Depression, Addiction and AA

Depression, Addiction and AA

Earlier this week, we all heard the terrible news that Robin Williams had died as a result of suicide. I was very shocked to see this news, as he had been pretty successful in his recovery so far, in the sense that he had managed a long period of sobriety for most of his recovery time. He had fought back to living an abstinent lifestyle, after a short period of drinking which is always something I admire and he seemed committed to this. There were signs that all was not well when he had checked into a rehab recently, as he was suffering from depression, but this can be seen as a rational approach to sorting out his problems and something that many would do, if they had the opportunity and the funds. It is a frightening thought, that somebody who has managed such a long period of sobriety, and who had access to every form of treatment, has died so tragically in this way. It does seem that there were many worries in his life, and it is now apparent, that he had health issues which would cause distress to anyone, but he was actively seeking help for his problems, at the time of his death. I am really sorry that he has gone in this way.

There have been many comments on the subject and the usual arguing on certain internet forums, by armchair counsellors, who are using the topic to either bash or support the 12 step solution that he used, and not discuss what has really taken place. Nobody really knows the full truth, of what finally made life unbearable for Robin, and why treatment did not work for him, in the way it should, or if he was  receiving suitable treatment.

As somebody who has suffered with depression at various times in my life, it has brought me down to earth a bit, and has made me think that I do need to be vigilant about falling into depression again. If this does happen, it is important that I am honest with myself and the people I go to for help about what is really going on with me. Unfortunately, this can be a very hard and painful thing to do and was something I avoided at certain times in the past. Sometimes things felt so unbearable, that I just wanted to withdraw, and not reach out to people for help. When I was that bad, any therapy did not have much effect. I do not blame the people treating me for my lack of progress, at that time. I am grateful for their attempts and small amounts of what they said did have a positive effect. I realise now that they did offer good advice, but I was not in a fit state or motivated to act on it. This was not 12 step treatment (far from it) and is partly why I do not believe that people, who simply think that changing approach to a non 12 step solution, will automatically save somebody, are correct. I do agree that the 12 step solution was not great for me when I tried it, but I did not view it as an answer for depression. Things changed for me over time, and I was lucky that I had some support from different people, through difficult times. There does not seem to be any simple cure for depression, yet many people are always ready to blame health care providers when things go wrong. I certainly think, some care is much better than others, but it is our responsibility to look for a solution that works for us, and to do something about it when it is not. This is a lot harder with depression than with other illnesses, as we are often not motivated to try something new, or may be frightened by changing approach when subject to peer pressure.

Robin-Williams

I have known people kill themselves, both in recovery and in addiction. I have come close myself, and know 2 people who thankfully failed in their suicide attempts, and who now live fulfilling lives. Suicide is a big killer, especially in young adults and I can remember feeling helpless earlier in my life, while presenting a fairly successful exterior to the outside world. I feel that society needs to change before many people will beat depression. There is a lot of emphasis on developing pills and talking about the merits of various treatments, along with arguments about whether depression causes addiction, or addiction causes depression. The solutions will always have limited effect while we live in a society that does not really care about the depressed, or those who have fallen into addiction. We need to make life better for people so they won’t get depressed in the first place and support those who do have problems. In todays economic climate this will be a problem. Many do not have access to decent care.

We also need to look at what treatments are on offer and what is appropriate. Many treatment centers guide people towards AA, but this can be a cause of problems. Many in groups such as AA, are very anti medication and believe that the steps are the answer for everything. Other people blame AA for causing depression and every suicide in recovery. I think neither outlook is that helpful. I viewed AA as a support group rather than any form of treatment when I attended, but I attended through my own choice, without having been introduced to AA through a 12 step rehab or a court. I think that some people who come from 12 step rehabs, view AA as part of their treatment and not a support group made up from laypeople. I had non 12 step counselling sessions that helped with life in general, that were not aimed primarily at beating addiction, as I was not active in addiction when I went to these sessions. I came to view my addictions as a symptom of a very dysfunctional lifestyle, rather than the main problem, that I had to deal with. I had to unlearn some bad habits, which had formed when I was growing up, and once I had done this, I managed to move forward. I think that some people offering solutions, get so wrapped up in the idea that addiction is a disease, that they do not look at other factors that may affect a patient. They have a blind faith in a spiritual solution, that they feel will solve anything. I moved away from AA once I had dealt with my depression and had a reasonable period of sober time.

