self evaluation and concrete ,effective tools and support in recovering form addictions. Please take a moment to review the site and refer it to motivated patients. While initial developed as a Sexual addiction site the materials are cross referenced for any addiction.

  • Frank in L.A.

    The bottom line is that AA and the 12 steps is a religion, and more specifically, a cult religion. The 12 steps have virtually nothing to do with not drinking.

    Is it successful for some? If you can have a program to substitute for drinking, and can then live your life with that program as a substitute, it works. But for most people, substituting a religious cult for drinking is not a solution to their substance abuse problem.

  • Frank in L.A.

    During Sep 2010 there was a long thread on this subject here on KevinMD (I certainly was a participant in that thread). Here is the link.

    http://www.kevinmd.com/blog/2010/09/bad-lifestyle-isnt-medical-issue-social.html

    • MD in recovery

      I remember that thread. Since then, my involvement in AA has lessened. You are right, the metaphysical part is just too much for me to be all-in. But, AA is the best thing I can find so I still go. I like Caduceus better. I think the benefit for me is more the social interactions and supportive friends I’ve made. I really identify with the author of this post too, I hope we both continue to do well. Someday I hope there will be a widely available secular program. The twelve steps work well enough without God so I leave that part out and try to get the universal benefit of humility and introspection from the meetings I go to. Great post! :)

  • tpetrusick

    Seven out of ten relapse. AA is cheap available everywhere everyone is welcome I have never encountered as humble a group of men or women as an AA meeting. I never felt captive, when I returned I was welcomed never coersed. I am happy for your success with remaining sober and hope you see the value of AA. I was on the Alanon side .

  • Been There RN

    What a great post. I totally agree with you on the Rehab/AA thing. Almost 11 years ago, I self reported, and the Board sent me off to one of the “highly respected rehabs” for a nice, long stay. For the first year or so, AA gave me the community I needed to get settled in a new town, get through a nasty divorce, etc. After that, it started to rub me the wrong way. I don’t like the idea that I have an incurable illness–I’ve been sober for 11 years, have no cravings, yada, yada, yada. I love my life. I re-tooled my career and found a completely unexpected path that I love. All of that, without AA and the steps.

    Thanks again for the great post. Best thing I’ve read today.

  • heliox

    Totally agree but just saying the things you said I can hear the recovery folks chanting,” It’s your best thinking that got you there (in treatment)”,” keep it simple, stupid” or “dry drunk” or” work the steps that is all you need”. Due to anonymity, no controlled studies have ever been done of 12 Step sucess rates, people get ORDERED to meetings by courts in spite of religious objections. The system is broken but I guess no one can come up with anything better.

  • AA

    This is one of the best posts I have ever read on Kevin MD. Thank you so much for sharing your story.

    Fortunately, I never had a problem with drugs and alcohol. But many years ago, I had a problem with compulsive overeating.

    I went to an OA meeting and to be told I was powerless over food forever didn’t sit well with me. I eventually cured my problem which is another post.

    Your post also highlights the cookie cutter approach in medicine particularly psychiatry and addiction treatment. Everyone is treated the same come heck or high water such as being forced to a required amount of AA meetings.

    I also relate to your point about being told something is incurable when that isn’t necessarily the case. I was on psych meds for depression and was essentially given the message I was on them for life. Well, to make a long story short, I got off them after extremely long term use due to horrific side effects. In spite of severe stresses, I have not relapsed just like you didn’t turn to drugs and alcohol in spite of stresses in your family.

    By the way, I am surprised you weren’t forced to take an antidepressant as that is becoming the convention treatment for drug and alcohol addiction.

    Finally, I would kill (in the literal sense) to have a doctor like you. Any way you can clone yourself:)?

  • Kelly

    Thank you for sharing your story. It is great to hear that you have taken your own approach and outlook and that it is working so well for you. 12 step ptograms, the litlle I’ve seen of them, are not for everyone, especially those of us that like to be in control of our own destinies. While I’ve seen family members helped by such ptograms, they are deeply religious…I was madeto attend AA after an underage drinking violation and I’ve never felt more out of place anywhere. Thanks again for sharing.

  • http://www.whiskeyandporn.com karin l burke

    I am glad to see this post, as well as all the comments that have followed it.

    “Recovery” may not be the word you want to use. It does, as you say, suggest a disease state. But as far as I know, the medical profession has recognized addiction to be a bio-psycho-social disease. If you have a problem with that, it is your problem: not the medical profession’s, AA’s, or rehab.

    I agree that the success rates for any sobriety approach are dismal. But this isn’t the ‘fault’ of the cultish AA. In fact, AA has given more people lasting sobriety than any other approach or medical intervention. Medicine/Rehabs imitate it and borrow it because it has proven itself. Not as proof, not as gaurantee, but as good as we’ve got.

