By Dr Adi Jaffe
My name is Adi, and despite my years of struggling with meth addiction, I am not an “addict.” I’m a father of three, doctor of Psychology and addiction specialist who used to be addicted; I don’t buy into the idea that I am powerless over any substance or external addictive force.
But that wasn’t always the case. For years, I accepted the tired notion that once an addict, always an addict.
I started drinking at 14 years old and smoking weed at 16. By the time I got to college, I was drinking and smoking weed every single day. I then started using meth recreationally, which quickly snowballed into a pretty serious addiction. To pay for my expensive habit, I began selling drugs.
My world came crashing down when a SWAT team busted into my room with guns drawn. I had a gun next to my bed, so it could have gotten worse.
Following my arrest, I went to court-ordered Alcoholics Anonymous and entered a residential rehab. I subsequently spent a year incarcerated.
The moment I relapsed, I felt an immense amount of shame.
A while after I was released, I relapsed. My parents had already spent thousands of dollars on lawyer fees and rehab (a privilege I acknowledge), and the moment I relapsed, I felt an immense amount of shame. Never mind that I had been sober for nearly a year before I served my jail sentence—that’s what gave me the chance for a reduced sentence—or that I had managed to get my meth addiction under control through my own efforts.
Because of the condemning rhetoric of AA’s tenets, I not only felt shame about my slip-up, but truly believed I was powerless over my addiction. This belief kept me feeling small and stuck long afterwards—even after I started pursuing my graduate degree in Psychology.
It was there that I met my now-wife. I wish I could say it was happily ever after from then on, but that was not the case. Though my meth addiction was behind me, I’d never really addressed the factors that drove me to begin using in the first place—like the immense social anxiety I felt being the new kid in school.
Because I’d never dug deep into my past or acknowledged my toxic coping mechanisms, addiction reared its head again—this time in the form of sex addiction and infidelity.
That was 10 years ago. I no longer do meth or struggle with sex addiction. But it’s not because I think I’ll go overboard and throw my whole life away after taking one hit or watching one porn video. I just don’t have the desire.
Abstinence will quite likely come, but aiming for it should never be a requirement for getting help.
I will occasionally have a glass of wine with dinner or take mushrooms with friends (a 12-step no-no), but abstinence is simply not a goal of mine. Nor is it something I require of my clients who are currently struggling with addiction. Abstinence will quite likely come once the client has worked through their traumas, triggers and unhealthy coping mechanisms. But aiming for it should never be a requirement for getting help.
Why? Because recovery is not a linear process. Nor does it look the same for everyone. The more we try to shove people into the same recovery box, the fewer people we will actually help. Many people don’t even want to try recovery because they don’t want to fail. Those that do will likely relapse, sending them into a pit of shame and blame.
For anyone reading this who still considers abstinence to be the only way out of addiction hell, consider the facts: According to SAMHSA’s National Survey on Drug Use and Health, an estimated 21.2 million people aged 12 or older in the US were in need of substance use treatment in 2018 (of whom almost 15 million had an alcohol use disorder). Only 3.7 million of these people received treatment of any kind, however.
It’s clear from these statistics that far more people struggle with addiction than receive any form of help. Though shame and stigma are major barriers to treatment, I believe mandated abstinence—the requirement to quit alcohol and drugs before entering traditional treatment programs, and to set abstinence as your goal after you do—is just as much of a deterrent.
So what’s the solution? Options.
Among those who seek help, anywhere between 50-90 percent “fail” by the abstinence measure within a single year, with substantial evidence of under-reporting of actual drinking in self-report studies*, suggesting actual rates might actually be substantially higher. So what’s the solution?
Options. Giving options is the ethical, appropriate and effective thing to do.
A personal treatment plan that includes individualized goals and nuanced measures of “success”—concerned with wellbeing, rather than abstinence—can make the client feel more connected to the treatment provider and less resistant to treatment. This will open vital communication channels between staff, clients, alumni and treatment centers to follow up or receive additional help.