Here is a rather disturbing section from a website made by AA members which actually goes against what AA itself advises. http://bigbookrecovery.com/now_that.html#solid_alcohol This is the sort of advice that an over zealous sponsor in one of the “cult type” AA groups will tell people. They believe that faith in the steps are all that is required to beat something like depression, and this often causes a dreadful outcome. Here is a section:

Alcohol In Solid Form

Illegal drugs? We should not be taking any illegal drugs. If we had difficulty stopping taking them, some found Narcotics Anonymous helpful (see later section: Other 12-Step Fellowships.)

Prescribed mood-altering drugs? Drugs that are mood altering (eg “antidepressants”) are often prescribed for the symptoms of the alcoholism. This is true even when alcoholism is not named by the doctor as the condition for which he or she is prescribing the drugs; for example, many of us are diagnosed as having a variety different sorts of psychoses and types of depression, which turn out to be the symptoms of alcoholism. (We cannot blame doctors for this for, as it says in the Big Book, we seldom tell doctors the full truth about our condition.) If they are prescribed for the symptoms of alcoholism, then they are to be considered as alcohol in solid form: we must be willing to come off these “chemical mood-changers”, which we are taking as a substitute for alcohol and in our experience are likely to lead to drinking in the future. Some people will suffer from mental illness and conditions that have nothing to do with alcoholism. For those of us in that situation it is important that we keep taking drugs as prescribed. The task then is to distinguish between the two; the Steps will replace the drugs treatment in the first case, but not in the second. As AA members, we are not qualified to make such an assessment. So how do we proceed?

Our approach is taken from another AA booklet, Living Sober, which offers practical suggestions based upon the experience of many members. In the section entitled Avoiding All Chemical Mood-Changers the following paragraph appears that seems to summarise the relevant approach:

As AA members, not physicians, we are certainly not qualified to recommend any medications. Nor are we qualified to advise anyone not to take a prescribed dosage under proper orders. What we can do responsibly is to offer only our own personal experience. {Living Sober, p53}

So here is what we did. We started doing all the Daily Suggestions. We approached the doctor again and explained that we were alcoholics and were now going to AA, and have made a start on the programme. We ask the doctor: “Would it be alright if I came off the drugs if I go to lots of AA meetings?” It is a good thing to keep a doctor informed of any major changes in our life situation that might affect the treatment. This is what we are seeking to do by approaching the doctor in this way.

Usually the doctor will be pleased and either stop the prescription immediately or start a controlled tapering-off. If so, we could proceed happily through the rest of the steps once the have come off them altogether. If the doctor refuses, saying that the drugs are not for alcoholism, then provided we are willing to come off the drugs should the doctor ever alter his or her opinion, then we make a start on the rest of the programme. Periodically we asked the doctor again if we could stop taking the drugs in the light of recent improvements accepting the doctor’s decision each time. It is very important that if the programme is to be a substitute for these drugs then we really must follow all the suggestions of the programme. If we do not then the doctor is making decisions based upon incorrect information and we are taking a grave risk.

Many people who do not have experience of prescribed drugs are reluctant to sponsor those who do not stop taking them reasonably quickly. In the end all any sponsor can offer is his or her experience. For a sponsor/sponsee relationship to work, both parties need to go into it freely and to feel comfortable that it is going to work. No one person is going to be able to help every type of alcoholic and if a potential sponsor feels that something seems far from his or her own experience they might be advised to leave this particular sponsee to others whose experience is better suited to help them.

