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Having a Life Worth Living—the Art of Recovery

What Is Recovery … What Does It Look Like?

My own journey into recovery was about authenticity. When I got clean and sober I had no idea that the greatest gift would be finding (or creating) my authentic self. It was a very painful, arduous, inconsistent pathway, and I made a lot of wrong moves on the way. But I’m a totally different person at 25 years in recovery than I was at 15 years of recovery.

I thought getting into a recovery was going to be boring, and I’d never be as dynamic again. Yet I do more in a day today than I did in a month when I was using. So it’s about perspective, and it takes a long time to change one’s perspective. You need to have experience; it doesn’t happen overnight, and addicts have to understand this is a process. There aren’t any quick fixes.

To maintain a life worth living, I want to identify some of the things people have said that can be helpful to building self-esteem and making yourself happy. Happiness studies around the world have found that money has little to do with it. It’s about relationships, about community, about finding a purpose in your life, finding a hobby, having healthy fun.

You could say, “That’s what I want my life to be about,” but maybe you find yourself falling back into thinking patterns and behaviors that are from the toxic past. You have to understand a couple of things. One is that drugs and other compulsions were not the problem—they were seen as the solution to the problem. The real problem existed probably from very early in your life.

Many experts remarked to me that a person’s emotional development sort of stops at the age when that person got dependent on a substance or behavior. Often this occurs in early adolescence, so when they come into recovery at age 30, or whenever, they remain emotionally stuck at the age they got hooked. This phenomenon carries huge consequences for how they are going to function in early recovery.

You need to work through the anger, the resentment that you have with your parents, and all that childhood material. It takes time. You can short-circuit that time expenditure by going to specialized therapy programs. They can be expensive, but you can do two years or five years of therapy in just four days doing some types of psychodrama exercises. It’s cathartic and meaningful in terms of changing some of the issues or putting them to rest.

Another important piece is life skills, the art of learning how to really engage life. If you’ve been screwing around with substances or process addictions, you missed the boat on a lot of things that you need to know in terms of getting a life worth living.

Experts I spoke with said community was probably the most important recovery factor, along with family relationships. Those were always at the top of the list. Getting a job, managing your money, taking care of your health, relationships, these are skill sets you need to function well. If you don’t get that, you’re going to function like an addict. What we’re talking about is enabling people to go into real life, mainstream life, and to function effectively.

Getting a job is important. Self-support from your own contributions is important. Decent relationships with the people in your life are important. Your health is important. However, in terms of a deeper understanding of the journey, there is a spiritual dimension that a lot of people come to when they go down this road.

You owe it to yourself to give yourself the opportunity for a different vision and a different experience of your life, but that takes a little time. You’ve got to give it 90 days to even start seeing and feeling a difference. It takes 90 days for new dendrites in the brain to form, and that gets back to activities and behaviors that use the plasticity of our brain to literally transform ourselves.

One question that I asked a lot of experts was, “What is the one thing people need to have within themselves to be successful in treatment?” The quality picked more than anything else was the desire to want to get better. I know that I did two things right. First, I didn’t die from this illness, and second, I always had the desire to get better. You need to have that desire to hold on to a part of your life that is the healthy part, and you need to be aware of what stands in the way and with that recognition, learn how to remove the barriers.

In research compiled by Alexandre Laudet, director of the Center for Study of Addictions and Recovery, National Development and Research Institutes Inc, it’s clear that when you give up a crutch, whether it’s a substance or a behavior, you will get a better, healthier crutch in recovery that will help you to stand up taller than you ever thought possible. That’s what you gain by giving up the compulsion. The taller you stand, the less likely you are to uncontrollably crave that toxic crutch again. Dr. Laudet phrased it this way: “The more your life improves in recovery and the more satisfied you are with your life, the more likely you are to maintain healthy habits. It’s a vicious cycle in a good way: don’t use, improve—that sustains not using, and you improve even more.”

Workaholism Can Hinder Long-Term Recovery

Everybody I know in recovery struggles with workaholism, which basically means, “I’d rather be working on my computer than sitting with my kids, getting to know what my kids are doing.” Nearly everybody I know in recovery is running fast, working hard, and they will do it sometimes at the expense of their own health and recovery. So they work and they work and they stop going to meetings, and eventually, they may engage in toxic behaviors again.

One of the keys to recovery is finding the capacity to relax. Workaholics find it difficult to relax, at least in the typical way that we define relaxation. For a workaholic, relaxation is doing more work, less strenuously, or not as fast, but it’s still the same sort of distraction from the compulsion. It’s a strategy, too, filling up life with work in the hope they won’t be thinking about their compulsion.

Clinical psychologist Barbara Killinger, author of Workaholics: The Respectable Addicts, offers this perspective on how that condition relates to the Seven Toxic Compulsions:

“A workaholic is a person who gradually has become emotionally crippled and addicted to control and power. And they’re caught in a compulsive drive to gain approval and success. The addiction in this case is to power and control, but the obsession is work and having a success persona that broadcasts that I am a successful person. So they become very driven, and the obsessive thinking takes over.

“These people have become addicted to the adrenaline high; they cannot not work; they get anxious. And so the work doesn’t cover it anymore. It’s a great downward progression because they’re predictable and very down. And so that’s when they tend to start drinking too much; they get into smoking, drugs, and all these other things.

“A workaholic cannot not work without getting highly anxious, so they are caught on the gerbil wheel and get more and more driven. They aren’t emotionally able to be present with people. They start to get very angry and righteous when they can’t be as fast as they want to. They talk fast, they eat fast—they are just very, very driven. That’s one of the things that I say to people when they’re first working with me. ‘Could you please slow down? Walk more slowly, talk more slowly.’ When you watch a workaholic walking along, they’re charging along, and underneath that arrogance is insecurity and self-doubt, but it’s largely unconscious until things in their life start to fall apart.

“I had a client who was going out to play golf. I said, ‘Would you try something for me this weekend? Could you go out and play golf tomorrow without keeping score?’ And he looked at me stunned and said, ‘What would be the point?’

