How I know I’m an addict/alcoholic…

This is actually a very important topic and something I need to revisit every day or I will undoubtedly listen to the voice that tells me (at least several times a day, sometimes in a whisper, sometimes a deafening scream) that I am not…And that I can, in fact, drink or use in moderation.

Over the past several months, as a consequence of starting on Campral (which is a medication designed to curb cravings for alcohol, and I’ve found works similarly for other cravings, like food binging), it has been increasingly difficult to convince myself I am an alcoholic. Why? Because when I slip and drink now, I actually AM able to stop after “only a couple.” Campral appears to help with preventing my ‘MORE MORE MORE’ switch from getting flipped as soon as I have ‘just one.’ It’s not a cure and it certainly doesn’t stop me from making other poor choices as being under the influence to any degree causes disinhibition, but it does temper my prior need to satisfy the ‘ALL’ on my all-or-nothing spectrum.

So, as you can imagine, my disease really enjoys this newfound ‘manageability’ and focuses on how because I am able to drink more moderately, I can’t be an alcoholic. Right? Well…, if I force myself to remember the not-at-all distant past and am honest with myself (and others), I am quickly reminded of what makes me an alcoholic. For starters, the fact that I’m f’ing taking Campral. Non-alcoholics don’t usually end up getting prescribed this medication. Oh, um, right. Things got bad enough that I couldn’t control myself on my own, so in addition to therapy, meetings, other psychiatric medication (Prozac), and err, inpatient rehab and intensive outpatient treatment, it was suggested I give Campral a try.

What was that, self? Rehab? Yeah, that’s another thing people who aren’t alcoholics/addicts don’t end up including in their “30 things to do before I turn 30” lists. And if that wasn’t enough, let’s consider in detail some of the additional ways I can be sure, I am in fact, an alcoholic and an addict.

There’s the Diagnostic and Statistical Manual of Mental Disorders IV-TR criteria for alcohol dependence I just happen to fit perfectly (I know, I say I/we can’t do anything PERFECTLY, but this time I’d say I come pretty damn close)…It classifies dependence as:

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
(1) tolerance, as defined by either of the following: (Check)
(a) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect (Check)
(b) markedly diminished effect with continued use of the same amount of alcohol
(2) Withdrawal, as manifested by either of the following: (Check)
(a) the characteristic withdrawal syndrome for alcohol (Check)
(b) alcohol (or a closely related drug such as valium) is used to relieve or avoid withdrawal symptoms (Check)
(3) alcohol is often used in larger amounts or over a longer period than was intended (Check)
(4) there is a persistent desire or unsuccessful efforts to cut down or control alcohol use (Check)
(5) a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects (Check)
(6) important social, occupational, or recreational activities are given up or reduced because of alcohol use (Check)
(7) alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption) (Check)

Then there’s the nice little CAGE questionnaire I can reference to be extra, extra sure I don’t try to find a loophole…

Two “yes” responses indicate that the possibility of alcoholism should be investigated further. The questionnaire asks the following questions:
1. Have you ever felt you needed to Cut down on your drinking? Yes
2. Have people Annoyed you by criticizing your drinking? Yes
3. Have you ever felt Guilty about drinking? Yes
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? Um well, yes, I’ve done that too.

I would actually classify myself as Polysubstance Dependent. In addition to alcohol, over the course of my life (and often at the same times), I have been actively dependent (according to the above criteria) on several other drugs…benzo’s (Xanax, Ativan), amphetamines (Ritalin), opiates (Hydrocodone/Oxycontin), and dextromethorphan (mood-altering ingredient in OTC cough medicines like Robotussin). GO ME.

And now, some personally relevant points to really drive it home.

Note: I am going to use ‘addict’ as an all-inclusive term here, pertaining to those whose substance of choice is chemical (drug/alcohol) as well as non-chemical (food/exercise, people/relationships). It is good for me to conceptualize it in this way because, as I have struggled with all of the above, such a view helps me not to compartmentalize my addictions.