 

Counsellors, Psychiatrists

The general approach for the majority of cases is for us to discontinue seeing psychiatrists and counselors if you are seeing them for treatment of the symptoms of alcoholism eg alcoholic depression (remember that the Big Book tells us that alcoholism causes manic depression in some people). There is a reasonable chance even if alcoholism is not discussed specifically that the difficulties being discussed with any counsellor are connected with the disease. Also there are likely to be contradictions between the two courses of treatment. AA is a spiritual solution, not a psychological one. We found that the best approach is to decide to do one type of treatment at a time, and see which one worked. We chose between the two. If we chose to do the AA programme, we stopped seeing the counsellor/psychiatrist until we had done the first nine steps. When we had completed the first nine steps, the alcoholism was dealt with and so anything left must be something other than alcoholism and could be dealt with efficiently by the professional (many discover through this process that in fact all our problems whether linked to alcoholism or not are dealt with by the steps).

There are exceptions, when therapy groups or counselling sessions are a condition of the provision of a home (as often happens with halfway houses), or of a job. These should be maintained until the situation arises where we are actually prevented from doing the programme, or are forced to do something that contradicts the programme. At this point we will have to decide between the two. If the counselling is by order of a court, then we must abide by the court’s ruling completely. We are all subject to the law.

In carrying out any of the above, we should always remember that other alcohol services do lots of good for alcoholics; any alcoholic who chooses a form of treatment other than AA may be making the right choice for them, certainly it is not for us to say that anyone is not; even if the alcoholic chooses to drop other forms of treatment and follow the AA programme until they have completed the Ninth Step, it is wrong to say that the other form of treatment has failed: it has performed an invaluable service in helping the alcoholic to understand his alcoholic predicament and so enabling many of us to begin the programme. Always we should be grateful that these other services exist to help us and it is often appropriate for the alcoholic who is choosing to cease treatment to express that gratitude to them directly.

The above piece highlights the attitude of a significant minority in AA, who unfortunately are very influential. I was a member of a group like this for a while, but saw through the idiotic ideas and the stupidity of many of the members, who treated AA as their religion. There are certainly several groups, with these types of views in central London, but their influence has spread to meetings outside. In my opinion this has lowered the effectiveness of AA, and is one of the reasons I walked away. I can certainly see the value of an alcoholic who has had some success in beating their problems, supporting another, which is the good thing about AA, but when the advice being given is like the rubbish highlighted above, then I am afraid AA is certainly not working for the benefit of a newcomer who may have many issues to deal with.

It is very easy to get caught up in one of these groups, as hardcore members often attend many meetings, and will try to steer newcomers to their type of meeting. They often have an unsuitable person as a sponsor coordinator, which is not a usual AA role, who will recommend newcomers who to have as a sponsor. The secretary who chooses the speaker or chair at a meeting, will always be a hard-core member, who the old timers have asked their sponcees to vote for. You will not be accepted into one of these groups unless, you share in the way they want and become a regular member of the meetings that the old timers like. The sharing at these meetings are often pretty sick and crazy and the members would not fit in outside the group.The irony is, that if you get caught up in one of these “this is the Big Book way” meetings, you are probably more likely to suffer problems, than if you attend a few more normal meetings and get some outside help.

I think depression has to often be treated as completely different issue to abusing alcohol. Although the two are connected and one may drive another, a balanced solution involving qualified health care professionals  and not a simple faith-based solution is probably required over a long period of time, if somebody is going to make good progress. Taking the advice of lay people in recovery groups, especially those who are evangelical about a certain solution, is often seriously counterproductive. Stopping antidepressants suddenly without supervision, can lead to big problems after a few weeks when people spiral downhill. People seem to think they are proving something by sharing in meetings that they are not taking medication, as if this makes them more sober. It actually means they are probably unstable and more worried about the appearance they give to others and fitting in with a group, rather than looking after themselves and sorting their life out.