“They’re not experiencing things because they’re all up in their heads. So, if they work from their neck up, they’re completely out of touch with their bodies, they’re not getting the signals that the body is sending telling them how they’re feeling or that they’re depressed or anxious. They’re repressing so much. The breakdown used to take 20 or 25 years; now it’s about five. It’s incredible how fast this has escalated. This is what technology is doing for workaholism. Some clients have been worried they were going to have a heart attack or stroke. Workaholism and the stress associated with it really affects health.

“One of the things they can do is make their home a refuge and not take work home. Ask people not to call you at home. Put a fence around the home so that it is a refuge with the rest of the family. Don’t over schedule. Don’t do two things at once. Don’t push yourself to be better at everything. You’re going to be miserable for a couple of weeks because you’re going to get into adrenaline withdrawal (a sign of the adrenaline junkie). You will be very anxious for quite a while. Meditation is a good tool, and so is mindfulness—anything to help them stay present in the moment and get in touch with their feelings.

“Those who get cured, I call them my butterflies. Their whole life gets transformed. Their values change. As their values change they become much kinder people. One of the things that I noticed is that people’s faces change. A workaholic is very intense, and you can see it in their face. And what I noticed as they’re getting better is that their whole face softens because their values have changed.”

Mindful Self-Compassion Helps Solidify Recovery

Combining mindfulness and self-compassion as an intervention program was an innovation of Dr. Kristin Neff, research psychologist and associate professor at the University of Texas at Austin and author of the book Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind. Dr. Neff explained:

“Having compassion for yourself is no different than having compassion for other people. Self-compassion operates in the parts of the brain that have to do with soothing. It’s the same parts of the brain that are activated when the mother comforts a crying child. If you add the self-soothing system of compassion to mindfulness or mindfulness meditation, that little addition is crucial in making a behavioral change last longer. The self-compassion exercises help to release oxytocin. So if you’re going to be addicted to chemicals, it’s better to be addicted to the natural chemicals of compassion.”

Dr. Neff described three elements of self-compassion:

1. Engage in self-kindness. When you experience failure, suffering, or feelings of inadequacy, rather than engage in self-criticism or ignore the pain, it’s important to bring warm and understanding thoughts about oneself forward. Be gentle with yourself. You cannot always get exactly what you want. Accept this reality with kindness and sympathy toward one’s circumstance.
2. Recognize shared human experiences. We are interdependent beings. Other people experience what we experience. We don’t have to take our failings and life difficulties so seriously. Acknowledge this fact of life with nonjudgmental understanding and compassion for the human condition.
3. Exercise mindfulness to observe negative thoughts and feelings without judgment. By not over-identifying with our thoughts and feelings, we can more readily maintain control over our impulses and not get swept away by reactivity or negativity. You observe thoughts and feelings as they come up, without trying to deny them or suppress them.

Studies have been done examining the psychological effects of self-compassion exercises. Five self-compassion studies were compared in 2007 by Duke University psychologists who concluded, “In general, these studies suggest that self-compassion attenuates people’s reactions to negative events in ways that are distinct from and, in some cases, more beneficial than self-esteem.” (Source: “Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly.” Mark R. Leary et al. J Pers Soc Psychol. 2007 May;92(5):887–904.)

University of Montana research psychologists examined the relationship between self-compassion and post-traumatic stress symptoms in 210 university students based on Dr. Neff’s work. This study concluded: “Individuals high in self-compassion may engage in less avoidance strategies following trauma exposure,” which facilitates healing. (Source: “Self-compassion and PTSD symptom severity.” Thompson BL and Waltz J. J Trauma Stress. 2008 Dec;21(6):556–8.)

You can find out more about Dr. Neff’s approach to self-compassion at www.self-compassion.org.

A second pioneer in developing self-compassion approaches to treating toxic compulsions and their underlying disorders is Prof. Paul Gilbert, head of the Mental Health Research Unit at Kingsway Hospital, associated with the University of Derby in Britain. Here is what Prof. Gilbert had to say:

“Substance abusers are trying to regulate their emotions. They are taking substances to make themselves feel less anxious or more activated. Controlling emotions is really a key to a lot of this stuff. What we know is that for mammals, especially humans, we control our emotions through our relationships, primarily. As a child, Mom gives you a cuddle, calms you down, then you feel better. We know that when children don’t get that or when their parents, for one reason or another, are struggling to provide this calming, soothing input to the child, the child actually grows up having difficulty regulating their emotions because they don’t internalize this loving and caring part you see in a person. And what we know is that there’s a system in the brain which is linked to endorphins and oxytocin. It has a calming effect on us. Endorphins, for example, help to deal with pain.

“These chemicals are released, assuming it is a loving and caring relationship. People who come from relatively secure backgrounds will have an internalized memory, which helps them regulate emotion. But those on drugs find it difficult to do that. The drug becomes a substitute emotional regulator. So we have to teach them how to get that soothing system, that endorphin system, going through other means. That’s what compassion does; it teaches them how to practice stimulating their affiliative [associating and befriending behaviors] system.

“One thing we focus on with self-compassion is how people are often very self-critical. And when you’re self-critical, you’re stimulating threat systems in your brain. Self-criticism is often about fantasy. What you fantasize about influences your brain. Fantasies are a very powerful way of influencing physiological systems. So why not use images that actually juice up other systems, such as your affiliative system, to pump up more endorphins? What we teach people is to create their own image idea of compassion. Supposing you wish to imagine a compassionate figure, what kind of figure would that be like? Would it be somebody who has been through what you’ve been through and really understands your pain and suffering?

“Anybody can love somebody who is smiling and good all the time. That’s easy. But compassion comes into its own when it’s tough, when it’s difficult, when things are bad for you, when you’re feeling really bad. So the point is to train your brain.

“You might want to try this little exercise we use. People often say, ‘I need to be self-critical because it keeps me on a straight path and if I keep pulling myself down, then I’ll make sure I won’t be arrogant.’ So what I want you to do is just close your eyes and imagine your self-critic. Spend a few minutes and imagine that you can see the self, the part of you that criticizes yourself. And you can see what it’s saying to you and you can see the emotions. So give it room to imagine the emotion for the critic. And normally people say, ‘Oh, my critic is very angry with me.’ And then you say to them, ‘Okay. Now look at that critic. Does it really have your best interest at heart? Does it give joy when you do well and you move forward?’ They see that it doesn’t. So the point is that what we’re doing is developing compassion. It’s not about whether you deserve it or not; it’s what’s in your best interest.

