By Ben Spielberg
I have a feeling that things used to be much more simple in twelve-step groups. One was either strictly sober (being defined as not using any mind-altering substances), or not sober (thus defined as using mind-altering substances). Both rhetorically and realistically, this doesn’t make a whole lot of sense. For instance, there are substances that alter the mind as a secondary response. There are millions of people who suffer from chronic pain (a condition in which the mental anguish is comparable to a mind altering drug). There are people who suffer from anxiety and depression, taking mild SSRI’s in order to preserve neurochemical and emotional stability. And there are people who do not “live” sober.
Tackling the issues one by one, I will start with the least complicated of the three: anti-depressant medications. In numerous circles of AA--as well as a variety of treatment centers--people are not allowed to take these. In fact, even if they have abstained from heroin, crack cocaine, marijuana, or PCP for years, they would still be considered “not sober.” The idea of Wellbutrin being equivalent to a relapse probably originated over 30 years ago, when the common medical treatment for addiction was the use of benzodiazepines such as Valium. Such is not the case any more, and people need to be reminded that the use of anti-depressant medications is for the safety and sanity of the members of Alcoholics Anonymous, adding nothing to its detriment. To clarify, it is my professional opinion that SSRI’s are fine to take as members of Alcoholics Anonymous. If anyone has a problem with that, refer them to this blog.
And then, there is the issue of pain management. Grunge artist Kurt Cobain was famously pitied after his overdose because he suffered from a lifelong stomach condition (admittedly painful, but still no excuse for leaving a child behind). What is an opiate addict to do when they are in so much pain that every movement, action, and even thought makes them cringe in agony? Surely letting them sit in misery brings upon an identical life to the alternate, substance dependent lifestyle. Personally, I could see the argument that weak opiates would be a medical necessity for people like this. Please keep in mind that when I say “weak opiates,” I mean something like Tramadol, and not “only half a shot with barely any coke mixed in.”
Part of the argument against this method of treatment is that it borders so close to “waking up the dragon,” meaning that taking these chemicals reminds us of the uncontrollable feelings we used to have in our active addiction, making it harder to maintain sobriety after admitting our powerlessness to the very chemicals that were just ingested. This is all notwithstanding the issue of actual maintenance--the “harm reduction” approach. If addicts can just maintain the same dose of Suboxone or Methadone every day and otherwise remain sober, does it “count” as being sober? The argument goes both ways. A stereotypical AA person may say that drugs like these are powerful narcotics that change perception sans euphoria. A proponent for harm reduction may say that these powerful narcotics don’t effect active addicts that same way that they do people with no tolerance. Somebody who works a very good program would most likely tell both of these people to stop taking other peoples’ inventories.
Finally, there is the highest form of the blur: living sober and acting sober. At Beit T’Shuvah, this is the most commonly addressed form of sobriety (and relapse). I have been sober 848 days today. In the past 848 days, I have been around people on drugs. I have touched marijuana with my bare hands and I have taken weak opiates because of seemingly unending diarrhea. These do not negate my sobriety; they add to it. One has to know where the line exists to find where it blurs. I called in sick to work the last couple days because of stomach flu and have done nothing but sleep and play video games (what I would consider the worst thing I have done in these 848 days). Sitting around and doing nothing is where I found my blur, because that’s all I did when I was high. In short, be mindful of the split; be weary of the blur.