Elements of a Good Recovery
Michael G. Brock, MA, LMSW
Recently, at a Downriver Bar Association Meeting, I ran into an attorney I do some work for on driver's license restoration cases, and we had a brief discussion about the elements of a good recovery from alcohol or other drug addiction. He went over some points that he considers, and which he believes the hearing officers also look at when trying to decide who is making a valid recovery. It occurred to me the topic might make a good article. When I got home I jotted down a few traits I thought were proof of positive momentum in sobriety, and I also asked an AA friend of mine what he thought.
The following is a list of traits that the attorney, the AA member, and I came up with. I'm sure the list is by no means exhaustive, and, if you deal with recovering alcoholics/addicts, you could certainly come up with a few of your own. But it is something worth thinking about and discussing with your clients if you handle driver's license restoration cases, because these traits are largely determinative of your client's prognosis, and his prognosis is possibly the most important single factor in whether or not he or she gets their license back.
Sobriety/abstinence from alcohol and other substances is first on the list. This might sound obvious, but every once in a while I run across someone with two or more OUILs who still thinks he can have an occasional drink. Are there some people who "got busted" twice for drinking and driving, but really aren't addicts in the sense that they can't control their alcohol intake? Maybe, but if so, they are the exception that proves the rule. Moreover, the law says they have to be abstinent a year to be eligible to get a restricted license. Then they are usually required to drive with an interlock device for a year before they can apply for full licensure. If they are not substance dependent, why can't they refrain all together as required by law?
Of concern also is the fact that some people think they can use other addictive substances, like Vicodin or benzodiazepines. While these substances may be necessary for some people in some circumstances, it is clearly the case that they are over-prescribed and particularly dangerous for anyone with an addiction history. If your client is taking them, he will have to have a DI4P from his doctor clearing him to take the meds, but even with this document, the hearing officer will be skeptical, as he or she should be. The potential for abuse of these substances is very high. It is also not all that unusual to run across former hard drug abusers who think they can drink alcohol without serious consequences. The obvious stupidity of this position is lost on them; making me think that the denial of the hard drug abuser/addict is substantially higher and that they are less amenable to change than those who have only abused alcohol.
The person who is making a good recovery is not going to want to take anything he does not absolutely have to take. This includes relatively innocuous medications such as antidepressants, and even aspirin. They will have a healthy fear of becoming dependent on anything they take, especially something that substantially alters their mood, and they will seek natural methods of mood alteration, such as exercise and meditation.
Improved physical health and emotional stability are next. The list of physical illnesses caused by alcohol and other addictive substances is endless, the most commonly known are hypertension, liver disease, congestive heart failure, pancreatitis, esophageal varices, sexual dysfunction, cerebellar degeneration, and cancer. Many of these are reversible if the alcoholic is willing to abstain completely. Some conditions related to IV drug use are chronic, such as HIV infection and hepatitis B and C, though they can often be improved through proper medical management. Most substance abusers are also smokers and generally experience a remarkable resurgence in health and overall well-being if they are able to overcome their addiction to cigarettes as well.
The current fad for diagnosing anyone who ever had a mood swing, or who demonstrates socially unacceptable or self-destructive behavior as a bipolar mood disorder notwithstanding, only a small percentage of substance abusers actually have diagnosable psychiatric disorders. Most disturbances of mood and behavior in this population are directly tied to the effects of substance abuse/addiction, and are ameliorated by a recovery that includes a positive support system and a systematic effort to live by positive principles.
It is also clear to anyone who has ever been involved in the treatment of the addicted population that when a client is a true dual diagnosis, the addiction of diagnosis is primary. No addict recovers from addiction by addressing their mood disorder as primary and hoping the addiction will go away. This is a myth left over from the Freudian era that says to understand the underlying problem is essentially to effect a cure. The current universally accepted model of treatment is an eclectic mix, with the dominant feature being cognitive-behavioral. In the current jargon, "If nothing changes, nothing changes." Or, in the words of psychiatrist Abraham Low, "We must move the muscles to reeducate the brain."
