Saturday, December 4, 2010

What do studies say about efficacy of AA's 12 Step Program?

A friend of mine, Rajiv Bhole, a self professed realist, linked a story from Washington Post about Lindsey Lohan and the new found fascination with celebrity dependency and dysfunction documentation.  I have some idea of statistical models for measuring treatment success rates, from WHO to Kripa Foundation to mom and pop operations, some of which are outright violations of all things sacred, and usually executed in the name of the very sacredness it defiles.

WP says, "Although AA's emphasis on anonymity makes it difficult for outside researchers to determine its success rates, some have tried. What they have found doesn't inspire much confidence in AA's approach. A recent review by the Cochrane Library, a health-care research group, of studies on alcohol treatment conducted between 1966 and 2005 states its results plainly: "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [12-step facilitation] approaches for reducing alcohol dependence or problems."

Many health conditions resolve themselves through what's known as spontaneous remission -- that is, they improve on their own. In the case of the common cold, for example, nearly everyone gets over the virus without medical intervention. In a 2005 article in the journal Addiction, Deborah A. Dawson and her colleagues calculated a natural recovery rate for alcoholism of 24.4 percent -- that is, over the course of a year, 24.4 percent of the alcoholics studied simply wised up, got sick and tired of being sick and tired, and quit. Without treatment and without meetings.

Why don't we delve into our own Doctus and learn to get better?

Wednesday, October 13, 2010

Misheard Prayer


To whom it may concern sort of prayer, so that when I'm having a really bad day, and it seems that people are trying to piss me off, may I remember that it takes 42 muscles to frown and only 4 to extend my middle finger and tell them to bite me.

Greetings for winter!

A more completely juvenile Serenity Prayer can be found here.

Disclaimer:  No dissing nobody nowhere.

Monday, September 13, 2010

The Politics of Powerlessness

I recently read this description of AA and Al-Anon, and even though it smarted of intolerance and judgmental-ism,  I could not stop marveling at the accuracy of it.

"Lack of religion is a concept I learned in Alcoholics Anonymous, a self help group for people who cannot drink responsibly, and Al Anon, a self help group for people who cannot relate to such people in a responsible manner."

One of the tragedies of modern man is the myth and mysticism of powerlessness.  The growth of organized bodies of thought or belief or ism's has in some ways destroyed the concept of individual empowerment.  Hence, we give in to politicians and government, oil prices and tax regimes, fatwas and confessionals.  We throng the psychology and self help sections in bookstores and libraries and are unable to think beyond the flavor of the month in personal productivity.

As a civilization, we have conditioned ourselves to believe that "power" is out there, and we need to tap into that power.  The AA movement with its 12 steps, which accepts lack of religion in an alcoholic seeking wellness but not the rejection of a God of our understanding, also stresses the absolutes of the Oxford Group through its insistence on total abstinence as a sign of success (regardless of the health of the member in other areas of life) and drinking alcohol in any manner a sign of relapse.  What is the weapon of overcoming the powerlessness that an alcoholic is possessed of?  It is "turning our will and our lives over to the care of God as we understood him."  

The literature of AA also goes on to clarify that all that is required of the nonbeliever is the willingness to believe in a God of his understanding, totally discounting that a person might not have an understanding of a God that he can subscribe to.  This too is a way of saying there is a power out there, and the reason why you are miserable is because you don't think so.

The sick and the suffering are already beaten into a submissive state by their circumstances.  The powerbrokers of religion and many so called self help groups, instead of helping them to rise above their circumstances, use their misfortune and vulnerability to hard sell (in that state pretty much any kind of sell works) their ideologies and dogma, often creating deep rooted conflicts in the mind of the suffering person about sin, guilt, and powerlessness. Faith healing, charismatic prayer meetings, lucky charms, and exorcism are all examples of this.

I myself have benefited immensely from the 12 steps of AA and philosophies similar to AA.  I have also been fortunate to escape largely unharmed from the disempowerment and conflict that such philosophies can give rise to.  All a poet can do is warn.  There are stages in the evolution of personal ethics and worldview, and at certain stages, the unquestioning submission to a philosophy along the lines of bhakti yoga is the best direction for growth, while at others, failing to question, failing to follow one's own heart, can destroy the spirit that spurs us to become all that we were born for.

As one journeys further into the realms of spiritual quest, one is able to see power in its true perspective; not the cacti laden hallucinations of Castaneda, nor the blunt analytics of Russell; not the self righteousness of Prabhupada, nor the militant meditation of the Samurai; that of the oneness of all phenomenon in the matrix of time-space and cause-effect.  Being one with that perception is true power.