“What would help you move forward? What would help you get stronger? What would help you develop courage? Because you really need courage in order to deal with your anxiety to get out of a bad relationship, or whatever. If you have a kind voice in your head that supports you and understands you, you’re more likely to have courage than if you have a critical or panicky or anxiety voice. So pay attention to the voice—that will help you. Pay attention to the voice inside of you that will give you the strength to do what you need to do.”

Experts on What Recovery Looks and Feels Like

“Let a thousand flowers bloom” might be the best advice here because recovery from a toxic compulsion can take many forms, at least in terms of how it feels inside and looks outside to others. With that in mind, check out what these experts have to say. Like holding a crystal up to the sun and turning it, each one reveals a different pattern of light and color that defines the experience of a person in recovery.

Recovery is another word for freedom

From Gil Gilchrist, chief executive officer, New Beginnings at Waverly: Recovery is a lot like enlightenment—most of the people who have excellent recovery, you wouldn’t even know until you spent time with them. They are human beings first and recovering people second. The recovery ideology does not define them, but it’s an integral part of their life. Recovery is not a feeling. It is a state of awareness and realization. You realize that you are free. No matter how good or bad things get, the fundamental realization is that you are free

The recovery process enriches you

From Dr. Drew Pinsky, addiction medicine specialist and clinical professor of psychiatry, University of Southern California School of Medicine: Recovery makes the world look flourishing and inspiring. It takes my breath away sometimes when somebody who I thought was going to die comes up to me a year later and says, “Something happened. I had a moment, and thank you for hanging in there with me as much as you did.” They have become so rich as a person. And what often comes along with that is the desire to go and help another person get to that place.

Always keep the recovery steps in mind

From Dr. Charles Whitfield, psychotherapist and trauma recovery expert and author of My Recovery: A Personal Plan for Healing: The first step in treatment is to name the trauma. That takes time. No patient will walk in and say, “I have just discovered I was abused as a kid.” If someone does say that, it’s often a red flag. I’d rather see someone resist or deny than come to a first session to be healed. It’s a process. Repeated individual therapy and weekly group therapy that is trauma-focused and relates current life issues to past traumas are effective. There are stages of recovery. Zero is no recovery. Stage one is going to meetings and working the steps, where the problem is stabilized. Two is addressing the childhood and other repeated traumas. That is the longest stage for many people, up to five years working a full recovery program. Three is the spiritual element. The journey to God often starts with a journey away from God. The Higher Power of 12-Step programs is important in bringing about stage three.

Successful recovery involves seeing new meaning in life

From Dr. Thomas McLellan, CEO of the Treatment Research Institute and former deputy director of the White House Office of National Drug Control Policy: I know a lot of people who are recovering from substance-use problems. I don’t know anybody who’s been able to go back to their old life without changes and remain sober. They need a new life and in that context, they’ve got to have new meaning from some of the old things they’ve been doing. I’ve seen that happen.

But more often they need new things to give meaning to their lives. That can be service to others in the community of AA, for example. It can be volunteering with kids. It could be mentoring somebody on their job. It could be a lot of things, but I think it’s, in its healthiest sense, the substitution of something that’s socially desirable and useful for something that really gave them trouble.

You can interpret it in the spiritual sense of being closer to God, that’s okay with me, that’s all right. But you don’t have to be spiritual and you can say, “Look, there’s another way of getting enjoyment.” Some people call it socialization—learning to feel good about accomplishing things that are also good for society and other people.

Something that changed the way I think about such things was said by Bill White of Chestnut Health Systems. He’s the first person I’ve heard say this: “Addiction is one of those diseases where if you recover, you end up better than you ever were before you had the disease.” It’s because of that kind of thing, that new perspective on your old life; you’re valuing things that you didn’t value in your prior life. Your order, your balance comes in ways that, frankly, don’t come from medications and they don’t come from simple abstinence. They come from other kinds of growth, which I think are really the key parts of recovery.

A participant in one of my National Institutes of Health studies, a 42-year-old African-American guy with a 20-plus year history of severe crack addiction, polysubstance use, jail, and everything else that goes with it, defined recovery thus: “My definition of recovery is life … ’cause I didn’t have no life before I got into recovery.”

Seven imperatives for healthy recovery

From Dr. Andrea Barthwell, CEO of the North Carolina treatment center Two Dreams Outer Banks: Here are my recommended seven life-enhancement imperatives for moving from dependent use or nondependent use to recovery: abstinence, peer support, professional guidance, medication, nutrition, exercise, and ritual.

Abstinence is acting on the realization that you can’t continue doing that substance or activity if you have a problem.

Peer support can be group therapy or a 12-Step program, but it’s about coming out of isolation and getting supported by peers who accept your disease but don’t support it.

Professional guidance can be one-on-one therapy, a psychologist, a psychiatrist, a counselor, even a minister or a shaman—anyone who can help you to evaluate what your needs are and how to meet them.

Medication is something given as an outside guidance support from a physician.

Nutrition means getting the nutrients you need rather than sugar and things you put into your system as addiction substitutes.

Exercise such as hot yoga or lifting weights or running helps with sleep hygiene, helps bring your endorphins back to normal, and helps to develop the muscles you need for body support.

Ritual is where you do meditation, your journaling, your attendance at 12-Step meetings, sitting in a hot tub for 30 minutes a day—positive habituation rituals to structure your mind and your life in healthy ways.

Recovery is service to something greater

From William White, senior research consultant, Chestnut Health Systems: What I know from watching people in recovery for the past 42 years is that there are degrees and levels of recovery. The kind of recovery I most admire involves a fundamental change in one’s identity, interpersonal relationships, and daily lifestyle. Recovery, like the escape from other near-death experiences, provides an opportunity to reorder priorities and live life in a more conscious, intentional way. It is a window of opportunity to find a level of meaning and fulfillment that might not have otherwise been possible. Through that process, everything in one’s life is touched. It is for many people, even with all its early struggles, a way to live simply and comfortably within one’s own skin and to live in service to something greater than oneself.

