The Center of Addiction Recovery Cannot Hold

Part 1: Welcome to the last, and only, house on the block.

The center of addiction recovery is broken. We have been losing too many, too fast, for way too long. At Workit we call these friends and family members the Lost, and we have grown tired of watching them die by the hundreds in our worlds. We have come to believe that there is a better way and that we are responsible for designing it together.

We have long relied upon a model of abstinence-based recovery. A two state model: On the wagon or off. A black and white model to treat an infinitely nuanced condition with many shades of gray. We got chemo or nothing. This makes sense at the end stages of a condition. It comes down to life and death. As we say in recovery circles, the cucumber becomes a pickle. It was this way with me. I choose abstinence because it suits me now, the lifestyle has seduced me. But it is a one-size-fits all model. We are forcing the young into the cucumber fermenter half-baked because “If it's a mistake, what’s the harm? Mistaking yourself for an addict may be the best mistake you make in your life.” In reality, most of us teetotalers are still “picking up” one or another addictive behavior long after we quit drugs and alcohol. This week its sugar. Next week, perhaps Nintendo.

We have long relied upon a model of abstinence-based recovery. A two state model: On the wagon or off. A black and white model to treat an infinitely nuanced condition with many shades of gray.

It's not as though we haven’t tried “Moderation Management” as a society. That story just happened to end in a real alcoholic’s path to vehicular homicide and ultimately suicide. The painful truth to those of us who are hard-wired to match well with abstinence, however, is that there are many among us who moderate well. 60% of young people grow out of risky use. They do #dryjanuary, they give up booze for lent. They quit when they’re pregnant. But we have cleaved as a society to the wagon as the ultimate solution, the road less traveled that everyone gets. Peer-to-peer self help groups have become the market dominant force. A horse and buggy solution in a world of self-driving cars. There have been none to replace them. Everyone trying something new is a snake oil salesman until proven otherwise. Nevermind that Bill Wilson was a self-declared snake oil salesman, nevermind that Dr. Bob was a proctologist.

In a world where abstinence is the dominant method, there must be pickles. People must become star-bellied sneeches and stay that way. One does not become a pickle overnight, but addiction can move lightning fast. For me it moved with a tailwind of hundreds of years of genetic predisposition. There was quickly a spectacle, but there were warnings and whispers long before I was intervention-worthy. Addiction starts with an evening and a mismatch between your intents and the outcomes. The first night you decide to drink alone for the wrong reasons. The moment the pursuit becomes about your un-quelled pain, unmet needs, underlying conditions. At first it's just a whisper drawing you into a place where you imagine you might smile more. But the center does not hold. Things fall apart.

Addictions are fed. AA has proven that you can starve them with spirituality and fellowship and poorly lit rooms with coffee. There are mutterings about feeding the white dog instead of the black one. There is comfort in the idea that our unbroken circles signal we’re feeding the right dog that day. When you enter the doors of AA if you “Do the deal,” you lay down the life you led before. You set forth on a new path. I needed to do this and I remember the magic of it. It served me well, it kept me alive. I learned to live, but it has taken me much much longer to learn to thrive.   

In the world of abstinence-based recovery the binary isn’t just limited to the wagon and whether you were on or off. We retell the story of our past as the dark time and then the redemption. Was everyone that you knew before broken? Perhaps not. But in the rooms we tell you that the only thing you have to change is everything. We tell you that to come away from it you must create a new world of service, unity, and recovery. You must cleave to us “as the drowning do to life preservers” and release all aspects of your former self that distance you from God and from your fellow men. The therapy offered is spiritual. We, the members, are the evidence.

You make another possible world when you reject the confines of your own. Such is the hero’s journey. You take your world and say, as Sylvia Plath did, “No, you do not do. You do not do anymore black shoe in which I have lived like a foot.” Taking this transformative leap is epic. It moved mountains in me. I felt change happening on a moment to moment basis in early sobriety. The present moment was more palpable than even my most vibrant memories of childhood. For a moment, maybe even a hundred moments, I sat astride the “pink cloud.” All was made new. The new world was a thing of great beauty.

Inebriation can be lovely. There is beauty in the camaraderie of connection and the release of inhibition. When I think of that world of merriment I’m reminded of a favorite quote: “Sit by my side and let the world slip, we shall ne’er be younger.” There is beauty even in addiction itself. There must be, or it would never be so effective at seduction. It would never have mesmerized us collectively for centuries. I would never find myself staring straight into the eyes of the Deans of Medical Schools and knowing they’ll never partner with Workit because they’re still so deep in the fray they’re shaking as we speak.

In abstinence based recovery, we tell ourselves it is not so. All was squalor in our newly minted history. Everything about that world was broken. You are either of that world or of this one. We take AA by the hand, we pick a sponsor as delicately as we might choose a romantic partner, and we let this be our medicine. We come to see the world we knew before as a whirlpool of temptation that comes and goes, but trust that it will not assault us for long if we rely upon these bonds, these actions, these rituals. And for me, that has been true. But it has been insufficient. At Workit we believe there are worlds beyond well we have not yet known. We are, as Cassie our Head of Content would say “carving them from the sky.”

The problem with the current models is that I have relied upon these bonds for well over a decade and they have saved me and not saved my friends. These bonds have not stopped the incessant call for release that plagued their minds and their anxious caffeine pounding bodies in their waking hours. Many of them have died. By overdose, accident, suicide. Some in the late stages of pregnancy, most dual diagnosis, and one who lived in my home and saved me countless times in the days when she was further along the road to happy destiny than I was. When they go we say “Man, they should have worked a program. They weren’t working the program hard enough.”

Those answers are insufficient. Slim survival in the company of the drowning is insufficient.

The irrationality of Alcoholic Anonymous is this. It fancies itself the center of the addiction world, but it is only a star. It is a beautiful star, but this center just cannot hold. Not in the era of personalized medicine. Not in a time of genetic medical breakthroughs, infinite technological levers for customizing care, and near-ubiquitous access to instant help. Not in the year when 52,000 people died from heroin overdoses (5k more than Vietnam). Something much much rougher this way comes. We must respond accordingly.

The irrationality of Alcoholic Anonymous is this. It fancies itself the center of the addiction world, but it is only a star. It is a beautiful star, but this center just cannot hold.

Stay tuned for Part 2 of 'The Center of Addiction Recovery Cannot Hold,' by Lisa McLaughlin, Workit Health's Co-CEO and Co-Founder, about building more houses on the addiction recovery block.


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Lisa McLaughlin

Lisa McLaughlin is the Co-Founder and Co-CEO of Workit Health. She has intensive experience serving on executive leadership teams at digital health and learning startups, supplemented with seven years of academic experience in psychiatry, information science, and social work.