I can think of no better poster child for the Twelve Step addiction recovery plan than James Frey. This is despite the fact that Frey argued extensively against the Twelve Steps method in his addiction, uh, “memoir” A Million Little Pieces, calling it spiritual nonsense. He wrote, “I’d rather have [relapse and death] than spend my life in Church basements listening to People whine and bitch and complain. That’s not productivity to me, nor is it progress. It is the replacement of one addiction with another.” Frey instead decided he could beat his addiction through sheer willpower.
Soon after, there he was, revealed as a liar and fraud who exaggerated his addiction and melodramatized his rock bottom. If that is recovery through willpower, perhaps that surrendering your will to God thing is looking a little better now. Jody, a recovering gambling and drug addict turned addiction counselor in Benoit Denizet-Lewis’s America Anonymous, at one point rants about the influence Frey may have had on addicts: “I mean, what’s the message of that book? The Twelve Steps are for pussies. Fight everybody. Hold on. Get better on your own. Don’t do anything the treatment center says… If you know anything about addiction, you know that he’s this typical grandiose, un-recovered, wannabe bad-ass… Because if you had to explain recovery through the Twelve Steps in one word, what word would that be? … Rigorous, painful, gut-wrenching honesty. And he couldn’t even be honest about his recovery. What a fucking coward.”
Jody and the seven other addicts profiled in America Anonymous all adhere to the twelve step program, even though their addictions all vary widely. While there is some debate as to what addiction really is, the basic 12 steps developed by Bill Wilson to help alcoholics has been adapted for a large number of other addictions. There is Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous… and even some of these groups have splintered into subgroups over what they believe recovery looks like. Food Addicts in Recovery Anonymous, for example, is a much more structured version of Overeaters Anonymous, defining recovery as adhering to a very structured eating program in which meals are planned out and weighed, and white sugar and white flour are forbidden.
Some believe that only substances that are physically addictive should qualify as the real disease of addiction: alcohol, nicotine, cocaine, etc. But some researchers — the researchers that Denizet-Lewis believes in, at least — say that a wide range of activities can stimulate the brain in the same way that drugs and alcohol do. The counter argument is that these things are not actually addictive, that people are just using the word “addiction” as an excuse for bad behavior. I’m addicted to food, then, rather than I eat too much. Or, I am addicted to sex, rather than I am a cheater. Denizet-Lewis is himself a recovering sex addict, and takes the book’s definition of addiction from Sex and Love Addicts Anonymous: “The use of a substance or activity, for the purpose of lessening pain or augmenting pleasure, by a person who has lost control over the rate, frequency, or duration of its use, and whose life has become progressively unmanageable as a result.”
The Twelve Step program appears to work for the addicts he follows. Despite the high relapse rate of those following the steps in the general public — which many studies put at around 90 percent — no one in the book offers any real criticism of the program. (According to Denizet-Lewis, relapse may in fact be a part of recovery and should be expected rather than taken as proof of failure.) The only problem is that there are not enough Twelve Step programs available in this country, and that treatment centers are prohibitively expensive. Denizet-Lewis writes, “Of the more than 23 million people in this country who needed treatment for drugs or alcohol in 2006, only 2.5 million received it. Joan Ward, a mother of a drug addict from Pennsylvania, summed up the problem this way when she testified before that state’s legislature about the lack of affordable addiction treatment: ‘We can build a better system, or we can continue to bury our children.’” Insurance generally only covers 30 days in residential facilities — if it covers addiction treatment at all — and no treatment center really believes that’s long enough to dry out, break pathological habits, and stabilize a person enough to be sent back out into what remains of their lives.
While pharmaceutical researchers look high and low for a solution to addiction that they can profit from, the only really effective treatment that keeps addicts from self-medicating might involve a total restructuring of society. In experiments, a Simon Fraser University professor of psychology, Bruce Alexander, took rats addicted to morphine and put them in “Rat Park Heaven” — a large residence with lots of toys, space to move around, beautiful scenery, and other rats to socialize and breed with. It worked. The rats shunned the sweet morphine solution offered by the scientists and instead preferred water. The experiment also shows why rehab seems to work, at least while you’re there. Beautiful surroundings, structured days, people to talk to, a total removal from the daily stressors of the world — abstaining from alcohol seems much less difficult.
But for all of the variety of the addictions listed in America Anonymous, the stories of how Bobby, Jody, Todd, and the others became addicted are incredibly similar. They follow the standard storyline for addicts everywhere: genetic pre-disposition plus traumatic event or unstable childhood plus escapist tendencies. The occasional drink to relax or OxyContin before a Friday night out becomes a daily routine; then comes the loss of job, spouse, family, house; then rock bottom; then, and only then, can they admit they have a problem and begin recovery. The Twelve Step programs believe addiction is not just a physical disease — although believing that is important part — but also an emotional and spiritual one as well. You wouldn’t guess it from America Anonymous, but not everyone feels that way.
Olivier Ameisen did not come from a family of alcoholics, nor did he have a particularly traumatic childhood. What he did have was an anxiety disorder, which he had struggled with for as long as he could remember. In The End of My Addiction, Ameisen explains that antidepressants like Prozac and Celexa did not work, nor could he stand the side effects of drugs like Valium and Xanax. Alcohol, however, filled him with a sense of euphoria and self-confidence and as long as he never stopped drinking, he wouldn’t have to deal with the hangover. So while he was able to stay sober in rehab, as long as his anxiety disorder remained untreated he would continue to relapse
But the addiction treatment world did not know what to do with him. When he tried to explain that he was drinking to self-medicate an anxiety disorder, he was told that the drinking caused the anxiety disorder. Treatment centers and the Committee for Physician Health — which was reviewing his license after his addiction came to their attention – demanded that he be completely abstinent, which included any anti-anxiety medication. Because Ameisen’s storyline did not match the traditional narrative of the addict, he had a hard time convincing people that he wanted to change. He was told he just hadn’t hit rock bottom yet, and this after losing his practice, his girlfriend, his associates, as well as all hope for the future, at the same time that he was beginning suicidal ideation. Just how much, he wondered, was he expected to lose?
Denizet-Lewis warns in America Anonymous against trying to find a medical fix for a problem that also needs emotional and spiritual treatment. The addicts he talks to have mostly never dealt with early trauma, and part of their recovery means, as they say over and over again, “feeling their feelings.” Ameisen, however, began to treat himself with baclofen after reading some promising studies and found that it not only stopped his cravings but that it also helped him manage his anxiety without causing overwhelming side effects. The spiritual awakening and learning how to cope on a daily basis are all fine and good, but if there is a physical component to the equation, it must be fixed. He writes, “The fact that every alcoholic seemed to have a preaddiction morbidity [depression, anxiety, or others] like my own encouraged me to think that alcoholism must fundamentally be a biological disease. And because it was a biological disease, it couldn’t just be addressed by willpower or positive thinking: it had to be addressed medically.”
Ameisen believes baclofen can help addicts everywhere, and wrote The End of My Addiction to draw attention to that belief. Whether or not it will remains to be seen. Medical cure-alls for addiction have been touted before, only to disappoint. Heroin addicts still relapse, despite the presence of methadone, after all. But addiction cannot be broken by will power alone, as, Ameisen writes, “there was no shortage of willpower among alcoholics.” But sometimes spiritual awakenings and group therapy aren’t enough, either. • 5 January 2008