People in recovery can be role models

From Dr. Daniel Hall-Flavin, addictions psychiatrist and professor, Mayo Clinic, and former medical director for the National Council on Alcoholism and Drug Dependence: We need to define very clearly what recovery is, because recovery is not only abstinence. Too many people intellectually appreciate that, but it doesn’t get translated into their daily lives. And so you’ve got people who are miserable, people who are angry, people who may not really make it into recovery.

So then the issue is quality of life. Once somebody has been in addiction, abstinence is necessary but not a sufficient condition for recovery. The recovery will mean different things to different people, but it’s going to mean forgiveness of yourself, which means really getting to the issue of stigma—being able to get past that particular issue no matter what society may say or not say, being able understand that stigma starts at home with the messages that we’ve gotten, and being able to examine that.

What are the things that people need to do in terms of improving their lifestyle and filling in the gaps where the alcohol was or where the drugs were? They’re not going to be able to do that very well without the family—their family support and family involvement. And oftentimes, those first steps, those first baby steps, are kind of reintegrating yourself into that larger social fabric and with the family.

This is just an old mantra in the field, but the family is the first to be affected and it’s the last to recover. So the family will go back oftentimes to what is comfortable. And so you find people suddenly undermining, one way or another, their loved one’s recovery, and being miserable at the same time in doing it, and maybe not even being aware of it. So I think it’s really important that the family be involved.

I would say my best teachers have been my patients and people who have lived this and who have been successful. The people I admire the most actually are people who are in recovery, because they’ve had a very difficult journey. When you have to come face to face with yourself and you have to come face to face with your fears and your demons, you’re kind of looking at your own humanity and you’re looking your own mortality straight in the face. And so I admire those individuals who’ve been able to really do that, been able to turn their lives around in such a way as to make this addiction and their past history of addiction work for them rather than against them.

They’re not a victim. They’re not a prisoner of the past. They’re really not able to erase that past, but they’re able to actually move ahead. Some days may be great, some days may not, but they’re able to move ahead honestly. And to me, that’s a great inspiration.

Recovery management helps create stability

From Melody Heaps, founder, Treatment Alternatives for Safe Communities (TASC) and chair of the steering committee for HHS/SAMHSA’s Partners for Recovery Initiative: The population we work with in Illinois is in many ways the worst in terms of high criminality, but we are more successful than regular populations in treatment programs because we offer avenues to the supports necessary for recovery, such as finding housing and leads to getting employment. Recovery management is the key to success. It’s about navigating the recovery process. “Okay, am I tied into AA or another support group that helps me when I’m feeling nervous or when I think I’m going to go off or whatever?” We watch that. “Do I have a relationship with my family?” If not, why not, what can we do to get you some counseling? Do you have a job or are you going to school? Do you have hope in a future, and how can we plug you in to a resource that will get you there? Do you have a stable place to live? That is critical. That’s probably number one. Do you have a stable place to live? Yeah. Where? How? We help plug you into that. The idea of accountability is also critical. So is tough love and being clear with guidelines so we don’t go from recovery management to enabling.

Recovery isn’t a one-stop-shop process

From Michel Perron, chief executive officer, Canadian Centre on Substance Abuse, and chair of the Vienna Nongovernmental Organization Committee on Drugs associated with the United Nations Office on Drugs and Crime: All too often our field and addicted people are seen as lost causes. We can’t do anything to prevent addiction, and treatment is far from a guaranteed success. But that’s simply untrue. We know what works and we need to apply it. Someone with an alcohol or drug addiction shouldn’t receive any less support, help, and care than someone with diabetes or cancer. When I injured my knee, I didn’t go look for a doctor with a bad knee. And yet, that’s very much how the field of addiction is viewed. What we need to do is build off the success of 12-Step programs and medical advances and spiritual enlightenment and the many other resources we know contribute to recovery and help. We have to stop looking at this as a one-stop-shop solution.

Having a life purpose is crucial

From Pamela S. Hyde, administrator, Substance Abuse and Mental Health Services Administration: We at SAMHSA have identified some elements of recovery, and here’s how we talk about it. We talk about health and that means not only a healthy lifestyle, but a healthy lifestyle free of drugs and alcohol. So health is critical to recovery. A home—and we mean that in the broadest sense. Literally a place to live, but a home that’s supportive and provides the kind of environment that people feel good about and feel good with themselves in it. Community, meaning your social supports, who you live with, the kind of community you live in. And then purpose. You’ve got to have some purpose in life or it’s going to be really hard to maintain recovery. For some people, that purpose is work, for some people it’s self-employment or art or volunteer work. But there’s got to be a purpose in life. For some people, giving back is the thing they say is what made it possible to be in recovery.

Shedding self-centeredness in recovery

From Dr. Robert DuPont, President of the Institute for Behavior and Health Inc, first director of the National Institute on Drug Abuse, second White House Drug Chief, and clinical professor of psychiatry at Georgetown Medical School: Addiction is a cruel, unforgiving and often lethal teacher. The gift of addiction, for those who survive and are willing to work hard enough and long enough to achieve it, is recovery. Abstinence from alcohol and other drug use is necessary for recovery, but recovery is more than that. It is a better way of living and a shared celebration of the small miracle of your own life.

Recovery involves having looked into, if not having been swallowed by, the abyss. Recovery includes a personal awareness of the slavery and the depravity of addiction. Recovery is emancipation from modern chemical slavery. Recovery is the joy that comes from the release from slavery. There is more to recovery. Bill Wilson [cofounder of AA] talked about self-centeredness being at the heart of addiction. At its heart, recovery is escape from the slavery of self-centeredness. That escape, also, is a source of tremendous joy because the person who is thinking about himself or herself is trapped in misery.