Here are a couple of links to pieces I feel are worth reading about depression.

http://www.substance.com/how-much-did-the-stigma-of-mental-illness-harm-robin-williams/10707/

http://www.theguardian.com/commentisfree/2014/aug/16/depression-disease-loneliness-friends

http://www.theguardian.com/society/2014/aug/15/suicide-silence-depressed-men

http://www.theguardian.com/film/2010/sep/20/robin-williams-worlds-greatest-dad-alcohol-drugs

 

A link to a good piece on rogue AA groups.

http://www.thefix.com/content/cult-aa-Atlantic-Group-Clancy-Pacific-Group-London-Joys2092?page=all

http://www.aacultwatch.co.uk/search?q=joys+of+recovery

An earlier post by me on antidepressants

http://www.recoveringfromrecovery.com/antidepressants-recovery-alcoholism-addiction/

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  1. Good post. However, after becoming uncharacteristically suicidal and depressed after two years in AA, being confused by advice like you shared here, I think the typical AA based advice to others about how to deal with me nearly drove me over the edge. Seemingly everyone in my life started ‘detaching with love’– a therapist and a couple of best friends–the people I really needed validation or acknowledgement from when I decided AA wasn’t working for me– when I reached out in the scariest times, that’s when they told me they couldn’t help me, or that I needed to ‘be working on myself’. Obviously depressed people are no fun to deal with, and that’s a tough problem. They seemed to have come to believe that the relationship itself was bad for me, that I was in denial and not trying or something– when I was desperately reaching out! That there was ‘nothing they could do for me’. This was when i most could have used some simple kindness rather than more 12 step coercion or being called an alcoholic. Nobody wanted to hear that AA wasnt working or was actually depressing for me, and this often made me feel crazy, unheard, and alone.

    • I can certainly relate to what you are saying. I certainly had the type of problems you talk about with some, including my sponsor, but other people were more down to earth.
      At the moment I have a friend I know from my time in AA who is going through a really bad patch and has relapsed again. He is being shunned by everyone in his group, and has no job, so no access to really good treatment. I have talked to him about trying other groups or methods but he does not want to know.
      I had many ups and downs in my time in the 12 step world. It gave me somewhere to go on a daily basis which helped but then I feel that many of the ideas affected me in a negative way. This seems quite common.

  2. Notice I’ve done a lot of different programs and it’s never occurred to me that SMART, or lifering, or rational recovery were depressing like AA was, because they weren’t. It doesn’t depress me to think ‘it’s better not to drink’. Even RR’s zero tolerance ultimatum (which is questionable because addiction can only be self diagnosed, but not so bad because it encourages responsible choice on both sides) isn’t as depressing as feeling that the only place to go is AA, where everything is a symptom of ‘untreated’ alcoholism, even though AA isn’t a ‘treatment’. It’s really crazy making.

    • I did not find other solutions as depressing as AA, because most of them aim at building self esteem rather than making somebody feel guilt. I feel the steps actually moralise addiction, after all step 4 is a moral inventory. This often leads to people ending up feeling depressed.Some people thrive in AA because they put down any success they have in beating addiction down to the program rather than giving themselves any credit. I found the whole dry drunk or untreated alcoholism idea to be really unhelpful. It seemed to be something that was used to get people to conform to a groups ideas. There was no room to speak out against any problems that I found with the program in many of the groups I went to. Others were more tolerant.

  3. It seems that a harm reduction approach is very appropriate in the toughest cases. I’ve been helped most by the people who remind me that there’s nothing ‘wrong’ with me for feeling the ways I do in the situations that I’m in.

  4. I agree harm reduction is a good concept. it is a practical solution that can help many. I really like the Hams network and Kenneth Anderson. Many people are made to feel a faliure if they do not manage abstinence straight away, even if that is not their aim. I think it is a great approach for young people.

