Recovery, Spirituality, and Recognizing "Outside Issues

After the election we have a country that seems painfully divided.  Members of Alcoholics Anonymous recognize the need to protect their connection to and need for each other from divisive issues.  Their lives depend upon helping each other stay sober and grow spiritually.  AA's 10th Tradition puts it nicely:

"No A.A. group or member should ever, in such a way as to implicate A.A., express any opinion on outside controversial issues — particularly those of politics, alcohol reform, or sectarian religion. The Alcoholics Anonymous groups oppose no one. Concerning such matters they can express no views whatever."

A Thomas Merton journal entry unintentionally captured the essence of AA's embrace of the spiritual and the avoidance of certainty regarding "outside issues" in the rooms:

Merton’s Journal 2/2/66

A flash of sanity: the momentary realization that there is no need to come to certain conclusions about persons, events, conflicts, trends, even trends toward evil and disaster, as if from day to day and even from moment to moment I had to know and declare ( at least to myself ) that this is so and so, this is good, this is bad.  We are heading for a “new era” or we are heading for destruction.  What do such judgments mean?  Little or nothing.  Things are as they are in an immense whole of which I am a part and which I cannot pretend to grasp.  To say I grasp it is immediately to put myself in a false position, as if I were “outside” it.  Whereas to be in it is to seek truth in my own life and action, moving where movement is possible and keeping still when movement is unnecessary, realizing that things will continue to define themselves and that the judgments and mercies of God will clarify themselves and will be more clear to me if I am silent and attentive, obedient to His will, rather than constantly formulating statements in this age which is smothered in language, in meaningless and inconclusive debate in which, in the last analysis, nobody listens to anything except what agrees with his own prejudices.

 

Trying to help an opiate addict

With opiate addiction on the rise we've been getting a lot of calls from family and friends of opiate addicts.  Most are desperately searching for ways to help their addicted loved one.  The painful truth is that they are asking the wrong question.  "How can we get help for ourselves" is the right question but, sadly, most aren't prepared to consider viewing themselves as needing care.

Loving and being involved with an opiate addict, or any addict or alcoholic for that matter, is a sad and painful experience.  The trauma is twofold: first is from a lack of a systematic strategy to deal with the problem and second is the pain from watching a loved one court despair and death on an ongoing basis.  It's a natural response for a family to focus it's energy and resources to "rescue" the addict and hope to get him/her to stop.  The desire for a quick fix camouflages the depth of the work to be done.

Those of us who frequently fly have heard countless times "In the event of a sudden cabin depressurization put your oxygen mask on first before you help the person next to you."  The same thing is true with an addict's loved ones.  Engaging in your own program of recovery and treatment is the best thing you can do to help not only yourself but the addict as well.  I know it sounds counter intuitive but it's true.

As loved ones engage in their own process they see things clearer, they recognize enabling, they start to accept limits and are better able to develop an effective strategy for dealing with the addict.  Most important, they also begin to change emotionally and spiritually which has a powerful effect on those around them.  This allows them to develop and implement a strategy for addressing the addict in an inviting, caring, firm and effective manner.

The reluctance for loved ones to engage in this process mirrors the reluctance of the addict to enter and engage in treatment.  Both are looking to feel better without the hard work of "letting go of old ideas" and developing a new "manner of living".  The best way to start a conversation with an addict is to say "We've been so focused on trying to fix you that we haven't seen how deeply we've been impacted.  We've decided that we're going to get help for ourselves and put on hold deciding what to do regarding your addiction and our relationship.  We'll let you know what we've decided after we get a foundation in our own recovery."

For those of you who still want to call we can help you develop an effective strategy that will increase your loved one's chances of getting help.  However, you should be aware that the chances of that strategy succeeding increases exponentially if you seek your own healing and recovery as well.

 

Drinking and Pregnancy

We frequently hear about Fetal Alcohol Syndrome but usually don't hear how it plays out as a child grows into adulthood.  Here is a great story from the Washington Post about a 43 year old woman and the ongoing impact of her FAS

www.washingtonpost.com/national/health-science/this-mother-drank-while-pregnant-heres-what-her-daughters-like-at-43/2016/01/15/32ff5238-9a08-11e5-b499-76cbec161973_story.html?tid=pm_national_pop_b

Her mother came from an alcoholic family and has alcoholism herself.  Now the mom is in recovery and is making it her mission to "carry the message" about abstaining from alcohol during pregnancy.  

