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Old 02-12-2014, 01:18 PM
sophos sophos is offline
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Join Date: Feb 2014
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Default Substance abuse and Alcoholics Anonymous

Hi Dr. Joe,

I am currently reading Self-Coaching as part of my dealing with debilitating anxiety and depression. In the section on substance abuse you say:

If you're drinking too much or using any illegal substance, you are contradicting your Self-Coaching goals. You must stop! If you can't, you need to get into a program (there's none better than AA) or at least consult with a mental-health professional.
As someone who uses marijuana and wants to stop, I personally didn't find the Anonymous-type programs helpful. I'm surprised to see you recommending them. AA teaches that substance abuse is a DISEASE which we have NO POWER over, so we must rely on a higher power. This seems to be the opposite of what you say about mental illness earlier in the book:

The program outlined in this book reflects countless hours spent helping patients understand that anxiety and depression aren’t illnesses, diseases, or conditions that you get; they’re nothing more than habits, habits of faulty, insecurity-driven thinking. And as with all habits, if you feed them, they will grow. If you learn to starve them instead, they will wilt and die. It’s no more complicated than that.
So do you believe alcoholism or substance addiction are actually diseases, unlike mental illnesses like depression and anxiety? What makes you recommend AA as opposed to say, SMART Recovery, which is based on CBT principles?
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Old 02-12-2014, 02:47 PM
Dr. Joe Dr. Joe is offline
Join Date: Nov 2009
Posts: 2,015

You're right to point out that AA isn't for everyone. In his book, The Power of Habit (a great read), Charles Duhigg states: "Researchers say AA works because the program forces people to identify the cues and rewards that encourage their alcoholic habits, and then helps them find new behaviors." I've always liked the group support and camaraderie offered by meetings, which I feel is a major component behind its popularity and almost cult like adherence. I do not, however, subscribe to the disease model, at least not as put forward by AA or, for that matter, by the American Society of Addiction Medicine who define addiction as "a primary, chronic disease of the brain, reward, motivation, memory and related circuitry...."

I feel that for many people, there are genetic predispositions (both physiological as well as psychological) that may lower one's threshold to certain addictions—some are more susceptible than other to addiction. Research, however, into the genetic implications of addiction remains in its infancy.

With long term substance abuse/addiction the brain does become altered. Whether it's alcohol, cannabis, opiates or even certain foods, once the receptors in the brain have become altered by an addiction (threshold) you remain sensitized to that substance typically for life. So, yes, from a Self-Coaching perspective, you don't catch an addiction (disease), you implement one. I guess the closest I come to the concept of "disease," is to think in terms of the brain becoming physiological altered, leaving you with an acquired propensity to relapse.

When I work with someone in "program" I do let them know that when it comes to being powerless over their addiction, I have a different take. For me, you are ONLY powerless when you've handed yourself over to indulging your addiction (i.e. when you're intoxicated), at which point the drug is in charge—not you. You are never powerless and should I ever write a third edition of Self-Coaching, I will stress this point.

As for the higher power, I absolutely love the adage, let go, let god. Whether the higher power is a diety, the universe, or as C.G. Jung would call it, the Self (with a capital S). The higher power, from a Self-Coaching perspective is that which goes beyond the ego...this may, in fact, be the instinctual realm of intuition and spontaneous, here-and-now living. Is it a "higher" power or just semantics? "Higher" in the sense that the ego can get bogged down in the contaminated thinking of insecurity causing what I call time-traveling (always living in the what-if future or past regrets). In my practice, I never refer to a higher power, but I do strongly support the let go-let god way of life, i.e., rather than over-thinking, learning to become reactive to life, living more spontaneously in the present moment.

Hope this clears up my stance on all this.

Dr. Joe

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Old 02-12-2014, 10:59 PM
sophos sophos is offline
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Join Date: Feb 2014
Posts: 2

Hi Dr. Joe,

Thank you very much for taking the time to answer my question. This does answer my question, and I will continue to think about this while I read the remainder of the book and implement your advice.
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