A substance free environment is another important element of recovery. AA members tell newcomers to "stay away from wet faces and wet places." Humans are social animals and few if any are self-directed to an extent that they are not influenced by their environment and the people in it. Going to the bars to drink a coke is comparable, my AA friend says, to "going to the whorehouse for a kiss." One aspect of AA's success is that it offers an immediate and extensive alternative to the drinking environment. But AA is by no means the only alternative to the drinking or drug-taking environment. Many people have strong extended family networks, church affiliation, and friends for whom drinking is just not central to their lives. Even for those who choose AA, it is not wise to make this group their entire social life. Rather, it should be a launching pad into a normal life, involving a variety of activities and interests which may have been ignored when the focus of life was abusing substances. A rebuilt life is a good indication of quality sobriety/abstinence.
Toward that end is involvement in sober social activities. Many of the people I see for treatment or evaluation become health and fitness buffs once they quit drinking and/or doing drugs. Some of them even run marathons. Even if they don't, they tend to take better care of themselves once they sober up, and they consciously or intuitively look for activities that don't involve the use of substances. AA has a lot of social events for their members, including picnics in the summer and conferences with speakers, meetings and dances. Some of the young people's groups organize activities, and there is even something called, "Sober Vacations," which provides trips and cruises for those who want the adventure of travel and the experience of other cultures without the pressure or temptation to drink alcohol to "fit in." There are also spiritual retreats organized through churches or specifically for the recovering substance abuser.
Many everyday activities can involve alcohol or be alcohol free, depending on the people one does them with. Ballgames, dances, bowling leagues, dinners, movies, plays, concerts and barbeques are all activities that can be done with or without alcohol. There might be people drinking at many of these events, but if the people one goes with are not drinking or using other substances, the peer pressure is to remain sober. At some locations, like churches or the gym, it would be rare to find someone using any kind of substance. People who are serious about recovery will either find sober activities, or go to events with others who don't drink, or drink very little. Socializing with old, heavy-drinking/using friends is generally a precursor to relapse.
People making a good recovery generally have better relationships with family, friends and significant others. AA cofounder Bill Wilson once wrote, "[i]t is from our twisted relationships with others that many of us have suffered the most." Every addict, family member, employer, spouse, friend or child of and alcoholic or other substance addict knows that this is the case. Much of this damage can never be undone, but much of it can be. The amends steps, eight and nine in the AA program, are devoted to repairing the wreckage of the past so the person in recovery can move on without guilt or remorse. Sobriety and a positive lifestyle foster improved relations with family, friends, significant others, and society at large; and recovering people will typically discuss these improvements with a profound sense of gratitude.
Better job and/or better job/school performance are also frequent indicators of a successful recovery. Every employer knows that one of the most common causes of absenteeism in the work place is substance abuse. And every employee knows that he or she does not function as well drunk, high, or with a hangover and he does sober. Recovering substance abusers will typically report better employment adjustment, including more job satisfaction, and, frequently, positive feedback from their employers, as well as job promotion or a better job as the result of abstinence. They also frequently return to school to obtain more education, or training to improve existing skills, or to learn new skills and find a new and more challenging career. Reports of this kind of life improvement are good indications that the person is making a valid recovery, and hearing officers know that.
Recovering substance abusers often report reordered priorities, including genuine concern for others. Addiction is a selfish disease. One might argue that the pursuit of pleasure is selfish in itself, but most people are able to keep the desire for pleasure within manageable limits. The addict is not. The desire for pleasure is overwhelming and insatiable; blotting out in large part any concern he might have for the welfare of others. The ability to genuinely care about the plight of others and, specifically, one's effect on others, is a very good indication that recovery has gone beyond mere physical abstinence and has become the foundation for a more productive life. Recovering people will often express gratitude for not having killed anyone while drinking and driving, and have a healthy concern for all the "yets" still out there-things they have not done or consequences they have not yet experienced that could and probably would happen if they were to relapse. Moreover, they will express a desire to make a positive contribution to their society and not just take up space on the planet.