The article states that back in October the American Academy of Pediatrics reported that there is no known safe level of alcohol consumption during any trimester of pregnancy.  With so much at stake for a child's development why risk drinking any amount?  Drinking during pregnancy isn't worth it.

Surrender vs Compliance

The first medical article I ever read about alcoholism was written in 1953 by a psychiatrist, Harry Tiebout.  It was called "Surrender versus Compliance in Therapy; with special reference to alcoholism".

Tiebout noted that superficial compliance with a program of recovery is different from an internal transformation.  I think a good comparison would be the difference between changing a behavior as opposed to changing one's self (an awakening or transformation).  Some in Alcoholics Anonymous would say it was the difference between being "dry" and being "sober".  Simple compliance could allow an alcoholic to stop drinking.  The questions that come next are "Is it enough to allow a person to stay stopped?" and "What kind of life would one have?'.

Several posts ago I wrote about Brother Francis and his wisdom about recovery from alcoholism.  I think he nailed it when he said "The man I was will always drink".  AA suggests the first step on the journey of recovery begins with an admission of powerlessness that leads towards surrender and a spiritual awakening .  Both Tiebout and AA claim that "a deflation of ego in depth" is required.  Francis nailed it again when he said "Make sure your recovery is not a 'Handyman's Special'.  That is one that looks good on the outside but doesn't have a firmly constructed foundation".

Please don't take this to mean that compliance doesn't have its place.  Especially in the beginning, the saying "Don't drink and go to meetings" is valuable. Frequently it allows a person struggling to stay sober to buy time and put some distance from a drink into place.  It also connects the newly sober alcoholics with a power greater than themselves (alcoholics who have recovered and are leading fulfilling lives).  It can be compared to scaffolding which supports a person while the renovation is going on.

So, how does a person in recovery surrender?  Sad to say that one can't make himself surrender just like one can't deflate his own ego.  It's something that happens for or to him.  It's a byproduct of willingness and desire.  Tiebout described surrender as an "unconscious event".  An AA member said it better "Don't stop coming before the miracle happens".

Wanting to stop but can't

A woman was talking to her family about why she doesn't need treatment.  She said she hadn't drank in a week and she was increasing her exercise, eating right and doing well at work.  She knew she needed to stop and felt better now that she had.  She could do it on her own. 

As she was talking I stood next to her and smelled the alcohol from the night before coming off of her.  I asked her if she drank the night before and she said "yes".  What was hard is that she then said "I'll just try harder".  She was in a very painful place.  She knew she needed to stop drinking; she was drinking despite not wanting to; she was afraid she couldn't stop yet she was afraid of the changes getting help involved.  

What would allow her to surrender?  What would allow her to "let go absolutely" and grab on to recovery?  Could she ever see that admitting "complete defeat" could be the key to a new life?

I don't know if that can be done as a function of will or intellect.  In one sense she knows her situation but that knowledge doesn't translate into action.  Our friend wasn't simply lying.  She was trapped in a spiral of not being able to stop despite wanting to and having to create a series of deceptions to cover up that fact.  

I believe she is in a place where good intentions and will power aren't enough.  I don't think intellectual insights and practical techniques for stopping drinking would work at this point.  AA suggests that one should ask for God's protection with "complete abandon".  It's easy to scoff at this but for many it's been the only thing that works.  At least it's worth a try.

Wasting a Crisis

When a crisis point is reached regarding a person's drinking or that of a loved one the pain also provides an opportunity.  It can break down preconceived notions and serve as a catalyst for change.  It might help a person realize that "their way" isn't working.  Even better, it might make the pain of fundamental change less than the pain of continuing the same patterns of thoughts and behavior.  

Unfortunately, most simply want the pain to stop without having to make fundamental changes in their thinking and actions.  For the person with alcoholism, immersing yourself in a program of recovery and making staying sober your "primary purpose" does not come naturally.  For the loved one, engaging in a program of recovery for yourself, setting limits, and allowing the alcoholic to experience the consequences of alcoholism is difficult.  Their response to suggestions that require fundamental change and surrender is reminiscent of the song by Meatloaf; "I'd Do Anything For Love But I Won't Do That".

A person at an AA meeting once said: "My best thinking caused this crisis yet I still want to hold on to my way of thinking and doing things".  The temptation is to do the same things over and over again all the while expecting different results.

