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.
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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