    As I read it, there seems to be a conflation of AA and ‘rehab industry’ and the medical profession. This would be a misunderstanding. There is no affiliation.

    I agree that medicine’s/rehabs cookie cutter approach is a complete failure and often a hoax. 7 out of 10 relapsing is a pretty low estimate, I think. I’ve seen higher numbers. I’ve also been to treatment (multiple times) and don’t think it worked.

    Or maybe it did…years later.

    I can sympathize with the idea that AA is a cult. I think Bill and Bob would agree with you. It’s a spiritual program.

    But there are no rules, no standards, and no need to even “do the steps”.

    The hostility toward 12 step programs is disheartening. Even if it didn’t work for you, why disparage it for others?

    I know sober people in AA and I know sober people outside AA. It may not mean a thing, but those outside are uninamiously anti-12 step, but also anti-much in the world, including tolerance and community.

    I’ve got a post on AA, treatment, cold turkey on my site. i’d appreciate any thoughts.

    • horseshrink

      Agree.

      “Secular” or “spiritual” people who promote one way out of alcoholism/addiction by denigrating another are not as useful to fellow sufferers as they could be.

      Has been a hard lesson for me to learn.

  • Will

    I agree with Karin. It is fortunate that through your own efforts, own intellect and own force of will you were able to be “cured”. But are you “cured” with no disease left to treat if you cannot engage in activities that other, non-ill people ? like enjoy a glass of pinot noir with your steak ??
    The key lies in your comment that “What I believe is that my narcissistic and avoidant personality got a lot of pathologic positive feedback from a bad behavior and ultimately lead to addiction. ”
    Sounds like those personality traits are still alive and well.
    I do agree that AA is not for everyone, but because your own personality made this so is no reason to “diss” it for everyone. Of course you were smarter and knew more than everyone else in the program. And how could you ever admit that there is the possibility of any type of “higher power” than you ??
    The problem is a practical one. AA is cheap and available everywhere. Any other ideas, doc ?? personalized and “tailored” treatment programs my be available to a few, but there are few options available for everyone else . and how do you create a treatment regimen when you don’t know the cause ? so for now we use what is available.

    and if sitting through the rehab program for 3 months and sitting on your hands and keeping your mouth shut was sufficient punishment / deterrence for the future, be thankful that you did not spend those 3 months sitting behind bars to learn your lesson for having engaged in what was obviously criminal behavior
    It is good that you have found positive reinforcers from and for your new life but it does not sound like you are “cured”.

  • Charles Cohn

    I am a lifelong teetotaler, and I always say that my reward for this is not being at risk for addiction and then having to beiieve in God and humble myself in order to get cured.

  • Gray

    I second Karin’s comments. I’m confused by and disappointed in the author’s contempt and outright hostility toward 12 Step programs. RCTs may be missing but clearly enough credible anecdotal evidence exists to support the hypothesis that 12 Step programs are efficacious for a significant percentage of addicts/alcoholics.

    My experience with AA is diametrically opposed to Dr. Anonymous. I have never been asked to believe anything. The basis for the 12 Steps lies not in cultish doctrine but in recommended values and behaviors that have stood the test of time and if practiced by all of us, not just alcoholics/addicts, would result in a profoundly changed and transformed world.

    I’m sorry that the author has had such an unsatisfactory and negative experience with a 12 Step based recovery program. Clearly it is not for all recovering people. However it seems to me that the author’s passionate dismissal of 12 Step programs has more to do with an unrequited anger toward medical boards and other regulatory fixtures that set standards and policies that recovering physicians must adhere to in order to practice again.

    I wish the author continued sobriety and, yes, serenity in his/her life journey. It is well worth the work.

  • DoctorS

    I totally agree with what you have to say. Check out ‘LifeRing’ as an alternate to SMART and AA. AA is a strange thing that works for a minority but is not right for many, many more for various reasons. I resent the AA’ers hostile response to any way other than theirs, as evidenced by ‘Will’ above. Nor do I buy into the label of ‘alcoholic’ or ‘addict’ for life. Plus, why do so many AA meetings end with ‘The Lord’s Prayer’?

    • Frank in L.A.

      DoctorS said: ” why do so many AA meetings end with ‘The Lord’s Prayer’?”

      That’s easy—because AA is a religion and that is just one of its many religious practices.

  • Molly Ciliberti, RN

    Thanks for you story. Although I have never had an addiction, I know many people that struggle with various forms of addiction. I suspect using AA could become a substitute addiction for alcohol or drugs and as an atheist I could never believe that a “higher power” would be a substitute for my own ability to take responsibility for myself. My friends who have made it to sobriety did so with the help of family and friends supporting them and loving them even when the slip. I don’t pretend to know what works, but I do know that having family and friends who are on your side as you work towards sobriety helps.