Recovering alcoholics/addicts have realistic goals and are commitment to achieving them. Experience teaches that it is not enough to experience pain-even extreme pain-from addiction. If there is to be any hope of a permanent and lasting recovery, the person will have to want something more than they wanted to get high. Those who do frequently have energetic and specific plans for improving their lives, involving education, employment, business, marriage, family, housing, transportation and retirement. They like having more money in their pockets and more time for productive activities. Their lives will indicate that they are in it for the long haul, and they will express the understanding that their goals would not be achievable if they were still drinking/using. They know that any progress they had made would be given up if they were to relapse, and they are typically grateful to have seen the light and been shown a way to change course.
Spirituality, broadly defined as a belief that life has meaning and purpose, is another characteristic of those who are committed to recovery. It's no secret that AA is a spiritual program, but the specifics of one's theology are left to the individual. Many people rely on traditional religion for their support, while others have no belief in something that could be defined as God. However, as Victor Frankl pointed out in Man's Search for Meaning, all people need some kind of faith in the basic meaning and purpose of life to remain positive and to carry on in the face of life's difficulty and adversity. This is particularly true for anyone struggling with addiction, and most will readily talk about their own unique discovery of this meaning and purpose in their lives.
Recovering people display clarity of thinking and purpose. A person making a valid will recovery will know where they are going and how they are going to get their. They will be able to say what their life is about; their thinking will be clear and not muddled. They may express regret over past mistakes, but they will not wallow in remorse. They view their mistakes as learning experiences, and move on, looking toward the future and making the most of the present. They assume full responsibility for their actions. Anyone hoping to make positive change must see their role in the creation of their own problems, and must take responsibility for changing that which is in their power to change.
If they are still blaming others for their difficulties their focus is outside themselves on things they can't change. This is a completely untenable position for alcohol or drug addicts, leading the AA co-founders to observe that, when it comes to destructive emotions inclined to trigger relapse, "Resentment is the number one offender. It destroys more alcoholics than anything else." Whether in or out of AA, the person making a valid recovery will focus on his or her part in both their illness and their recovery, and will demonstrate this understanding though changed behavior.
It is impossible to divorce self-esteem from behavior and if one would have better self-esteem, he or she can only obtain it by demonstrating self-respect through self-control. Self-control is often motivated by a spiritual awakening or other philosophical change, but if it is not demonstrated by a change in behavior, it is essentially theoretical, as famously expressed in the New Testament in the Book of James . In recovered alcoholics and substances abusers, self-control is demonstrated first by abstinence, and then by more manageable and productive lives. Positive behavior, self-respect and self-esteem create a vitalizing cycle that motivates increased positive changes and replaces the vicious cycle of addiction, demonstrated by poor self-control, lack of self-respect, and low self-esteem.
Many people are of the opinion that AA is essential to prove that a person who is substance dependent is making a successful recovery, but that is not our experience. The reason AA is the preferred course is that it addresses all of the above issues. Moreover, AA members don't feel a need to convince the hearing officer they don't have a problem. Non-AA members often don't see that such an argument is counterproductive. It invites the response of, "You don't have a problem? It's a problem for the other drivers on the road if you're under the influence! And if you don't have a problem, how can you have a solution?"
Hearing officers are generally quite knowledgeable regarding addiction and recovery and they expect to see tangible evidence of recovery in the prognosis section of the evaluation. They will also most likely ask questions in the hearing aimed at discovering whether there is a change in lifestyle sufficient to escape what I call the gravitational pull of the substance abuse/dependence "milieu." The client must be prepared to satisfactorily answer these questions if they are going to make a "clear and convincing" case that their driving privileges should be restored.