No matter how painful the crisis it always creates a "turning point".  Can the pain allow for a "deflation of ego in depth" leading to surrender and acknowledgement of a "power greater than yourself" or will it come and go with no meaningful change.  A crisis allows a person to ask: "Is my way working?".  The sad fact is many can't face that question and just want the crisis to end with no real conversion of thought and action.  

Imagine falling into a cesspool.  Not having the means to get out you're barely able to stay afloat and keep your chin above the liquid.  Hearing people above will you ask "Please help me get out of here!" or will you say "Just teach me how to not make waves!".  

 

 

Holding on to old ideas

"Some of us have tried to hold on to our old ideas and the result was nil until we let go absolutely."  That powerful quote comes from the chapter titled "How It Works" from the book Alcoholics Anonymous.  It seems to me that desperation is an alcoholics best friend when it comes to letting go.  In the early days of AA when most members were late stage alcoholics who wanted to stop drinking but were unable to do so a key question was asked: Are you willing to do whatever it takes and whatever we suggest in order to stop?".  It's easier to say "yes" to that question if you know you're going to lose everything or die if you don't.

Now many people approach recovery with some ambivalence: : "I think I'd like to stop but I really can't change that many things because of all my responsibilities.".  They view their drinking as somewhat of a problem and all they need is a bit of help managing it.  The fortunate thing is that when they're ready to drop their "old ideas" and "let go absolutely" AA will be waiting for them with open arms.

The times they are a changin'

We've done it!  Being a small, "boutique", "ma and pa" place means we've been swimming up stream for several years.  Navigating the increasingly difficult regulatory and insurance waters has been draining.  Though we've known it for a while, we couldn't quite get ourselves to acknowledge that we could no longer provide the quality care we are known for in a manner that makes economic sense.  We finally hit bottom and through the help and support of others accepted reality:  We could no longer operate as a facility licensed by the Office of Alcoholism and Substance Abuse Services.  One result of that decision is that our service is no longer covered by insurance.  

What does this mean?  The rest of our site explains our "new focus" but the biggest change is that Alcohol Services is going to consist of Karen and I working on a part time basis.  We're starting by being open Wednesdays and half of Tuesdays at our new location.  We'll see where it goes from there.

At a time like this our thoughts go to all the people who have worked with us and made Alcohol Services unique.  Though it will just be the two of us we are both aware of our colleagues over the last 31 years and carry their contributions with us in our ongoing work.  Our thoughts also go to those who have come to us for help over the years.  It's an honor to have had them trust us enough to violate the rules of the alcoholic family "don't feel, don't talk, don't trust" and by sharing their "experience, strength and hope"

 

Kindly Honest

If you're looking for a present to give a person who has alcoholism I suggest kind honesty.  Not honesty used as a weapon but getting the courage to say what you've been afraid to say in a caring manner.  Perhaps you can stop offering vague excuses for not going out with a person.  Maybe you can say how it scares you to see the person interact with your kids when she's been drinking.  Can you imagine saying the real reason the person is excused from the car pool activity?

"I'd love to go with you but the last time we went out you got drunk and scared me."  "I know you love my kids but when you were over after drinking you teased them until they cried."  "It would help a lot if you drove but the last two times you drove over you had alcohol on your breath and slurred your words."  These hard truths said in a kind way may provide the impetus for a person to seek help or at least start asking questions.

Alcoholism frequently needs a conspiracy of silence and accommodation to flourish.  Being kindly honest about your perceptions and being specific about your limits and why you set them is a gift.  Once problems caused by drinking are acknowledged and the word alcoholism is mentioned things are never the same.  Seeds are planted and whether they sprout or not doesn't matter.  The alcoholic has been given the gift of honesty and consequences. 

 

 

If you want to know more ask your doctor about......

That tag line appears in just about all the pharmacuetical companies commercials asking you to pressure your doctor to prescribe their drugs.  It usually follows a rapid recitation of side effects that blow by quickly in the hopes of not taking attention from the idyllic images of healthy people portrayed on the screen.  

If you'd like to make a contribution to the health of your community here's something you can "ask your doctor about".  Given the large number of patients who have alcoholism and addiction why aren't you screening for it in the same manner you screen for other prevalent illnesses when you take a health history?  Unlike the drug companies spiel this "Ask your doctor about..." idea has no negative side effects.  In fact, it's easy to do, simple to incorporate and it's free.  Better yet, it has tons of science behind it.

The best screening tool is only four questions and is called the CAGE test:

Have you ever been Concerned about your drinking?

Have you ever been Angry when someone talks to you about your drinking?