Thursday, April 8, 2010

First Steps in Getting Better

Addiction is, by definition, physical or psychological dependence that causes damage to a persons life and environment. That is how it looks from the outside. From the point of view of the addict, however, it is an entirely different story. Addiction is about love, love that sustains itself at any cost, love that doesn't care if Rome burns, love that feels like death in the absence of the loved one. This is precisely what makes addiction so difficult to treat since the therapist and the client are using two different reference points, two different languages, coming from two different planets altogether.

Addiction can involve substances, like drugs or alcohol, as well as behaviors, gambling, shopping, food, sex, pornography, the works. Even relationships with other human beings can take the form of an addiction once it crosses into the realm of dependency at the cost of damage to life and environment. The behavior makes the person feel complete (be it drug-taking or gambling or whatever) and this feeling of completeness is so precious to the self image of the addict that the mind sets up a defense system to block out any attempt to interfere with the behavior. This is called denial.

The food that feeds addiction is shame, guilt, fears, hopelessness, and the addictive behavior simultaneously strengthens these feelings as well as suppresses them with the feel-good factor of the behavior. The first task of an addict who wishes to break out of the addictive cycle is to recognize that the problem is less in the behavior (drug taking or drinking or masturbating or whatever) and more in the food that feeds it. Once the diet is addressed, the need to indulge in the behavior and the fear of withdrawal will be eliminated.

Even in the most drunken or lovestruck state, one can usually come up with a rational list of things that are going wrong in his or her life because of the addictive behavior. If this seems difficult, try the other way round, list out the reasons why the addiction needs to be indulged in. To a large extent the lists will be the same. Addiction makes us feel that the consequences of our addiction are actually the causes of our addiction. This mystic insight can often break the back of the monster called denial. A zen moment for those who upload the correct teaching. I accept that I am in denial!!

Once that is done, and the cost of continuing with the addiction is weighed against the cost of bringing it to an end, the most painful part of recovery comes into play. That of initiating abstinence. I recently had a chat with Shashi Singha, a therapist I hold in high esteem, and we were talking about total abstinence and harm reduction. To the concept of social drinking by a recovering alcoholic, she pointed out that the risk of allowing an addictive behavior to remain present in one's life reinforces the subconscious association of the feeling of well-being and powerfulness with that behavior. She and I have never been able to agree on a host of things but that has not detracted from the respect I have for her.

The first task is to totally put a break to the behavior. This may need medical or psychological supervision. It is best to consult with a qualified professional before attempting this. Qualified professionals come in varied shapes and sizes, and the tragedy of addiction treatment is that most of the professionals are in the profession by virtue of their being recovering addicts and not by virtue of professional training. Of course, most of them are highly qualified as addicts, but walking gulf wars as far as being treatment professionals. Even in the business of recovering from their addictions, like me, they can at best be called trainees. It is often wiser to seek counsel with the mentor within us. For those who are part of a religious or spiritual discipline, prayer for wisdom and strength to do the right thing is often helpful.

The detoxification from an addiction can take anywhere from weeks to months. This is a very vulnerable time, and it is most advisable to stay as supported as possible by loved ones (who will support recovery and abstinence, not enable relapse or substitution with another addiction), to keep one's task list as low-stress as possible, to spread out and defer immediate responsibilities or decisions, to eat and drink healthy, to sleep well and get in moderate but regular exercise.

The predominant feeling as one emerges from the initial pain of stopping an addiction are the very same feelings that drove one into addiction, shame, guilt, fears and remorse. Having to look at the mess that one has made of one's life in the stupor of addictive behavior is very painful. Yet, it is a fact that cannot be wished away. Getting a grip on this reality can prove stressful and often is the cause of a return to the addiction. Being in a protected environment for the first few weeks or months is not a luxury all can afford, and one might actually be forced to look at and address these issues early in recovery. It is essential to do this systematically.

The body and physical discipline comes first. Get back to a regular lifestyle even if it hurts like hell. Sleep regular hours, do not oversleep (the body and mind will crave for the restorative medicine that sleep is, but don't worry, you will catch up on it), go to bed at a fixed hour, stay in bed even if not sleepy, read or listen to music or an audio book if you must. Eat full meals, at regular times every day, and try and get a well balanced diet. Don't worry about food cravings for particular things, if your body needs something, it will ask for it. Stay away from fried stuff and empty calories, get enough fiber, and try and stick a couple of helpings of vegetables with every meal, and at least one helping of fruit a day. Yogurt is a miracle drug at this time. Throw in some exercise as it suits you. A 30 minute brisk walk is better than no exercise. Fix a time for rising, for getting outdoors, for having a bath, for meals. Stick to this physical discipline no matter what. With time, you will no longer need to make an effort.