Relapse is a natural part of recovery

From R. Gil Kerlikowske, director, Office of National Drug Control Policy: We think that if somebody goes in for 28 days of inpatient drug treatment that once they leave there, they’ll never have another problem. We don’t look at any other disease that way. We know that cancer can re-occur; we know that the people who have worked hard to lose weight can sometimes gain some of or even all of that weight back. Why don’t we think about drug treatment as a part of the recovery process, one that also involves relapse at times? We should just understand it and accept it. And remember, when people do relapse in drug treatment, they always relapse to a lesser degree than the original disease they had, and they end up doing less harm to themselves and others, even during that time of relapse. So there’s some positive aspect to relapsing that people should see.

You must believe you can change

From Alexandre Laudet, PhD, director, Center for Study of Addictions and Recovery, National Development and Research Institutes Inc.: Regardless of the specific type of behavior you are trying to change, there is no getting around the fact that we as human beings usually do not like change. Change is difficult. You know what you are giving up; you’re not sure of what you’ll gain in exchange. This goes double when trying to free oneself of toxic compulsions, or of behaviors that have progressed to the pathological/dependent level. By then, these behaviors have probably constituted the bulk of the person’s coping repertoire for many years. So in that context, initiating change essentially boils down to asking someone (oneself) to give up the only crutch they have known and relied on for years, be it drink, drug, sex, or hoarding. Go ahead, put the crutch down and let me see you stand up. Yeah, right!

One of the things we’ve learned in our NIH-funded studies of people at various stages of recovery from drug and/or alcohol problems is that motivation is key. You have to want something pretty bad to put yourself through the recovery obstacle course and not give up after a brief attempt. So what motivates people? One thing you need is something positive, a goal. Some people want their kids to grow up with a healthy parent; some people want a second chance at life, as they put it—they want to become the person they feel they were meant to be before compulsions took over their lives. That pull is much more effective when it comes from within (intrinsic motivation) than when externally applied, as when your boss or wife gives you an ultimatum (extrinsic motivation). You have to want it yourself because if you do it for someone else, the minute you get mad at them or they get mad at you, or the minute the external pressure lessens, you’ll go right back to the crutch. So one of the most important elements of recovery initiation is to find a reason to change that makes you want it. You need to believe that what you are going to gain is more valuable in the long run than what you are giving up, because in the short run, you will have doubts. Temptation will rear its little head and you will have doubts: “Why am I doing this?”

Another way we may look at this is as meaning or purpose in life. You need something meaningful to you that will make you strong and help you stand up when the compulsion crutch is gone and you are not yet strong enough to stand on your own. Most people we’ve interviewed in our studies, those who were doing well in their recovery, which I understand as meaning not only having freed yourself from toxic compulsions but also developed a healthy lifestyle, had found some meaning or purpose to their challenges and to their path. We conducted a study trying to understand the mechanisms that underlie the demonstrated benefits of participating in 12-Step fellowships among people recovering from drug and/or alcohol problems. A number of mechanisms have been identified by colleagues, especially motivation and social support (meaning that the support people get from peers in 12-Step is one of the key ingredients in why 12-Step works). In one study, we looked at having meaning and purpose in life as a potential mediator of 12-Step benefits. We found that greater 12-Step attendance and involvement (e.g., having a sponsor, working the steps, doing service) in the first year of the study were significantly associated with greater levels of life meaning a year later. They also predicted remaining continuously abstinent over the subsequent year, and the same patterns occurred in the following year. What’s more, the association between 12-Step attendance/involvement and subsequent patterns of continuous abstinence from drugs and alcohol was partially mediated by how much meaning and purpose in life people had. Life meaning/purpose is spiritual or religious for some, but not for all. It can be just wanting to raise your kids to give them a better life than you had, making your parents or wife proud, giving back to society, feeling good about yourself, helping other people with similar problems.

Once you are committed to change, you need to believe. Believe not only that change is attainable but that you can do it. And that’s one of the reasons why 12-Step meetings are useful, especially early on: You sit there and hear people whose experiences are not that different from yours and there they are today—they changed! You want what they have, as the expression goes.

Assuming you are motivated to change and you believe you can make the change, as you start freeing yourself from the grips of compulsion, you start experiencing the miracle of recovery. It’s deceptively simple yet critical, and it needs to be emphasized that when people start the process—as you begin accumulating some time free of your compulsion, even as you reduce giving in at the beginning if you cannot fully stop “cold turkey”—you start feeling more free. You start having the energy or time or money to do things you haven’t done in a long time because all your energy/time/money was consumed by feeding your compulsion. As recovery progresses, your quality of life satisfaction increases significantly and progressively, especially in the first couple of years. And stress decreases in the opposite direction. That’s critical because stress is very often, if not always, implicated in returning to a compulsion or addiction, especially early on, when people haven’t yet developed mechanisms to deal with everyday stress.

We did a couple of studies to examine the role of quality of life satisfaction among people in recovery from drugs and/or alcohol problems. What we found is that controlling for how long people had used and how severely addicted they had been in the past, their quality of life satisfaction level predicted whether people were staying in recovery or went back to active use. We also found that when people leave drug treatment (a very vulnerable time for most), there is a strong association between how satisfied they are with their life at the time and how strongly motivated they are to stay clean and sober. That’s important because motivation, as I mentioned earlier, is one of the strongest predictors of human behavior. So people who start the change process, regardless of what behavior(s) they are dealing with, any of the seven compulsions really, need to know that it gets better and that improvement is very instrumental to helping you stay on the new healthy lifestyle course you have embarked on. I think that’s what they mean in the 12-Step promises where it says: ‘If we are painstaking about this phase of our development, we will be amazed before we are halfway through. We are going to know a new freedom and a new happiness.’”

Recovery should be a spiritual quest

From Marianne Williamson, author of many inspirational books, including The Gift of Change: Spiritual Guidance for Living Your Best Life: The Western mind, the American mind particularly, loves the to-do list. They love the silver-bullet theory of making everything all right, just tell me what to do. And that’s true if you are dealing with addiction, but also with any level of serious compulsion. What becomes clear is that a deeper inquiry into the nature of human existence is why we’re here. How do we realign with that understanding, how do we make it practical, how do we make it operational, what does that mean for our lives and why are we on a mission, how can we carry out whatever mission our soul has here? Any conversation less significant than that is ultimately a conversation that does not allow a person to find genuine sobriety or the deeper purpose of recovery.