Have you ever felt Guilty about something you did when you were drinking?

Have you ever had an "Eye opener"?

If you answer "yes" to two or more it'd be good to get a full alcoholism evaluation.  The good news is that when physicians ask the questions it takes very little work on the doctor's part to have patients drinking in a high risk manner reduce their consumption on their own and those who have alcoholism accept a referral to treatment.  Screening and referring for alcoholism treats it as any other medical problem and goes a long way towards reducing stigma and creating an environment conducive to the patient accepting help.

So "ask your doctor about" using the CAGE screening tool.  It can make a difference.

Three Pertinent Ideas

The pioneers of Alcoholics Anonymous discovered "three pertinent ideas" which made their recovery from alcoholism possible.  As outlined in the "Big Book" they are:

"a. We were alcoholic and could not manage our own lives.

 b. Probably no human power could relieve our alcoholism.

 c. God could and would if he were sought."

Christmas morning is a good time to reflect on these thoughts.  Should I strive to control my drinking or finally admit defeat?  Do I struggle to conquer my problem or ask for help?  Do I surrender or keep fighting?  Am I on my own with my alcoholism or is there a "power greater than myself" I can turn to?  Will I connect to that Power in a solitary manner or find it in community with others?

Late December, when the days are filled with more darkness than light and, at least in Syracuse, so much of life is caught in frozen numbness, is a good metaphor for the internal life of a person with active alcoholism.  There's little difference between not taking the first drink one day at a time while reaching out for help and the "hopes and fears of all the years" that today represents.  If you stop drinking today imagine having Christmas as your sobriety date!  It's hard to think of a better gift.

 

Try this if recovery feels a bit stale

Alcoholism isn't a team sport.  Even if a drinking alcoholic is surrounded by people there's an internal isolation.  As time goes on, the magic once found in drinking diminishes then disappears.  It's a disease of loneliness.

The first couple of years of sobriety and recovery reverse the process.  A person starts to come alive in community with others.  The newly sober alcoholic discovers others who have had the same or similar painful descent, found a sober way of living and now offer to share it.  Often one develops gratitude, wonder and belonging. 

Unfortunately as time goes by recovery can feel a bit stale.  The body heals; the chaos of active alcoholism recedes and life gets filled with more pressing "priorities".  It's not unusual to hear folks complain they "don't get anything" out of meetings anymore or they become tired of hearing "the same people saying the same things".  An AA member I know said something wise: "When I feel as if I'm not getting anything from meetings I try to look at what I can bring to the meetings.".

If you find your recovery a bit stale maybe these suggestions might help.  They all involve reaching out to others which is another way of being grateful and giving back: 

-Drive to meetings/group counselling sessions with another person.

-Call someone who's struggling and provide support

-Shake someone's hand at every meeting

-Help set up and clean up the room. 

-Share a meal. 

The key is getting out of yourself.  Staleness can't exist when the focus is on being of service and reaching out to others.   

 

 

 

Would You Like To Stop Drinking?

Such a simple question.  Unfortunately  it's rarely asked.  Instead the phrase "stop drinking" is often preceded by phrases such as "You should"; "You ought to"; "I wish you would" and finally "You'd better".

If the answer is "Yes, I'd like to stop drinking." maybe you could also acknowledge the existence these simple, yet powerful, phrases preceding "stop drinking";

"I'm afraid to"; I don't think I can"; "I don't know how to" and most powerful  "What will be left if I";  

A couple of posts back we talked about what to do to see if you could "control" your drinking.  This is different.  If you've tried to limit, manage or control your drinking and are still struggling perhaps now is the time to get quiet with the question:  Would you like to stop drinking?

If the answer is "yes" then help is available. 

 

Alcohol Services Turns 30

I'm a bit chagrined that it's taken me so long to recognize that Alcohol Services would not have existed, let alone last for 30 years, without the help and support of others.  This anniversary has given me a chance to remember the people who went out of their way to make this venture possible. 

One man loaned us a typewriter (remember them?) and a woman let us forward phone calls to her house when we were seeing someone or not in the office.  Another scavenged used desks and file cabinets to  put in our office until we got on our feet.  Many others freely gave of their expertise and insight. 

The biggest change is thirty years ago I thought I had the answers and if people would only listen things would get better.  It's bad enough to think that way but re visiting things that I've written with such assurance almost makes me wish they weren't preserved on paper.  One of the benefits of a long period of time going by is the realization that the best we do is witness a person's journey, be kindly honest  and care for them.  It's more that we offer seeds rather than plant them. 

