12-Steps FTW
In the course of my job I just read an excellent article on those who get arrested and the relationship between mental illness and addiction. It took my thoughts on a rabbit trail that didn’t have much to do with my job, but I wanted to think it through. Here is the phrase that got me thinking:
“…[A]dults reporting … mental illness and substance use disorders in the past year were far more likely to be arrested compared with both those with mental illness alone and those who didn’t experience any mental illness or substance use disorder….”1
On the surface, that’s common
sense. But there’s more that isn’t being
said. What’s under the surface?
My Take-Away (with Conjecture):
There are many people with a mental illness, who also use mood-altering substances, and claim to be ‘self-medicating’. They are straight-up justifying their addiction, and their lack of behavioral-change. I know that nowhere in the statistic referenced above does it say anything, let alone hint at, the concept of, ‘self-medicating’. I inserted that point as a focus, not because of the article, but because of my experience – especially my experience in jails.
People want to show how they are not bad people, or even weak ones. They want to say that what they do is somehow okay, in one fashion or another. People want to say that it’s not that they are an addict, pure and simple, but rather that they experienced a trauma, or have depression – and so naturally they use heroin and meth. It is like medicine, as the story goes. I hope you don’t know this world or this way of thinking, but when I read the article referenced above, those are exactly the words that I hear, even though they are not explicitly stated. I’ve heard it said countless times.
I also point out that phrase “self-medicating,” because there are many more people who have very real issues – either a mental illness or a straight-up addiction – who don’t get arrested. Those who struggle with the very real difficulty of Anxiety or Bipolar without getting high are not adding insult to their injury; they are not making things worse for themselves.
- Mood-altering substances are, by their very design, not bringing a person’s mood into equilibrium – but rather, it is about getting high.
- Medications, by their very design, try to bring what is off balance into correction – without getting high.
Why a person may choose mood-altering substances (I don’t care if they are legal or not) over medications is due to their preference – at least in the beginning, before the addiction sets in. Once the addiction sets in, that person very easily, and very likely, will continue to make that same choice. We all get good at what we practice, and addiction has an even stronger pull on us than say, training for a marathon or a low-carb diet.
There are questions (of course there are questions), about what else is going on with those whose drug of choice are benzos or marijuana or alcohol. I like those questions and want more of them, but I don’t have any hope that the answers will find any definitive resolution. The question of what else is happening besides mental illness doesn’t take away from the fact that addictions, as addictions, still need to be addressed.
Addictions, by their very nature, make problems worse, and addictions absolutely can be dealt with successfully. Justifying addictions gives them a longer lifespan, which add more problems into a person’s queue. Addictions are pervasive, no respecter of persons, and lead to death if left unchecked. Like diabetes. Like sin.
It’s not that addictions have to be addressed first, before the mental illness, but the sooner they are addressed, the less problems develop, both in number as well as in intensity. Addictions can absolutely be addressed right alongside mental illnesses – a person with both doesn’t have to prioritize getting sober versus managing their PTSD or Depression. But it may very well be that a person can only take on so much at once, which is understandable. We are limited, after all. So if a person feels like they can only address one of those two areas where their life is spiraling out of control, I would offer the challenge that they tackle the addiction first.
I have a couple reasons for prioritizing sobriety. First, it makes the path forward clear – because I know that path, and I am not abandoning the person to their best efforts; because I am walking it with him/ her, there is hope. Secondly, that person will likely be taking on his/ her mental health needs anyway, because once the path of sobriety comes into view, everything else comes into better focus also. And third (and my main reason, to be transparent), is that the longer a person holds on to their addiction, the less likely they are to give it up – addictions are both a lifestyle and a god.
Yes, it is possible to address
mental health without entering into sobriety – but if a person makes that
choice, it rather shows how embedded the addiction is in his/ her life. It proves the point. If there is no harm, there is no foul, but with
addictions, there is harm; real harm.
The addict is not a very good judge as to how much harm they have
caused; their credibility is lacking.
The addict needs to ask instead those who are close to them, what the
cost of their addiction has been; if they even still have people close enough to
ask. If they don’t, they should assume
the addiction has cost them that, as well.
Step Back:
What is addiction, anyway? We all seem to intrinsically know what it is, but it’s good to define our terms, if possible. Clinically, there is no diagnosis of ‘alcoholic’. Seriously. There are symptoms of what is called Alcohol Use Disorder. And that diagnosis, as identified according to the DSM-5, is based upon how many symptoms are identified in the past year: Mild has 2-3, Moderate has 4-5, and Severe has 6-11. Before 2013, there were two different categories, one being ‘Abuse’ and the other being ‘Dependent’, and the timelines were different. I have come to appreciate the update from the IV-TR to the 5.
Some critics may say that the only way that a person cannot have an Alcohol Use Disorder is to have 0-1 problems with alcohol, so therefore it is a flawed diagnostic criteria. That’s a fair point, but it rather proves the need to have criteria.