I have talked to people in prison. I have talked to people who are disadvantaged. And sometimes it’s the people who had suffered the most and then been most cast out by society who are the most receptive to a deeper conversation. And interestingly enough, it is the people who have suffered at the deepest level who know intuitively that a superficial conversation will not be enough to address the deeper source of their despair. It’s when the level of real “Oh my God, this really isn’t working” fear sets in that people are most ready for a deeper conversation. They need to get very serious with the cultivation of a spiritual practice.

With someone who’s a drug addict or someone who’s an alcoholic or food addict, they understand that the addiction doesn’t just want to inconvenience you, the addiction wants you dead. Once you realize that you are addicted, and you want recovery rather than being at the mercy of false appetites that are increasingly destructive, then that means this is the day your spiritual quest begins.

You lost your job. You lost your money. You lost your wife. You lost your kids. You lost your health. Life itself tends to say to the person, “Are you ready yet?” And when it’s not quite loud enough, the universe itself has a way of saying, “Excuse me, are you ready yet?” The line in the Course in Miracles says, “It is not up to you what you learn. It is merely up to you whether you learn for joy or through pain.”

A New Recovery Movement Is Needed

In my interview with Dr. Patrick Carnes, he told me something about the present state of the recovery movement that needs to be widely shared: “I see that we’re making progress. But the reality is we have massive education to go, to teach people about how addiction works and why, how the 12 Steps work, and why therapy works, and how they all work together in extraordinary ways, if we just can get out of the way to make that happen. We [the treatment industry] are a part of the problem because no disease entity ever got what it needed until the people with the problems stood up and said, ‘You’ve got to do something.’”

There is also the attendant problem of what Dr. Carnes calls “convenient recovery,” which he defines this way: “Convenient recovery is where you take all that you’ve got, but if it [the recovery process] asks you to spread the word and to stand up in a community where people are going to judge you, we won’t do that. When family members don’t stand up and they don’t do their therapy and they don’t do their part and don’t listen, they’re part of the problem.”

Consider this book to be one of my ways to stand up and shout, “We’ve got to do something! And we’ve got to start right now!”

What I’ve attempted to do with this book is give people the best information available on the planet about these diseases and to provide a new perspective on treatment and recovery. “There are hundreds of competing treatments for addiction,” said Dr. Robert DuPont. “None has worked for everyone and none has failed to work for everyone. Some paths to lasting recovery have been successful over long periods for millions of addicted people, while others are less tested. In your struggle to get well, it is important to remember that the core problem of addiction is not getting clean and sober, it is staying clean and sober, not for a month or a year or even for five years, but for your lifetime.”

People with this illness do recover, but the longer you have it, the more deeply you’re in it, the harder the recovery process becomes. That also holds true for the loved ones who are, knowingly or not, accessories to the illness. There are also lots of people who don’t meet the dependency criteria but who also need specialized help. This book was written with all of you in mind.

Dr. Christopher Emerson points out that “because dependency is so complex—it’s multidimensional, multifactorial, multi-everything—we need a more comprehensive way of thinking about it and working with it. I’m always asking myself, ‘How do I make a space for something transformative to happen with my patients?’ Sometimes it comes out of saying very little, just being a quiet, consistent presence. But many times, it’s also in the acknowledgment of my own struggles with drugs, alcohol, and compulsivity.”

As a community we need to demand a recovery that we can believe in and one that we deserve. Those already in 12-Step programs understand the power we have as a group, yet they have a very strong orientation to keeping that anonymous, which I agree with as a spiritual principle and to protect the 12-Step organizations and their traditions. However, there are people in those church basements who are yearning for more, who want to do more service, who want to get out into the world and make a difference, and they should feel empowered to do that. If you’ve danced with the 800-pound gorilla of addiction and you’ve lived to tell your story, you have a lot to give the world in terms of your perspective and your spiritual fortitude, and God knows, we need spiritual fortitude in the world today.

We have a long road ahead to obliterate the stigma, the shame, and the sort of carnival nature of public discussion surrounding this disease. What the media has made interesting about this illness is the train wreck, the horror. We have to offer more than the horror of our past. We need to offer the triumphs of our present and the hope of our future.

It’s a paradigm shift that I am proposing, and it has to come from us. We need to know that we’re worth something, and not just in terms of having overcome our illness. Do you think a cancer patient defines their whole life in terms of being in remission from cancer? No. It’s just a part of their life. It’s a bump in the road. By contrast, we tend to make the addiction illness our whole life, and that’s part of the tradition in 12-Step programs. It doesn’t have to be that way. You can make that your choice, but you’re not condemned to playing that role. You can be in recovery and still become president of the United States of America, as George W. Bush proved.

Just to be clear, I think the 12-Step programs and their traditions should stay in place and should be left alone. I’m just talking about the people who want to do more and are capable of doing more.

Two things we need to do are build an economy and create an advocacy movement. I’m just starting to see where people believe that they’re worth enough to create their own businesses in recovery. They don’t have to hide anymore. They can hire people in recovery, and everybody that works for that business is in recovery. They want to live in sober communities. We are taxpayers. We win Academy Awards. We have families. We have power. We have a lot to give to society.

Obliterating stigma and shame means millions of people coming out and saying, “We are the real face of addiction.” It’s not just guys with needles hanging out of their arms on the south side of some city, or alcoholics in dirty raincoats—it’s everybody. It’s housewives, artists, teachers, children. It’s Wall Street guys. It’s people in government. This illness affects everybody, and we must recognize this reality and come to terms with it.

We can give people who are in recovery and people who are in the helping professions and who are in the families of addicts the ability to come out and be a part of a movement that states: “We have a community. We have an economy. We have business. We have grassroots. We have power. We vote. We have the ability to get things done and make changes when we need to.” We can change the perceptions around this illness. We can change society’s commitment to this illness in terms of resources being made available. And most important, we can change things in terms of how addicts feel about themselves and help them see that they deserve recovery.