The mind is next. This is a long story, and will take a long time to address, but remember that the mind is the devils favorite target. When all ways of thwarting your determination fail, he targets your mind and you yourself will start telling yourself that the effort is not worth it. This is the most dangerous moment, when you start wondering if getting well is worth the trouble, when you start saying, now I have it figured out, this time I will walk the razors edge and not get hurt. Beware. This will happen to you. Zen moment again, I know can't get hurt because I know I can get hurt. Start keeping a journal, however rudimentary. There is a vast ocean of things that you will need to sort out, start getting into the habit. Write about yourself, your thoughts, your feelings, your secrets, your regrets, your desires, your debts, your earnings, your commitments, your health, your madness, the list is endless. But getting into the habit of getting your thoughts out of your head and on to paper helps a great deal. What do you think I am doing out here? :)

The body and mind healing is an ongoing process, and as time passes, newer issues will surface and need to be addressed. Having a strong spiritual (you can use the word social or psychological or religious or whatever) discipline is integral to sustaining the recovery that has been achieved in body and mind. It helps to be able to see that the strength for the initial journey was neither from the body nor from the mind but from the desire to become that which we are destined to be. It is not important how you label it or understand it. What is important is to acknowledge it and to strengthen it.

When I started writing this post, I was intending to write about the process of bringing an addiction to a stop and to look at the grief of letting go of something that we are accustomed to, something that we believe is integral to our well-being, but it took on a life of its own and touched on a host of other things.

If you are looking at any issues that you would like to know about or share about, feel free to email me at subhorup at gmail dot com. All the best in your efforts to become who you were meant to be.

Saturday, March 20, 2010

Careless Love

We are quick to profess the depth of our love for people, ideals, things. We rarely question the validity of our beliefs in the light of reason. Addictive behavior is often grounded in a sense of love. Yet this love is often centered around fear, fear of loss, fear of being deprived of the object of our desire. One would think that true love couldnt care less. Then what is the logic behind this kind of love?

The first step towards breaking an addictive relationship, be it with a substance, object, institution, ideal or person, is to identify it as dependence and not love. This is incredibly painful and difficult, since our belief system, our self esteem, our self image, our sense of meaning and purpose seem inextricably linked with the object of our so-called love.

I have had the good fortune of having had to battle addictions for a very large part of my life. I say good fortune for a number of reasons. I have learned in the most painful way possible what a true loving relationship is all about. I have learned, often at the cost of chaos and disaster not just in my life but in the lives of my significant others, to value wisdom, faith, courage and prudence, to delay gratification, to acknowledge the value of pain, and appreciate the gifts of joy and contentment. Heavy stuff!! But truly, that is what it boils down to. In the course of my journey, I have been blessed with fortitude, gratitude, and contentment, gifts not easy to come by.

Pain and fear are at the crux of all addictions, the pain of loss, the fear of deprivation. Once one is able to see what lies at the core of one's love for a particular behavior, relationship or substance, it becomes easy to understand whether that love is life defeating or life enhancing. True love can entail pain as part of the journey, but it will also be accompanied by life enhancing vistas. Our organisms are built in a way that cannot experience the surrender of love to anything or anyone that does not sustain and enhance life.

Why then does a fix of a drug, or the rush of sex, or the thrill of vandalism feel so much like love? If one gets real, it doesn't, but the truth of that reality is so painful, that the mind deceives oneself into only processing the pleasurable short term memories of that experience. The cellular memory pushes the painful memory of heroin withdrawal into the subconscious, and only remembers how good the high feels. The compulsive shoplifter forgets the beatings or the humiliation and only remembers the feeling of power and victory when he emerges from the store unharmed and with a heavier pocket. The body knows the pain of withdrawal, the sex addict knows the hollowness that follows every conquest, the shoplifter knows the consequences of being caught, yet the pain of accepting that reality is so great, the fear of accepting the truth is so strong, that the mind tells itself that accepting that truth is as good as self destruction, and that must not be allowed. Thus starts the web of self deceit that is commonly called denial.

The only way to break denial is to starve it. Starve it of the need to defend itself unrealistically. Starve it by putting it face to face with the deprivation that it fears. This means an absolute and complete break with the object of the addictive relationship, be it a person, place or thing. It is common to seek medical management for substances like drugs or alcohol. For other addictions, a supportive environment may involve forced abstinence from the object of addiction.

The initial period is one of physical mental stabilization where the mind and body learn to relate with the environment without the filter of the object of addiction. While substances are much easier to manage in that withdrawals from them, and stabilization thereof are much more manifest, and easier to measure and monitor, addictive behaviors and relationships require much more intensive, prolonged and careful handling. When an addictive pattern has been established over years, it is impractical to expect it to reverse or disappear in weeks or months.