Compartmentalization is a wonderful rationalization tool that anyone with multiple ‘substances of choice’ is apt to use throughout the recovery process …For example, I’m just out of control with food, or THIS particular drug, but THAT one, THAT I can use in moderation…Thinking in these terms only results in substitution and gives me permission to ‘just’ work on my addiction to THIS while in the meantime, THAT is spiraling out of control to become my next THIS. I hope that made sense.

Ok, moving on to a few examples that help me keep my powerlessness ‘up front.’

1. Non-addicts do not feel compelled to keep using until their substance is gone, even after they feel physically and mentally sick from it.
2. Non-addicts do not go to bed at night swearing on everything they love that they will not use the next day and then not even make it halfway through the day before they break their promises and end up using.
3. Non-addicts do not use (to the point of impairment) and drive.
4. Non-addicts don’t seriously consider injuring/killing themselves in an effort to end the cycle (and they don’t steer their car into a guardrail so they don’t have to go to work because they feel so out of control).
5. Non-addicts do not go from store to store, sometimes completely out of the way, in order to prevent store proprietors from thinking they might have a problem (SO many people I’ve seen in liquor stores appear to be alcoholics that I have often wondered what owners/employees think when they see how their business is so obviously contributing to the destruction of lives…no, I’m not saying they are to blame for our use as we have the choice to recover and all of that, but I imagine they have to think about it)…This one also applies to my history of frequenting multiple fast food drive-thrus and convenient/grocery stores to stock up on binge foods.
6. Non-addicts don’t hide bottles (empty or opened) or leftover pills around the house for their next use.
7. Non-addicts don’t use in the morning or in excess, alone.
8. Non-addicts stop using when they experience significant medical issues that are likely the direct result of their use. They don’t, while being fully conscious of the relationship between using and health problems/risks, continue to (frequently) use dangerous amounts.
9. Non-addicts don’t lie ALL-THE-FREAKING-TIME to protect their addiction(s).
10. Non-addicts don’t sneak off from whatever activity they are doing at various points throughout the day to use.
11. Non-addicts don’t use at work.
12. Non-addicts don’t go through people’s medicine cabinets and steal their pills.
13. Non-addicts don’t put their substance before everything else they value and end up losing (or come incredibly close to losing) relationships, jobs, homes, and ultimately lives because they continue to use despite experiencing or facing these losses.

I could go on. And on. But I’m tired and it’s pretty damn clear to me that I am an addict. Well, I said I was going to be honest. Does it make sense why I might have some guilt and shame to work through?…Oh, I guess for those who don’t know, I should add I was doing these things, at times, while working with people struggling to recover from their own addictions…This hypocrisy ate me alive and kept me sick for far longer than if I hadn’t been a professional ‘in the field.’ Because I just couldn’t tell…how could I tell?

An evolutionary perspective on anxiety

A friend (Sean, to give credit where it’s due) just reminded me of a theory I recall learning about in an undergrad psychology course, which explored the hardwiring of anxiety. Before we evolved into our current human form (so as animals), an instinctual tendency to be wary of others and on the alert – at least until we received a sign to indicate whether another was friend vs. foe – was adaptive in our struggle to become one of the ‘fittest’ who survived.

Unfortunately, in some of us (hi, Sean), this system appears to have over-evolved and mutated to the point of us being startled in response to completely benign, non-threatening stimuli, such as when our s.o.’s merely enter the same room we happen to be in…which coincidentally occurred earlier today when I was vacuuming and Kristen came by to tell me she was going out. With my exaggerated startle reflex, I jumped and uttered some kind of primal scream. Yup, my stuff’s mutated.

Organized chaos

Whenever I try to get clean/sober from all my addictions, I become significantly more productive. Especially around the house and in terms of scheduling appointments and just overall managing my life. All of a sudden, I become really aware of how messy and out of order everything is and am subsequently driven by my racing thoughts and heart (hip hip hooray anxiety!) to clean, get organized, and get my external life in order. Internally, I feel more motivated (except for the times when I’m feeling less motivated, of course, which correspond with my phases of depression) and also much more unsettled. My internal self is less at ease and care-free, so I focus my energy on trying to control my surroundings and make them appear/feel less chaotic. I am driven partially by berating myself for letting everything go and ‘wasting’ so much of my time, life, etc., being numb and oblivious to everything, which is an unhealthy component I need to keep in check.