Treatment centers don’t like to talk about a continuum of care, which isn’t the conventional and predominant model that we currently have. What we have is like 28 days of treatment, or at most, 90 days. Come and spend $65,000, $75,000, and then go back to your community. And the relapse rates are 80 percent. They’ve got your 75 grand and then you’ve got to go back. That clearly doesn’t work. Rehab shouldn’t be a revolving door, because you’re not doing anybody a favor if you keep going in and out. We’ve got to treat people for long periods of time and, as we learned in this book, outpatient can be as effective as inpatient care, and a brief intervention early in the process is just as effective as going inpatient down the road.

If you don’t want to go to 12-Steps, you don’t like 12-Steps for whatever reason, then maybe you’re not ready for that kind of recovery. Some people will never get ready on those terms, so they need alternatives. Treatment and recovery can happen in a lot of different ways, and we see that reflected in the breadth of ideas presented in this book.

To further promote treatment and recovery options, I am launching The Global Recovery Initiative and a Web site, www.Recover2Live.com, to bring people together around a lifestyle, not just as a lifestyle of going to meetings, but of really disseminating the information that people need to have a good life in society, in real society, not in a shadow society of people ashamed of their illness. Both initiatives are about disseminating information and giving people tools to enable them to have a full and productive life. We would not tolerate that state of affairs for people affected by diabetes, heart disease, or cancer, and we must never stop our efforts until addiction is treated with the same level of resources, and recovery from addiction becomes celebrated with the same openness.

Why a Global Recovery Initiative

From Dr. Kevin A. Sabet, assistant professor at the University of Florida School of Medicine, policy consultant, columnist, researcher, and former senior advisor to three U.S. presidential administrations: People in recovery have enormous potential to change public policy and erase the stigma associated with addiction and recovery. If only they would move beyond telling their stories—and instead arm themselves with evidence-based, scientific arguments that go beyond anecdote in order to shape responsible public policies—we would live in a very different world.

From Paul N. Samuels, director/president, the Legal Action Center: People with addictions can recover and have a meaningful life in the community—if they get the help they need. Individuals in recovery often suffer discrimination as they seek employment, insurance, and other necessities of life. This failure to integrate addiction prevention, treatment, and recovery effectively into our nation’s health care structure has cost us over 100,000 lives and more than a third of a trillion dollars annually, harming families and communities across the country.

The Global Recovery Initiative

The Global Recovery Initiative (GRI) is a collaborative organization that harnesses the power of people in recovery for policy change. Its mandate focuses on three major areas of public policy:

Build off of the major success we in the addiction recovery community are still celebrating—integrating Addiction Services into primary health care under the Affordable Care Act. As Paul Samuels stated above, not integrating these services into our nation’s health care structure has cost us over 100,000 lives and more than a third of a trillion dollars annually. But now we have a commitment from Congress and the president that this will change. GRI and our partners are going to make sure they live up to that promise.

Eliminate barriers to recovery that exist today in the law by getting rid of outdated, discriminatory policies. Several laws were passed in an era with different drug threats (like crack) that today either have shown no evidence of deterrence or simply do not reflect what we have learned about addiction as a disease in the past 10 years. It does not make sense to forbid someone with a 10-year-old drug conviction who has paid his or her debt to society and is now in recovery from obtaining student loans, employment, housing, or the right to vote. People just starting on their road to recovery should not be subject to employment discrimination or get their Social Security disability benefits taken away. And clearly, it does not make sense to incarcerate someone for $30,000 a year and then, as soon as they are let back into society, simply abandon them and not provide them with job training and other skills to succeed.

Advocate for proven, comprehensive strategies that get people into recovery faster and help them stay there. Programs like Project HOPE and drug courts that use a carrot and stick method to change behavior and keep people off of drugs must be expanded. Just because science has told us that addiction is a disease, it doesn’t take away responsibility from the user. We as a society need to assist in creating environments where that responsibility is fully realized.

Recover to Live

I was promised a life beyond my wildest dreams in recovery, and it’s happened for me. I understand my circumstances. I was really lucky. But I know many people who have found the same thing even when coming from more ordinary circumstances. You’ve got to change who you are, and not just your spirituality. You have to change your ability to work. You must change your ability to have relationships. You have to change your capacity for healthy living.

We don’t come to recovery with all of that. We need to learn it, and sometimes that information isn’t available in 12-Step programs. Recover2Live is all about anchoring yourself in a recovery that’s expansive in all aspects of your life—your work, your health, your relationships, your home, your spirituality.

Dr. Nora Volkow told me that we spend a lot of money on prevention and a lot of money on treatment. We know a lot about those things and do them pretty well. Yet we spend no money on recovery, and we don’t know much of anything about recovery. But it’s time we did. The more we know about recovery the better chance we have of getting people into recovery sooner and keeping them there longer.

There is at least one hopeful sign on the horizon for a widening of our scientific understanding of the factors that make for a successful recovery. The world’s first systematic registry of addiction recovery was launched in October 2011 by Virginia Tech in Blacksburg, Virginia. It’s called the National Quit & Recovery Registry (www.quitandrecovery.org). This site collects the experiences and recovery strategies of those involved with alcohol, drugs, overeating, gambling, and excessive sexual activity. “No one has ever systematically looked at people in long-term recovery for clues about beating addiction,” said Warren Bickel, director of the Advanced Recovery Research Center of Virginia Tech’s Carilion Research Institute. “We’re trying to understand the addictive brain by shining a spotlight on the recovery process. We can learn what methods these recovery heroes used to quit their addiction and what strategies they use to remain in recovery when faced with challenging circumstances. We can learn about their decision-making skills. And, with neuro-imaging techniques, we can learn how their success impacts their brain function.”

What I want to do in Recover2Live is to give people a destination to learn what is possible in their life and how to enhance every aspect of their life. When I got sober, people told me I could have a life beyond my wildest dreams. They didn’t say, “You’re going to spend the rest of your life in a basement talking about what using was like and just feeling kind of grateful that you’re not doing that anymore, one day at a time.”

For those of you with a dependency on a substance or process, recovery is a lifelong process. But for those of you who have a nondependent use disorder, Dr. Tom McLellan and other experts I spoke with assured me that you can be cured of this. You do not have the genetic component of this disease.