In the book Alcoholics Anonymous it's suggested that one of the keys to recovery is a "deflation of ego in depth".  In a too infrequent moment of humility I can be grateful for the last 30 years rather than take credit for them.  It's all a gift.  Dr Bob, one of the co founders of AA, said it very well in his farewell address: 

"None of us would be here today if somebody hadn't taken time to explain things to us, to give us a little pat on the back, to take us to a meeting or two, to do numerous little kind and thoughtful acts in our behalf."

Dag Hammarskjold's prayer says it best: 

"For everything that has happened; 'Thanks'.  For everything that's to come; 'Yes'." 

 

 

 

 

Middle Class Folks Deserve Help Too

In New York State, if you're middle or upper middle class and wish to seek outpatient care for alcoholism/addiction the deck is stacked against you.  If you're a parent, spouse or child of an alcoholic/addict it's even worse.  Despite giving lip service to  the fact that alcoholism is an illness that severely impacts both the alcoholic and family, our State wide system of care has morphed into an adjunct of the social service, criminal justice and indigent care systems.  It's primarily about public health, harm reduction, decreasing incarceration and social services combined with chasing Medicaid dollars and public funding.

According to the New York State Office of Alcoholism and Substance Services 5 Year Plan only 12% of patients in the entire system pay through commercial insurance.  12%!!!   Not surprisingly, there is no thought, let alone mention, of this being a crisis.  The biggest "under served population" in the State is middle and upper middle class families with alcoholism and addiction.  It's hard for an alcoholic but harder for families.  The median level of admission for family members in outpatient facilities in Upstate Urban Areas is ZERO.  No matter the payment source treatment providers just ignore them. 

It's no wonder why physicians and hospitals don't identify and refer patients with alcoholism/addiction into treatment.  New York State has created a structure that's an adjunct to the criminal justice and social service systems rather than a partner with medicine.  A physician or mental health provider in private practice won't refer a middle class professional or worker to an agency that is overwhelmingly composed of patients who pay through Medicaid or indigent assistance.  What makes this sadder is that middle and upper middle class persons make up the majority of those suffering from alcoholism and the medical field contains the largest pool of patients in need of our care.

"Middle class folks deserve help too" should be the mantra of those who believe alcoholism/addiction is a treatable illness that also impairs families.  At Alcohol Services we've made a decision to stay small, not accept Medicaid and provide quality care to middle class people.  We know we're outside the mainstream and the regulatory system is stacked against us but it's worth it when patients say they didn't think they'd feel comfortable and connected in treatment.  

It makes one wonder when our system is working hard to create the very stereotype it claims it's working to dispel.   

 

Controlled Drinking?

Now I may be wrong, but it seems to me that the only reason a person has to control something is because it's already out of control.  There are many tips and techniques people use to "control" their drinking: switching from liquor to beer, limiting drinking to particular times, avoiding certain drinking buddies and having every other drink be water are just a few.  Underneath it all is a sense that drinking has become problematic on some level and needs to be reined in.

Why work so hard?  Is there any other area of your life that has to be so contained to avoid problems?  Why not just stop?  Is there someone you could be honest with about what you get out of drinking and why you're continuing to drink despite having to place restrictions on it?  Perhaps the most fearful answer is "Drinking used to be magic but now the magic comes infrequently and I can't imagine stopping completely.  The few times that it works makes me keep hoping."

If recovery from alcoholism is simply about not drinking and doesn't provide a wonderful life that replaces and improves upon the lost "magic" then many will quietly decline the opportunity.  One way to look at controlled drinking is a person's desperate attempt to recapture the lost "magic" while trying to minimize the problems and damage drinking is causing.  Saddest,  this struggle is usually happening in isolation.  High risk drinking and alcoholism can't tolerate in depth honesty.  Conversely,  a quality recovery and freedom requires in depth honesty.

It never occurs to people who don't have alcoholism to wonder if they do.  If you're making efforts to control your drinking maybe the question has changed.  "Prove to me that I have alcoholism." has shifted to "How can I prove that I don't have alcoholism.".  One of the things we can do at Alcohol Services is provide an opportunity for you to explore those questions.  In a caring environment you can talk about your drinking, what role it plays in your social life and how your loved ones feel about it .