So, sobriety brings these pros and cons…The cons being that I can’t remain focused on one task without thinking about the trillion-and-one other things I need to do, leaving me consequently feeling very, very disquieted. It goes something like this: I start organizing clutter and throwing out papers, magazines, etc. that have accumulated in every room, on every table, in every corner of this house. Invariably, I end up coming across statements, bills, ripped-out magazine articles, and crumpled up, coffee-stained, quarter-completed old to-do lists, driving my nervous energy through the roof. Most frequently, I will find post-it notes of songs to download, books to read, or appointments to schedule, so nothing to warrant the beginnings of an anxiety attack. To drive my heart-rate back to a normal range (and deescalate enough to avoid sharing with Kristen I think I’m having a heart attack), I scurry back to my NEW and IMPROVED to-do list – the GRAND, MASTER list where I will neatly and comprehensively compile my responsibilities onto a single sheet of paper. While scribbling whatever reminder I was compelled to add, I PROMISE myself that from here on out, I will maintain this level of organization. Yeah. Right.

Without fail, I will stay relatively on-track for a few days (if I’m doing particularly well), and then, rather quickly, become overwhelmed and swan dive back into an old, familiar pool of disarray. Unfortunately, or probably fortunately, I’m not actually comfortable in this state either (Jesus, what state am I comfortable in? I used to toy with idea of hopping into my car without any advance notice and driving to California because I was convinced it was there that I would achieve the relaxed balance between accomplishing ABSOLUTELY NOTHING and operating like Energizer Bunny Sonja. In my fantasy, something about eternal sunshine and calming ocean waves would lull me into the more mellow, yet still productive version of myself I was seeking.) So, here I am, yet again desperately striving toward moderation (as in most aspects of my life). The journey has been exhausting, so I sure hope the destination is worth it (yeah, yeah, the journey IS the destination or whatever that motivational quote is, yeefreakingha).

I am fully aware of my penchant for becoming overcome by the endless pressures of being an accountable, contributing adult member of society, resulting in a semi-conscious (occasionally fully conscious, occasionally subconscious) decision to just say, “F it,” and cease trying. Accompanying this decision to ‘let go’ or ‘give up’ is often a slip, relapse, whatever terminology you are happiest using. All-or-nothing. A release of pent-up anxiety to satisfy my id and assuage a nagging superego that (when sober) will not leave me the fuck alone. Always, always, always leading back to the same repetitious cycle of regret, recommitment to sobriety and return of restless anxiety. I’m looking to break the cycle. Find different ways to release. Like writing this blog. I already feel calmer than I did when I sat down with images of all the ‘chores’ I have to do swirling around in my head. And now, I have to take a deep breath and tackle one thing at a time. Like vacuuming. Which I’ve been procrastinating for way too long.

Another thought I keep having that will surely be revisited in future postings:

If you ever want to feel like you have more time in your life, develop an addiction and then recover from it. Ok, so maybe that’s not the best advice I’ve ever given…but the point is, you end up having a seemingly disproportionate amount of time when you put down your substance(s)/activity of choice.

Also, I need to come up with a different plan (location?) for writing this blog because whenever Kristen catches wind I’m posting something, she will periodically (every 5 minutes or so) ask me what the ETA of my entry is…It doesn’t do wonders for my already-impaired concentration, so I kind of grunt or give her an irritated look, or if particularly engrossed in thought, yell, SSTTOOOPPP!)

Some quotes from “Drinking: A Love Story” I can relate with

Along with alcohol, include any other drug I used, and in some instances food, in these quotes and they have been my thoughts and experiences as well…Though with food, the effect was less of an initial seemingly positive transformation (e.g. increased confidence and sociability) than with other mood-altering substances..The binge-purge cycle alleviated anxiety but certainly didn’t make me more interactive (quite the opposite). It had a calming effect that always culminated in depression…so although it served the similar purpose of anxiety relief, it was overall quite different…

“These are utterly typical examples: strong, smart, capable people who kept drinking – who put off looking at the dozens of intangible ways alcohol was affecting their lives – precisely because they were strong, smart, and capable. In retrospect, a lot of the alcoholics I know are amazed at how much they accomplished in spite of themselves, how effectively they constructed and then hid behind facades of good health and productivity. At the time, they just got through. Just hunkered down and worked and got through the days.”