To summarize, here are five outdated ways of measuring recovery:
1. Number of days sober. When we measure recovery success as an absence of relapse, we are setting people up for failure. Estimates suggest that as many as 90 percent. of people struggling with an addiction who seek help and complete an addiction program will relapse after treatment (many within 30 days). And those are the people who actually complete the program. What does this say about current treatment programs?
2. Absence of addiction medications. The people who object to medications like methadone and buprenorphine argue that you are just “replacing one drug with another.” But for people with opioid use disorder, long-term use of these medications is demonstrated to greatly increase chances of survival. It’s pretty hard to undergo treatment if you’re dead.
3. Powerlessness. The first step in AA is admitting that you are powerless over your addiction. This is not helpful. The notion can become self-fulfulling, and exacerbates the negative self-talk that is rampant among many who struggle.
4. AA membership. While AA has helped many, and there are some good aspects of the program (such as group support, and the fact that it’s free), I’ve found that it also greatly perpetuates shame for many more of its members. I believe that AA membership should be seen as an option, and that we should stop sending people to AA because participation there is seen as an essential part of recovery. There are many other programs out there that address addiction with less dogma, and people should have a choice. Research certainly shows that social support is a powerful aid in recovery, but providing more options would allow more people to benefit from this powerful tool.
5. Breaking your physical addiction (dependency). Just because someone breaks their physical addiction doesn’t mean their quality of life has improved. There are many more variables that should be accounted for, like daily functioning, criminal involvement, social integration, and more. What if an unemployed man who drinks seven nights a week and is cut off from his family and arrested regularly is able to cut down his drinking a bit, maintain a job, earn an income and keep a roof over his head while staying out of jail? Shouldn’t that be measured as success compared to the alternative—a man who is in jail, has no job, money or home? The answer is a resounding yes.
When you only focus on the addiction as the main problem, you’re neglecting the potential pain beneath the surface. As Gabor Mate says, “Ask not ‘why the addiction?,’ but ‘why the pain?’” At IGNTD, the recovery program I founded, we seek primarily to get to the root of the problem.
It’s time to stop marking recovery by saying how many days in a row we’ve been sober.
We need to move away from these and other outdated ways of measuring recovery. The point of recovery, after all, is to allow people to achieve a way of life in which they are happier, more satisfied, and operating as functional members of society.
As helpers, if we are only measuring “success” by consecutive days sober, we aren’t giving people a lot to be hopeful for.
Here are three things I would recommend measuring:
1. Overall quality of life. Areas that deserve attention include relationships (family and romantic), employment, mental wellbeing, lack of criminal involvement, fun and recreation (yes, life is to be enjoyed), personal growth and purpose, and more. Too many practitioners assume that achieving abstinence will automatically confer benefits in all of these areas. This is a false belief, as I point out in my book, The Abstinence Myth. We know individuals in recovery who are abstinent and yet miserable, and those to whom the opposite applies. It takes work to address each of these areas of life.
2. Percentages of abstinence over a period of time (for those who choose this goal). For instance, a person who has been abstinent for a year (365 days) and then drank for a weekend (three days) would be said to be 99 percent sober over the last year, despite currently having zero consecutive days sober. This measure can simultaneously acknowledge both progress and struggles—for people who relapse, the commonly used system of merely counting consecutive sober days focuses instead on “failure.”
3. Lack of criminal justice involvement. Many people who are new to recovery have found themselves tangled in criminal behavior. While they’ve typically been judged as being deviant for these reasons, it is often heavily influenced by the fact that the drugs they are using are illegal —something that can be laid at the door of those who determine our drug policies, not individuals who are impacted. Yet on an individual level, being able to pull yourself away, even partially, from the hazards of the criminal justice system should be celebrated. This is also where drugs like methadone and Suboxone can help, because in practical terms they allow many people to get their lives in order without a criminal justice threat.