Depending upon how many symptoms on the list are checked, a person fits into one of those three degrees of severity. I live in that clinical world, yet I find that when I’m off the clock I don’t speak it. (Well, I do, but only when I’m in a nitpicky mood and listening to some self-described expert – then I take them to task, even if I’m just ranting to myself.)
Instead I say ‘addict’, and I use the AA understanding: “That which causes problems, is a problem.” Now that I think about it, that definition was likely a phrase used by Father Martin, rather than the Big Book, who made that statement in his lecture on Step One. It’s an oldie, but a goodie.
What is sobriety? Bill and Dr. Bob figured it out about ninety years ago, and soon afterward, they wrote it down into twelve simple steps. Simple steps, mind you. Not easy ones. And those steps correlate with living righteously.
Getting Sober and the Becoming Righteous:
Getting sober is a lot like killing sin. And interestingly, working those same twelve steps is the same for getting sober as it is for becoming righteous. Don’t hear what I didn’t say. I didn’t say that a person who gets sober has also gotten righteous, or vice versa. I’m saying, that the application for the one is the same as the application for the other. Those steps are rooted in Scripture, after all.2 Sobriety and righteousness start with an understanding of who we are that is patently true and objectively real – we are broken and unable to fix ourselves. Because we can’t do it ourselves, we place our trust in somebody else who can – who is trustworthy, capable, and loves us. As we mature, we grow in our love for Him.
Step 1. Romans 3:23 (LSB) – “…for all have sinned and fall short of the glory of God…”
We are powerless over our addiction, and our lives have become unmanageable.
Step 2. 1 Timothy 1:12-16 (NIV) – “I thank Christ Jesus our Lord, who has given me strength, that he considered me trustworthy, appointing me to his service. Even though I was once a blasphemer and a persecutor and a violent man, I was shown mercy because I acted in ignorance and unbelief. The grace of our Lord was poured out on me abundantly, along with the faith and love that are in Christ Jesus. Here is a trustworthy saying that deserves full acceptance: Christ Jesus came into the world to save sinners —of whom I am the worst. But for that very reason I was shown mercy so that in me, the worst of sinners, Christ Jesus might display his immense patience as an example for those who would believe in him and receive eternal life.”
Came to believe that a power greater than ourselves could restore us to sanity.
Step 3. John 14:1 (LSB) – “Do not let your heart be troubled; believe in God, believe also in Me.”
Made a decision to turn our will and our life over to the care of God, as we understood Him.
Addiction is a Disease:
Addiction is absolutely a disease. In standard AA fashion, it is referenced as a disease, and it ticks off all the characteristics of a medical-biological one. A disease is not normal, has recognizable symptoms, and those symptoms cause predictable problems. I’m sure there’s a more technical definition, but think of diabetes.
Do we know why one person has diabetes, and another person doesn’t? No, but there are risk factors and predispositions. A person can make their diabetes worse by eating poorly – just refer to any Jim Gaffigan bit. (Always recommended, btw.) A person with diabetes has to monitor their insulin levels, their diet, their exercise, and just about every aspect of their life, to stay in the clear. Some people bring about their diabetes by a lifestyle of poor choices, while others are born with it. Some get the luck of the genetic draw even without any family history, while others get trained into their condition by what foodstuffs their parents keep close at hand, as they were being raised. Addiction is no different.
Those who use substances are more likely to become addicted than those who don’t (duh). And just like no sugar-lover ever thought they would develop a medical condition, no alcohol-lover ever started out thinking they would either. The diagnosis is only ever figured out after the body conforms to what it’s been inundated with. By the time a person’s biology shifts and their brain chemistry changes, shame will also have taken root.
Shame is a secondary issue, but it is part of every addiction. It’s almost like the addiction could never have happened if shame wasn’t also present. You see, shame removes the option for a person to be honest about their problems. This process of hiding, the more adroit ones might call it ‘coping’, is what somebody eventually labels ‘denial’. I hate that term more than I hate the term ‘codependent’, because it’s used so often that it’s lost its meaning. So, I avoid the term. Seriously. I deny denial. Take that.
Back to the Point:
And so every addiction flourishes in the cover-up – and shame, as
happened in the Garden of Eden, causes a person to hide. AA has a phrase that I love: “We are only as
sick as the secrets we keep.” With
shame, the addiction feels like something other than what it is, which makes
getting sober more difficult and less hopeful.
Addiction feels like a moral weakness to those who don’t have a problem
with alcohol. But once a person crosses
the line and now has a problem with alcohol, it has become biological. Did it start as a moral weakness? Yes and no – the diabetes analogy is still in
play. If it ever was a moral weakness,
that’s not what it is anymore – that ship has sailed along any hope of righteousness apart from Christ. Right into the storm.
2. https://12step.org/references/bible/
NA uses the term ‘allergy’. I don’t like that as much, but I can see their point, as in a normal response is one thing, and the addicts response is another. The DSM calls it ‘Substance Use Disorder’. I think that’s weak sauce, but it works. How it works, primarily, is that it looks at symptoms, and removes the whole question of cause. I have no problem with that, and is consistent with the disease model.