“When people asked how it felt to be so ‘revealing,’ I’d usually shrug and say something inconsequential, but the honest answer would have been: Well, it feels…incomplete. Humor, after all, is a classic defense, a foil that allowed me to create an impression of distance and self-irony while keeping the real depths of those feelings carefully tucked away, hidden in the deepest corners of my heart. That’s where the truly secretive nature of the high-functioning alcoholic exists, in those deep corners. It’s not so much that people like me hide the truth about our drinking from others (which most of us do, and quite effectively); it’s that we hide from others (and often from ourselves) the truth about our real selves…Beneath my own witty, professional facade were oceans of fear, whole rivers of self-doubt. I once heard alcoholism described in an AA meeting, with eminent simplicity, as ‘fear of life,’ and that seemed to sum up the condition nicely.”

“The truth gnaws at you. In periodic flashes like that I’d be painfully aware that I was living badly, just plan living wrong. But I refused to completely acknowledge or act on that awareness, so the feeling just festered inside like a tumor, gradually eating away at my sense of dignity. You know and you don’t know. You know and you won’t know, and as long as the outsides of your life remain intact – your job and your professional persona – it’s very hard to accept that the insides, the pieces of you that have to do with integrity and self-esteem, are slowly rotting away.”

“The drinking felt more like an experiment, an act based on some vague hypothesis I’d begun to form about the connection between liquor and anxiety, liquor and sadness, how one corrected the other.”

“The knowledge that some people can have enough while you never can is the single most compelling piece of evidence for a drinker to suggest that alcoholism is, in fact, a disease, that it has powerful psychological roots, that the alcoholic’s body simply responds differently to liquor than a nonalcoholic’s. Once I started to drink, I simply did not know how or when to stop: the feeling of need kicked in, so pervasively that stopping didn’t feel like an option.”

*—>For me, Campral has tempered the above, which also proves to me that it is physiological/neurological. The times I have drank when I’ve been on Campral, I have been able to stop and have NOT felt that NEED to keep going and going until everything or I was gone…

“Most alcoholics I know experience that hunger long before they pick up the first drink, that yearning for something, something outside the self that will provide relief and solace and well-being.”

“It had to do with transportation, with the very real-and, to alcoholics, enormously seductive-phenomenon of taking psychic flight, ingesting a simple substance and leaving yourself behind.”

“For a long time, when it’s working, the drink feels like a path to a kind of self-enlightenment, something that turns us into the person we wish to be, or the person we think we really are. In some ways the dynamic is this simple: alcohol makes everything better until it makes everything worse.”

(Part of) My Story.

I’m reading Caroline Knapp’s “Drinking: A Love Story” on my Kindle and I can’t get past a page without highlighting something. She so precisely puts into words what I feel…what it is to be an alcoholic, an addict, and have an eating disorder. The constant internal restlessness, sense of unease, and battle between deprivation and excess, wanting and needing more than our “fair share” of food, drink, relationships, life…the craving to be filled with anything and everything…To finally, once and for all, feel whole and full and satisfied, no longer in need, so desperate and empty…And some of us may know where this emptiness originated, but many will never discover its source.

For me, I only know it was a part of my core since I was young. The pull toward something that would ground me, plant my feet a little more firmly on this earth and enable me to take assured, necessary steps toward a life I wanted, was just THERE. I had an inherent desire for a panacea to soothe me and stop my agonizing perseveration about what was past or yet to come, what may never come…An elixir that would permanently annihilate my nagging fear of floating away. This inexplicable sense of fragility drove me to grasp at and cling to whatever/whomever I could because I JUST KNEW I couldn’t make it on my own. Life was too scary, too overwhelming, too much. I felt like I didn’t belong (it should be noted that this ‘differentness’ is also a common feeling of people who are LGBT before they become aware of their sexuality…so I had that going for me too…and I won’t even try to parse out the what if’s – if I hadn’t struggled so much with accepting my homosexuality, would I have developed my eating and substance use disorders?…Because I have no idea and never will and it doesn’t really matter anyway). I sensed I was ‘different’ and didn’t quite fit. It was as though everyone else was familiar with and following the directions from a book I didn’t even know existed.