A lot of treatment protocols, especially in countries where regulation of mental health services are lax or missing, involve forced abstinence and involuntary confinement. Is it right? At the cost of being considered insensitive to the plight of affected families and loved ones, I will loudly say, no. I am aware of many cases where the patient is incapable of making choices that will save his life and spare the lives of his family, and it may seem the more humane thing to do. I will still hold that there are professional interventions that can be arranged that will allow a person the right to choose a life saving course of action.

Abstinence from the behavior is not treatment by itself, it is only a starting point. It is not always essential that one need to undergo formal confinement, therapy or treatment in order to overcome an addictive pattern. However, it would appear to be the most useful and one that seems to assure some certainty of long term health.

My experiences in India, in Kolkata, Mumbai, and Hyderabad, with treatment modalities, interventional approaches, as well as self help groups, including the 12 step fraternity, have shown me that most protocols presume a return to the addictive pattern as an essential part of the process, thereby assuring that the afflicted addict never gets to look at a life where he can rise above the addictive patterns he is already crippled by.

The most basic premise that all treatment protocols work with is that addiction is a disease of relapse and the recovery from addiction has to center around building a behavior pattern that prevents a relapse. If the foundation is based on accepting the futility of trying, however much one builds upward, collapse and failure are already built into the system. One needs instead to look at understanding the addictive pattern in the relationship, in the love, in the longing, and to re-evaluate it in the light of reason and faith, through the filter of values different from those that led to the delusion of love in the first place, and to replace those patterns with patterns that will contribute to life and not detract from it, that will lead to victory for all, not misery and defeat. This cannot be done overnight or with a few weeks of therapy. This has to be hand held by a long term commitment to battle our old brains, to challenge our darkness, to risk venturing into the light, and to shiver and thrill in the joy of being the light.

Mean Business, or Secret Chords, is simultaneously my efforts to heal from my addictive patterns and to be the light to those who are on their way. I have been processing this for way too long and it is likely that when I write, I may have taken some things for granted as accepted or acceptable to the reader when it really might be vague or poorly communicated. Please do let me know if there is anything I need to be more explicit about.

If you are a person with questions about addictive behavior, please share your journey here. you can post a comment or you can email me at subhorup at gmail dot com.

Monday, March 8, 2010

I Want, I Want, I Want (hushed - to break free!)

We all have desires – it’s part of the human condition.

We want to be loved, to have friends, to experience joy, to have security.

But a desire for things is not as natural as we’re often led to believe. Sure, we all have desires for things: nice cars, nice clothes, nice houses, cool computers and iPhones, beautiful furniture and notebooks and shoes and jewelry and bags and bikes and on and on.

But these desires are manufactured in us, by advertising and marketing. They play on our natural instincts: for hoarding (security), for the pleasures of food and drugs and sex (desire for joy), for fitting in with clothes and bikes and gadgets (desire for friends), and so on.

Desires like these lead to all kinds of problems — in fact, all the problems of modern society. They are rooted in the immense power of corporations in our society, and their drive for massive profits. Problems result that include obesity and related diseases, massive consumer debt, shallow consumerism, overwork (to make money for all these things), lack of true human connection, and more.

And while desires are perfectly natural and unavoidable, if we can learn to let go of the manufactured desires, we’ll start to free ourselves from the chains of consumerism.

Start to become aware of these desires – recognize their signs in you. Pause before acting on them. Take deep breaths, go for a walk, get some perspective. You don’t really need more things, and buying is not the answer. Make do without and find happiness without more stuff.

Let the desire go, and feel the lightness, the freedom. Become liberated from desires, one at a time (not forever, but for the moment). You’ll love it.

This post comes from

Hoarding Disorder in DSM-V

from a feed elsewhere

The Diagnostic and Statistical Manual of Mental Disorders is currently under review by psychiatrists and other mental health professionals for its fifth edition (the DSM-V) before its official printing in 2013. Included in the draft of the DSM-V is a new section on Hoarding Disorder, listing hoarding as its own diagnosis separate from Obsessive-Compulsive Disorder.

The disorder is identified by five characteristics, the first three being:

A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.

B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

The third point, that the hoarder is incapable of “maintaining a safe environment for self and others,” seems to be the dividing line between hoarding and chronic disorganization.

Hoarding also appears in multiple places in the document as a symptom of other disorders. According to the Hoarding Disorder entry in the DSM-V draft, hoarding can also be a symptom of Obsessive-Compulsive Disorder, Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, and food storing in the Prader-Willi Syndrome.