 When they first come to us to talk about their drinking many discover how  difficult it is to be open and how easy it is to minimize the amount and impact despite their good intentions.  That discovery is a gift.  The dissonance one experiences when he seeks someone to talk with about his drinking then is unable to be honest with that person is often the start of surrender and acceptance.

Many are reluctant to stop drinking because they fear losing something.  Those who stay in recovery do so because they've found something.  Maybe it's time to give up solitary efforts at control and get some help figuring it out.  What have you got to lose?

 

Remission and Relapse

I was having breakfast with a friend of mine who was intrigued by alcoholism, treatment and recovery.  He asked me about "success rates" for treatment.  That simple question created a cavalcade of thoughts.  What's success for a person with alcoholism?  While people are in treatment at our place only a few return to drinking or using drugs.  What happens after discharge is a different story.  The relapse rate is higher.

I was talking to him about a person who returned to drinking after 20 years of sobriety.  He surprised me when he considered that a success.  He explained that to him it was just like cancer.  Due to treatment the person was in remission for two decades before the illness returned.  What a kind way to look at it!  So many in our field would think that the person "failed" as opposed to the disease flared up again.  While it's true that the person who relapsed stopped doing what was necessary to maintain and enhance his recovery, at least he had a number of years  where he was free from the ravages of this illness.  It's not as black and white as I thought it was.

Perhaps Alcoholics Anonymous' notion about not drinking one day at a time is a spiritually profound statement rather than a trite slogan.  In AA members are asked to not drink just for today and in order to do that ask for help from a Higher Power, reach out to another alcoholic and try to be of service.  If that happens tomorrow will take care of itself.  That's a powerful way to live.

The only problem is now that I have some sense of the concept of remission the question of whether recovery is more than abstinence rears it's head.  The cavalcade continues.

Alcohol and drug evaluation?

Alcohol Services has been providing evaluations for people in the Syracuse area who have been concerned about their drinking and/or drug use for a long time.  What about the people who may be concerned about their drinking but don't want to consult with a professional?  Are there any special criteria or formulas people could use on their own?  Is there a test that's "So simple you can do it at home!"? 

Here's one approach.  It's not going to involve stopping drinking completely.  Instead, take a 12 oz serving of beer, 4 1/2 oz glass of wine or an ounce and a half of liquor.  (They are considered standard drinks)  Now, for the next 45 days drink one, and only one, drink.   The key is to drink no more than one.  You don't have to finish it but you can't exceed it.

With alcoholism it is easier to stop drinking completely for a period of time than it is to have only one.  The technical term for it is "loss of control".  That doesn't mean a person gets drunk every time he/she drinks.  Instead, it means a person with alcoholism loses the ability to predict how much will be drunk once drinking has started.  It's like the Lays Potato Chip commercial where the person is challenged with the dare "Bet you can't have just one!".  

So there it is.  If you were able to follow through on your commitment and drink one drink a day for 45 days then maybe you were just drinking in a high risk manner and it wasn't alcoholism.  The next step would be developing a low risk manner of drinking which is no more than two standard drinks for a man and one for a woman per occasion.

If you weren't able to drink only one then there's a good chance you've lost the ability to control your drinking and you should come to a place like ours for an evaluation.  "I changed my mind" "My friends were in town" "My favorite team was in the Super Bowl" are all code for "I can't keep my commitment when it comes to drinking".  People in AA have two sayings that capture this: "One is too many and ten aren't enough." and "It's not the fifth or sixth drink that gets you in trouble; it's the first one."

Finally there's one last thought to leave with you.  The only people who have to control their drinking are people whose drinking is already out of control.


I vs We

Why does Alcohol Services place such a premium on recovery groups? This question is especially relevant in an era where focus is on finding the right addiction medicine, teaching ways to change one's thinking about drinking, recognizing drinking cues and individual empowerment. While these are important they pale in comparison to developing and belonging to a recovery community. There is something special when one alcoholic breaks through the isolation of another. "Sharing your story" helps not only the speaker but the listener. Ernie Kurtz once described AA as based on the "shared honesty of mutual vulnerability freely acknowledged". That's what we try to create for our patients.

Group therapy is not to provide education or one on one counselling in front of an audience. We try to create an environment where members attempt to stay sober and enter recovery together. Members who have been sober for a while help newcomers. They reach out and show how they were able to stop drinking and begin a program of recovery.

Here are the magic phrases: "Yes, me too." "You're telling my story." "How did you know?" "If you can do it maybe I can too."

In essence we try to create a structure where a community can develop and create an environment where recovery can happen.