You may ask, “How do I know which one I have?” You’ll know it if you can’t stop and you keep going back. This is tricky territory, but our 30-day challenges in Part One can help. You can ask, “Well, is there a gene that I have that tells me I’m one or the other?” No, we don’t know that for sure yet. So everybody has to assume that this is a chronic condition they’re going to have to maintain for the rest of their life.

There shouldn’t be any shame attached to the realization that recovery can be a lifetime process, just as there should no longer be any shame attached to going public about this illness. Bill Wilson, the cofounder of Alcoholics Anonymous, testified in front of a Senate subcommittee in the 1950s that included an alcoholic senator named Harold Hughes from the state of Iowa. Sen. Hughes was a public servant and a sober individual who did enormous good in furthering public policy concerning how society treated alcoholism. In his testimony before that subcommittee, Bill Wilson stated that members of AA could and should speak publicly about recovery because they know about recovery. It was his view that those in AA shouldn’t discuss publicly their membership in AA, but they should talk about their recovery from alcoholism.

Today within the treatment industry, perceptions about the necessity and usefulness of anonymity are beginning to change. As Michael S. Early, chief clinical officer of Caron and former manager of continuum services for the Hazelden Foundation, said, “We have remained anonymous for so long because of 12-Step traditions, and that anonymity has been misunderstood. As an individual with the disease of alcoholism, I believe it’s time to come forward publicly and talk about it. Whatever one might think about the celebrity rehab sort of shows on television, they are helping to dispel public attitudes of stigma and shame when we see these well-known people go public with their struggles against this disease of addiction.”

During the final weekend of work on this book, my collaborator, Randall Fitzgerald, attended a memorial service for a 55-year-old construction company owner in Clearlake, California, who had been killed in a motor home fire. Randall observed something remarkable that occurred during this service, a phenomenon that gives me hope that the stigma of public shaming can finally be overcome as members of 12-Step fellowships speak out in public.

“About 200 people were crowded into a small United Methodist church,” said Fitzgerald, “and the service to memorialize Jim began with the minister leading everyone in saying the Serenity Prayer: ‘God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.’ These words were familiar to me because I knew that decades earlier this prayer had been adopted by Alcoholics Anonymous and most other 12-Step programs as an unofficial cornerstone of inspirational sayings and spiritual tools.

“When the time came for mourners to share memories of Jim and comment on his life, it became even clearer this wouldn’t be any ordinary memorial service. A full minute of awkward silence passed as the minister brandished a wireless microphone, waiting for someone to take it and speak. It was as if everyone held their breath to see who would summon the courage to be first. Finally, a boyish-looking middle-aged man in the front pew stood up and turned to face the rest of us. ‘Hi, I’m Rob and I’m an alcoholic,’ said this former coworker of Jim’s. ‘Hi, Rob,’ several dozen mourners replied in unison. As the man explained how Jim had saved his life by offering him support in the local AA fellowship and then by giving him a construction job, I studied the faces of other mourners around me, and it was clear from the puzzled expressions that many people didn’t know that Jim was a recovering alcoholic, or that he had met his fiancée in the program.

“Another awkward silence ensued until another person stood and said what was on many people’s minds: ‘Now that anonymity has been dispensed with today, I feel like I can say, ‘Hi, I’m Bill and I’m an addict.’ ‘Hi, Bill,’ came the sing-song response, this time spoken by even more people in the room. The taboo of maintaining anonymity about 12-Step program membership, the reluctance about speaking out honestly while surrounded by ‘normies,’ as nonalcoholics and nondruggies are called, had been broken. It was like a dam breach and resulted, almost with a collective sigh of relief, in a torrent of emotional testimonials that kept flowing. One by one, other members of the local AA and Narcotics Anonymous fellowships stood, identified themselves, and spoke about Jim’s own battles with the disease of dependency and how he had helped them as a friend and sponsor to stay clean and sober.

“People laughed and cried, spoke with gritty unflinching honesty, and everyone present, normies and all, felt drawn together without shame or judgment. It was really a quite extraordinary scene of shared feeling. The minister was moved to remark that love and acceptance had enveloped the room to embrace everyone. I walked out of that service sensing what was possible for the broader recovery movement and society as a whole. This day wasn’t a fluke or just an overwrought aberration generated by a sad occasion. This was a level of maturity that could be replicated in room after room, planet-wide.”

Randall Fitzgerald’s experience is instructive. One reason why 12-Step programs have been so successful is because they really are a recipe for living that can be beneficial for anyone. We can have a program for living, and we can have a program for recovery to secure a life beyond our wildest dreams. We need it. We deserve it. And we’re capable of securing it for ourselves.

It isn’t just the 12-Step programs that get the job done, of course. For example, the highly regarded Faces and Voices of Recovery (www.facesandvoicesofrecovery.org) helps those in recovery deal with society and the stigma of dependence. For example, Faces recommends those in recovery introduce themselves something like this: “Hi, I’m _________________ and I’m a person in long-term recovery. For me, that means it’s been ______ years since I used/had _________________.” It’s not the simple 12-Step greeting but it more than gets the job done. It takes you out of the shadows.

If you’ve danced with this illness for a decade or however many years, with this gorilla of addiction punching you in the face the entire time, and you’ve lived to tell your story, you’re already one willful, committed human being. That recognition alone should be reason enough to start believing in yourself and your potential again.

You can help me shape what this new recovery paradigm will look like in the Global Recovery Initiative and its partner, Recover2Live (www.recover2live.com). On this Web site you will find accessible self-help tools for treatment and recovery, along with curriculums to deal with second-stage recovery issues. There will be a community of people connected through this site dedicated to making our lives more worth living.

Whether you are in recovery or not, whether you are in a helping profession or not, whatever your station in life happens to be, I would be honored if you would join me in helping establish this new movement. Together we can undertake the challenge of not only bringing long-term recovery to more people, but also delivering the promise of a richer, more fulfilling life.

My uncle, President John F. Kennedy, said that the true measure of a nation is its success in fulfilling the promise of a better life for each of its members. Let this be our measure, too. Our goal should be nothing less than to fulfill the promise of a better life through treatment, care, and eventual recovery for the millions of people struggling with the various forms of addiction around the world.