  5. I’ve shared my story here before, but will briefly mention it again. I drank abusively as a young adult and at the age of 21 quit and did not drink for another 30 years. Off and on, I too suffered with depression, but managed to stay clean regardless. Then my world fell apart, I lost 4 loved ones in 9 months, including my father, my 32 relationship with my husband ended in divorce, my children were grown, and I moved away to help care for my elderly mother (I enjoy having her in my life, but miss my sons terribly), and finally I did not find employment for a year. My depression hit an all time high and I chose the wrong manner to deal with it by nearly drinking myself to death in an 11 month period. I decided I was going to continue to drink, but responsibly, in moderation. I wanted to quit for a couple of months completely and give my body a break. My withdrawals were so bad it landed me in the hospital and I was referred to rehab. I didn’t have a clue about rehab or that it was essentially going to be an indoctrination into AA. I also didn’t have a clue what AA taught, but it didn’t matter, I could not detox safely, so I agreed to give it a try at the advice of my doctor and counselor. After detox I attended my first meeting in inpatient rehab. I read the 12-Steps for the first time and the first red flag was raised. I didn’t believe I was powerless, I didn’t believe alcoholism to be a disease, and I didn’t believe I had to work those 12 Steps to gain sobriety as I had managed to do so for 30 years without any program. Then the more I learned about the program, as a Christian, it truly conflicted with my beliefs. I spoke with my counselor and indicated my desire to leave. She told me if I left my insurance would not pay for the five days I spent in detox, so I chose to remain. Three weeks into the program they had me brainwashed into believing the “Disease Theory” and most of the other hoopla, but they would never convince me that my God could be whatever I chose, even a door knob if I wished. Fast forward after 6 weeks of I/P rehab, followed by 3 months of outpatient rehab, and 10 months of daily AA meetings, I began asking questions and I wanted to know more about the development of the program, it’s founders, and from whom they based their beliefs. I began research and what I found disgusted me that I was ever sucked into this program. I’m not going to cover that information because that is a personal decision every one must make based on their own findings and I respect the fact that others beliefs may differ from my own. However, I concluded that AA is misleading, manipulative, and, yes, even a cult. I had made a lot of what I thought were friends, so it was difficult for me to leave, but I left for good and I have no regrets. So what does all this have to do with depression? I will try my best to explain! First off in my case I began drinking again because I was very depressed. Of course I realize now that is the last thing I should have chosen. I entered rehab and I honestly thought that the issues that led me to abuse alcohol again would play a large role in my treatment. However, my depression was not dealt with, I only saw my counselor for individual sessions once a week, and instead I was taught some truths about alcohol abuse, but what I consider many falsehoods as well, and for the most part I was introduced to the world of AA. Outpatient rehab was not much better. They had to assign me a new counselor after the first one ridiculed me for still being depressed about my failed marriage, even though my divorce did not even become final till my stay in inpatient. A young, never been married, twenty something telling a 51 year old, married for 29 years, and mother of two children to just get over it. To think me and my insurance were paying for this advice! My second counselor was more my age, divorced, and much more helpful. Originally the AA meetings were somewhat helpful for my depression because they got me out of the house and around other people and I was a lot less lonely. However, from day one in rehab, there was a feeling of darkness in the program I experienced and what started out as a bad case of depression only grew worse. I was sober, with the exception of a few relapses, but I was even more miserable than before I entered treatment. During the 10 months I attended AA meetings, for the first time in my life I was admitted to a mental hospital for treatment of depression on three separate occasions. My last visit was from a failed suicide attempt, also a first in my life. It was shortly after my third visit that I decided to research AA and ultimately to leave. I’m not going to say I don’t have bad days here and there, but I can tell you for certain my depression was gone within a few short weeks of me leaving the program. I believe there are many reasons for the change. First off my counselor dumped me when I told her I was leaving the program and referred me to another counselor who just happens to see some of the faults of AA as well. She too is a Christian and she has helped me so much more than anyone else has been able. However, there is a lot about the program that increased my depression as well. Sitting around on a daily basis hearing people discuss their past struggles and the lows to which it took them, after time, became depressing for me. I also found many of the regulars to be quit critical of themselves, to the point that I found it disturbing. Then there was the one control freak sponsor I had. I’m an independent individual and this woman took things way too far. She treated me like a child. I finally had enough and apparently she did too when she fired me as her sponsee. My sister had come into town and I insisted on going out to dinner with her instead of a meeting, thereby breaking one of her rules, attend daily meetings every day for a year. There came a point where I had read enough of the Big Book that I had some serious questions and I had the nerve to question some of what was written. Big mistake, a couple gave me their 2 cents worth and a few started avoiding me. I also faced a certain amount of ridicule for taking antidepressants as well as pain killers to recover from two surgeries I had during this period. However, I believe what depressed me the most, is just like in rehab, there were times my depression was so bad that I would reach out for help, and as it turns out I was reaching out to some of the wrong people, the AA fanatics. I would share my discouragement in not finding work or how much I missed my sons or another struggle I was working my way through and the responses I would sometimes receive were unbelievable. Apparently, I wasn’t supposed to be depressed anymore because I had AA. Forget about the fact that I no longer had my husband, dad, my son’s nearby, a job, and I was scared to death of how I was going to support myself if something happened to my mother. Questions such as “Are you working the steps, reading your Big Book, attending daily meetings, did you do a thorough inventory or are you keeping secrets, etc…became the norm. On a couple of occasions these people were even more blunt and accused me of not working the program and telling me until I did I would never live the promises. When depressed people reach out this, is not what they need to receive. AA was the last place I needed to be during this difficult time of my life. I was already depressed and the program made it much worse nearly ending my life. Shortly after I left I found work, I eventually got over the fact that all my former AA friends now act as if I don’t exist, I received real help, and am a much happier person for choosing to walk out of the rooms of AA and never return. I won’t even try to speak for Robin Williams, I don’t know his situation, I only know mine. What I can say is that because of my own personal experience, if I learned that AA played a role, it would not come as big a shock to me as the news I heard the day an actor I really admired had taken his own life.