  • pao

    Addiction – the disease surrounding this posting taking many forms and woefully inadequatly assessed for , detected and effectively managed by present & costly recovery & relapse prevention . WHat needs to be discussed here is how. We ,as PCP’s need to increase our sensitivity in focusing on adequate risk assessments, careful prescribing ,managed interventions and referrals to recovery programs;inpatient ,outpatient ,on-going and crisis. We need it all. I am especially sensitive to the reality of the increasing short-sited management of inadequate coping, stress , out of control med lists , multi-providers,depression and aniexty by one stop quick fix’s often with as addictive & dangerous prescriptions;escalating abuses,complications and sadly too often profit margins. We need to have enough time to develop therapeutic alliances , fair & adequate re-imburshment s for the complex & very timely approachs that get to the extent and nature of the problems and follow-ups warrented ,as well as all the necessary coordination of care. I doubt a one size fit all approach works for any of the complex Chronic diseases we manage but I know It takes time..and we need to be reimburshed fairly for the efforts that demonstrate effective returns on that investment .Addiction , It’s recognition,management & prevention belongs within the scope of Primary care and we need to figure out how to improve the dismal outcomes & raging epidemic’s; not bicker on the merits or not of one program or another. My patient’s are people with Body- mind & Spiritual dimensions..I need to address them all.

  • BertW

    Whether addiction is or is not a disease is irrelevant to me. I’m an alcoholic and a drug addict. Period. End of sentence. I am also cheerfully and frankly agnostic and I have never felt unwelcome in AA. I have friends who attend meetings regularly who are atheists–a level of faith I don’t even aspire to. They too are welcomed in AA. It takes all kinds. Literally.

    AA is only a cult for those inclined to be cultists and it is not any kind of religion. The 12 Steps are simply a tool kit offering a “design for living.” And I personally choose to TRY to practice these principles in all my affairs. If you don’t want what “we” have, that’s not our problem. May it not be yours. Move along and good luck to you.

    AA has worked for me, so far, for 15 years. And I like it. I know some wonderful people in AA who are just trying to live deliberately, conscientiously, happily.

    I hear a lot of good stuff at meetings; I also hear a quite a bit said that’s pretty much horse manure, but that hardly makes an AA meeting stand out as remarkable. For me? I take what I need and I leave the rest. So far, so good.

  • horseshrink

    I do not speak for AA … these are my own observations and opinions.

    AA notes: “Upon therapy for the alcoholic himself, we surely have no monopoly.” “If he thinks he can do the job in some other way, or prefers some other spiritual approach, encourage him to follow his own conscience.” “We realize we know only a little.”

    Some react strongly to the spirituality of the program. AA accepts that and requires nothing. People who are desperate to quit drinking already know about a “higher power” – alcohol, else they wouldn’t have such trouble stopping. AA suggests the “higher power” needn’t be alcohol, and probably ought not be oneself, either.

    AA is not chiefly about quitting the drink – abstinence is a given. The desire to stop drinking drives people through the doors in the first place. Rather, it suggests a way of living without drinking, with a strong focus upon cleaning wreckage and becoming a less self-centered, more useful member of society.

    Nobody makes a profit. There are no dues or fees. The program itself requires no attendance. Nobody has any power or authority over anybody else. There’s no government. Social position and distinctions are left at the door. Groups glue together with the old social instinct of herding against a common foe, in this case alcoholism.

    In my opinion, people should not be required to attend any 12-step program. AA is not for people who “need” it. It’s for people who want it.

  • Lisa

    I wonder when our healthcare system will embrace mindfulness based therapies in working with addictive behaviors? There is now over 30 years of research that supports the health benefits of meditation. I understand the concept of the 12 step programs, but feel learning to meditate and work with one’s own mind/behavior is extremely empowering. Finding compassion/acceptance of self is a powerful tool in opening to our environment…which is a very large and courageous step for anyone who wants to shift behavior. The notion of touching our own basic goodness in recovery(of any sort) moves us away from the notion of “disease”. Does anyone really want to walk around with the label “diseased?”Everyday offers us a fresh start along our path.

  • franky

    12 steps are self-defeating and teach that you are primarily powerless and at the mercy of some nebulous higher power. You can’t think for yourself because your “best thinking” got you where you are. Real science and evidence based research shows that mindfulness, meditation, and empowering and encouraging the recovering addict is much more effective for the long haul than sitting in a smoky room listening to drunkalogs and the same stories repeated ad nauseum. I would often laugh to myself at a meeting when all these steppers would thank their higher power for freeing them of their addictions all the while they are smoking 3 packs a day and 100 lbs overweight. I found this contradiction as well as the our way or no way mindset just too much to take. I am much better off with myself and my cohorts who are sober by their own power. I am not powerless. Never was. I didn’t have some terminal disease, I had selfish behavior. Addicts do recover and maybe even heal completely. good luck.

    • horseshrink

      A person who has never been powerless has probably never been an alcoholic or addict.