So I was predisposed by composition and shaped by perception and experience to be vulnerable to self-destructive behaviors. To become one of those who JUST COULDN’T COPE without external armor for protection. I don’t know why I needed a shield to feel comfortable, normal, less apprehensive, I just did. Looking back, there is very little rational basis for my heightened sensitivity and anxiety. Nothing particularly traumatic (e.g. death of a loved one, physical/sexual abuse, seeing the atrocities of war, etc.) happened to me. But regardless, I was highly sensitive, anxious, obsessive/compulsive, with a low frustration tolerance. It was my temperament. My parents did the best they could, but they didn’t know any more than I did about what I needed. The stage was set for me to become an addict.

I found my comfort first in food, or rather self-deprivation of food. Well, I suppose that’s not entirely true…I experimented a bit with alcohol and other substances here-and-there before I became anorexic. It was teenage experimentation. Except it wasn’t. Because I was the only one sneaking alcohol from my parents’ liquor cabinet at a sleepover party I hosted when someone who wasn’t invited (because as far as I could tell, she didn’t like me) showed up. Why my first impulse was to get obliterated instead of face the situation and just deal with unpleasant feelings that arose, I can’t say. But it’s what felt necessary and it’s what I did. Only my best friend at the time knew. The secrecy started from the beginning. That’s why I know it wasn’t normal ‘kids being kids’ behavior. I wasn’t at a party drinking with friends. I drank vodka from the bottle because I didn’t want to think or feel emotional pain. It is one of my first memories of self-medicating. There were many more that followed, where I was the only one drinking or using, and most of the time, the only one who knew. As I’m writing this, memories of other incidents are flooding me and it would take too much time to share them all, so I’ll spare the details for now.

So back to food. It was something I could control in the face of so many things I couldn’t (inherent loneliness, being attracted to the same sex, never separating and individuating in a healthy way, the list goes on). I was a Freshman in college, on my own for the first time, anxious/obsessive, a high-achieving perfectionist with low self-esteem. I didn’t stand a chance. The tipping point was Thanksgiving break that first year. After a few months of college and no longer playing every sport known to man, I went home and got on the scale and saw ‘129’ or maybe ‘128’ but that’s not as important as the decision I made that day, which shaped the rest of my life right up until now. I thought, ‘I am NEVER going to be 130 pounds.’

People who develop eating disorders aren’t dumb. Statistically we’re actually usually fairly intelligent and high-achieving, but from an outsider’s viewpoint, we sure can appear to be pretty idiotic, as we time and time again make completely irrational decisions based on cognitive distortions instead of objective reality. And you can’t convince us of anything rational when we’re in our disease, which makes treating eating disorders so challenging and frustrating because we are incredibly treatment-resistant. We also think we know more about our eating disorder than any professional (and a lot of times, at least for people who are like me, we have read so much about it that we often do). Hence, I dropped to 105 pounds, stopped getting my period, felt exhausted, ate EXACTLY the same thing every day, and still needed to obsessively count and recount the caloric content, fat, sugar, carbohydrates, salt, etc., of everything ALL DAY LONG. And because I was pretty sure I was underestimating how many calories were ACTUALLY in what I was eating (cognitive distortion), I added a few hundred (or a thousand) calories to my daily count, just to be on the safe side and reach my goal of staying under the magic number I arbitrarily chose.

Oh and I went to the gym every day for 3-4 hours. I have no idea how this was physically possible, but it’s true. Then enter some medical complications, mix in a few episodes of binge drinking, a couple of trips to the ER and several ‘morning after’s’ wondering how I was still alive. Normally I wouldn’t drink because I considered alcohol ’empty calories’ but every few months when I did, I would drink until I passed out and vomit until I was dry-heaving for the entire next day. One time I remember trying to tally how many shots of tequila I had so I could keep track and try to ‘find my limit’ and when I looked at my tally sheet the next day, I saw 5 lines followed by 5 or 6 more that were crooked and haphazardly placed somewhere further down the page.