  6. Thanks so much for your post, you highlight many of the problems that people face in the rooms of AA. It is such a shame that people do not get sent to appropriate support groups, when they need help, and AA was certainly not a good place for you.
    Quite a few doctors do not know about alternatives although this is starting to change. Depression is something that is really not dealt with well in AA and can actually lead to relapse or worse. I felt a huge sense of relief when I had left AA and did not have to worry about sponsors or those judgemental people. The very things that were supposed to be helping me in AA were actually the things causing me problems. Most of the people that joined AA around the same time as me have not been very successful. I think we have to take responsibility at times and find a way of sorting out our problems that works for us, and not just go along with a program, especially one with such a low success rate.
    I really hope everything goes well for you in the future.

  7. So true, AA was not good for depression. After time in the program, I almost got the opinion you were supposed to suppress your emotions. This was true not only of sadness, but other emotions, such as anger. I was told in more than one meeting how important it was to contain anger, because such an emotion could lead to relapse. Reality is sometimes we all face anger or sadness, however, we must learn to handle it in a healthy manner. Drinking yourself to death is not the answer, but neither is living in denial.
    It was difficult for me to leave the program because of the friends I thought I had made, but immediately I too felt a sense of release. The Sponsor situation was definitely not for me, as I quickly learned. My father was a retired USAF Captain, and he taught us to be very independent and quit frankly I felt like the program encouraged co-dependence.
    Thank you for your encouragement. My life is going much better today. I found a job I really enjoy, made friends at work, and have the sweetest Border Collie that keeps me from getting too lonely and keeps me active. Interesting thing happened a few months ago at work. There was a young lady who dropped out of the program shortly before me because she too was having problems. A couple months ago she came to work at the same company I work for and we have become friends. She too was treated as though she did not exist after she left the program, so we have something in common and have shared our experiences, which has been beneficial to both of us. I did not know her real well in AA. She was very quit and seldom smiled. She told me that she too was experiencing depression while in AA, but like me, she too was struggling with it before she entered. I’ve seen a whole different side of her at work. She is talkative now, laughs, and smiles a lot, and it’s a good thing to see. Of course, that nice young man at work she started dating shortly after starting the job may play a role in her change as well.

  8. I also have a close friend who left AA a while before me and gave me a lot of help. I think it is a good idea to just get on with life when you are ready to do so. I also find hanging out with people from outside the recovery world is really helpful and brings a sense of normality. Too many people get stuck in a rut.

  9. It would be nice if AA actually encouraged to get on with one’s life instead of telling them they need meetings for life.

  10. That is what I like about SMART Recovery, even though it is secular does not mean they take a negative position about one’s faith. Many people find their faith helpful during difficult times. No one should be forced to religious meetings and told only through a higher power can one be relieved of addiction. Otherwise how would agnostics and atheists abstain? Obviously they do succeed at it as well.

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