I was sick. Cold all the time-nauseous-losing my balance-joints aching-sick. Fast forward a bit, moving past some of my denial, I was offered professional help. I saw a psychiatrist who put me on meds, entered therapy, met with a nutritionist, started eating according to a recommended plan and gradually put weight back on and started getting better. Physically anyway. Changing your thinking is always the hardest part and I believe the mental component will challenge me for the rest of my life.

So anyway, I arrived at a healthy weight (though still obsessing/restricting/over-exercising) just in time to be faced with new stressors, which compounded with my same old underlying sense of feeling alone and out of control and proceeded to freak the fuck out. I had introduced new ‘unsafe’ foods to my diet to eat ‘in moderation’ and because I had never done anything in moderation EVER, I quickly began binging on them. Then came the terror – I’M GOING TO GET FAT – I’M COMPLETELY OUT OF CONTROL – I WILL NEVER BE FULL – and subsequent panic which ultimately led to my transition into bulimia. It is the same switch that was flipped as when I took any mood-altering drug. The need for MORE MORE MORE. And the sinking desperate awareness that no matter how much I took in, it was never going to be enough. But that didn’t stop me from trying. Consequently, for the next several years of my life, I binged on an objectively absurd amount of food and purged by vomiting and compulsive exercising on a daily basis. Good times.

Because I was a perfectionist, terrified of failure, and this was the phase of my life where I was still ‘keeping up appearances’ and needing to excel to prove my self-worth, I somehow managed to graduate summa cum laude with a 3.96, 7, or 8 (I can’t even remember, that’s how important it turned out to be…whoopdeefuckingdoo…and at what expense?) from the University of Rochester with a double major and then go on to become a Fulbright scholar. It’s amazing I’m even sharing this because I have a very difficult time saying anything positive about myself because to me, it always feels obnoxious. Since I was young, I have always elected modesty, to the point of self-depreciation.

…This is getting longer than anticipated and my legs are cramping up and Samson is eating Kristen’s plants again, so I am getting distracted by having to scold him….

Where was I? Right, a bulimic mess. So that continued and then eventually the vomiting stopped (I was back home at the time and it became too difficult to hide, I got tired of it, too depressed to put the energy into it? Not sure..) but the binge eating didn’t. So I gained more weight than I felt comfortable with, though still not outside of my healthy BMI-range. Then the vomiting started again, but only sometimes and then at some point drugs and alcohol (re)joined the game, with more players, and catapulted me from being an introvert to the extrovert I always wanted to be, or at least more of a ‘gregarious introvert’ (who am I kidding?) When using, I feel the need/want to be social and go out and engage with others.

Substances have been paramount to shifting my natural inclination to be a loner to what (I think) is a preferred level of sociability that fills my desire for connectedness. This is one component that has been a barrier to getting and staying clean and sober…when I’m sober, I often have no motivation, drive, etc. to socialize. This leaves me with that same sense of alienation and spiritual aloneness that caused me to seek refuge in warming, numbing substances in the first place. It is what makes going to meetings difficult, despite knowing that meetings are where I am likely to find the connection I am seeking to fill my spiritual void. I am ashamed to admit it, but I would love going to meetings if I could go under the influence, but that completely defeats the purpose…Ok, more on my downward spiral into substance use will have to come in Part 2 because I’ve been sitting here at the computer for hours now and I need a break.

Thanks for listening…

OCD Update.

I haven’t felt this much relief from obsessing about – and then compulsively – plucking hairs out of my face and shaving my ‘sideburns’ and the back of neck…ever. Elephant’s dose of Prozac combined with Campral appears to be doing something (along with helping with a number of other obsessive-compulsive-craving things…alcohol, binge-purge cycle, exercise insanity). Don’t get me wrong, I still care and I still think about all of my ‘stuff’ A LOT and have to fight against acting on my thoughts, but the intensity of the impulse/urge is somewhat tempered. I don’t have to waste hours of my life engaged in some completely unnecessary routines anymore. Three cheers for meds.