Any alkie or addict will be familiar with AoD – the Alcohol and other Drugs outpatient units that have to deal with us sooner or later. In major cities, these units have detoxification beds and meds that assist people to get off their poisons safely. Outside of the major cities? Not so much.
The staff at AoD units listen with weary resignation as we shuffle in through the doors, saying things like ‘I’ve had enough of drinking this time’ or ‘If I don’t get clean, DOCS (community services) will take the kids away’. At my local, they hand out Bupe and Methodone, so there’s a regular queue of tweaking and sometimes very agitated heroin and prescription opiate addicts lining up for service, along with the quieter weirdos waiting to see a GP or shrink, like me. AoD staff are quite rightly shielded from we, the addicted. I do say ‘we’, but mostly from the amphetamine freaks. The word in the waiting room is that the plexiglass went up not long after meth hit the streets. Although, the smackies and alkies would say that!
I was never attracted to ‘uppers’ like speed and meth because, rather than granting a momentary release from FEAR (Fuck Everything And Run), they appeared to speed fear up in others, or at least delayed its onset before a terrifying comedown. I’ve had friends walk out into the bush with rope during upper comedowns. They never came back. Multiple friends, white and black, in two different states. Friends who had their whole lives in front of them. Of course, I self-medicated to oblivion to process those deaths. That is, after all, an alkie’s modus operandi.
It was confronting for me to show up to the doors of my first AoD detoxification unit in 2013, with my PhD, public service job and a clean t-shirt. I promptly checked out the next day, citing the tedium of having to do a cooking class with shaking addicts as being the final straw. That, and the fact that my ward neighbour OD’d on ice (methamphetamine) the previous day and was coming down in a screaming, banging heap. People like me, who learned to hustle in hospitality, don’t need cooking classes. We need a magic pill!
I, like many other alkies and addicts, was on a mission to find the cure to my condition – not to give up drinking entirely, but something to let me join the ranks of my esteemed social drinkers. My advantage was reaching the peak of my alcoholic powers at the same time as I had the best multidisciplinary addiction journals at my fingertips, and a good few months to compile a literature review of what constitutes ‘best practice’ in treating alcoholism. This was a unique coincidence of life meeting work. Despite this, I still failed Detox101, and drank soon after completing a three week rehabilitation program at a regional AoD (the waitlist was three months).
In 20:20 hindsight, I was seeking something external to enable me to handle uncomfortable situations and strong emotions, and a way out of my alcohol-related problems. For context, remember that I had been self-medicating for more than two decades prior to failing a three week rehab. These types of ingrained behaviours don’t just disappear overnight. It’s like muscle memory – when I type my fingers short circuit the need for my eyes to look at the keyboard – now imagine reaching for a bottle every time you feel happy, sad, confident or afraid. I thought AoD would replace the bottle, but it didn’t. I did, however, get to form a lasting relationship with a counsellor whose advice to persist with AA was sound.
I identify with Nic Cage’s character Ben Sanderson in Leaving Las Vegas (1995), a film based on the semi-autobiographical novel by John O’Brien. Sanderson, reflecting the experiences of O’brien (who suicided two weeks after the film commenced shooting), cuts all personal and professional ties to drink himself to death in Las Vegas.
There’s this magnificent scene where Sanderson’s alcoholic nihilism (the belief that life has no meaning or value) is allowed to run unfettered with a shopping trolley in a liquor store. I used to dream inchoherent dreams of being able to do what Sanderson did, shades on, whistling a sweet ditty as I swing bottles of 40 percent spirits from the top shelf. By mid 2014, however, it was mostly casks of goon paid for in coins. There aint no shame when you’re shameless.
Leaving Las Vegas, Liquor Store scene, Mike Figgis, 1995
I’m coming up to my third AA birthday next week, but I’m not counting my chooks yet. AoD rehab statistics suggest I have less than even odds of staying sober for three years, and this is even worse for younger adults.* Whichever way you look at it, it is pretty grim. Especially when you drink like I did between 2010 and 2014 – I know now it only takes one drink to kick off my madness, and unconsciousness or physical restraint the only means to end it. There are no swaying palm trees, tubing waves and golden sands in my alcoholic future. The best I could hope for is another trip ’round the white walls and ethanol handwash of the rehab circuit.
AA’s philosophy focuses on sobriety from all drugs unless they are prescribed by a doctor. Doctors and AoD units prescribe a range of drugs to help keep alkies on track,** including:
- a fine selection of antidepressants (pick a colour and set of side effects, including increased risk of suicidal ideation)
- Disulfiram (Antabuse), which makes you get heart palpitations, turn red like a beetroot and become very sick if you drink
- Naltrexone (ReVia, Vivitrol), which is supposed to reduce the pleasure you get from booze
- Acamprosate (Campral), which can reduce cravings, although most people I’ve spoken to reckon shelving a sugar pill would be more effective, and
- Diazepam (Valium), distributed mainly in early sobriety or during detoxification to control tremors, seizures, or panic attacks. Addictive.
I’ve tried Naltrexone (nope, didn’t work) and relied on Disulfiram to keep me sober right up until I stopped taking it in Alice Springs during a particularly ill-timed misadventure. This time around I detoxed without medication and was a shaking mess, terrified of substituting a diazepam addiction for alcoholism.
New directions in complimentary pharmacotherapy
In Berkeley, California, where medical cannabis is legal, researchers surveyed 350 alkies attending a medical cannabis dispensary. Cannabis, which is not considered physically addictive, is being used to treat a range of conditions, including alcoholism, and related comorbid conditions such as chronic anxiety, depression and PTSD.
The idea is that even street-bought cannabis is relatively harmless – a person can’t fatally overdose on THC like they can with alcohol, although they may have an extremely unpleasant experience, meaning its use can be self-limiting.*** Furthermore, the side effects of low-THC, high-CBD medicinal cannabis have been reported as being significantly less than standard pharmacological (chemical) interventions. In the Berkeley study, 85 percent of those surveyed reported that cannabis has much less adverse side effects than their prescription medications and 57.4 percent better symptom management from cannabis over prescription medications.
Anthropologically-speaking, what I find interesting about this study is not the survey results per se, but its implications for AA, and AA’s begrudging acceptance of pharmacological interventions as being complimentary to its support-based, loosely spiritual philosophy of recovery.
Researcher Amanda Reiman quite rightly remarks that cannabis-as-therapy brings up two important points: ‘First, self determination, the right of an individual to decide which treatment or substance is most effective and least harmful for them. If an individual finds less harm in cannabis than in the drug prescribed by their doctor, do they have a right to choose? Secondly, the recognition that substitution might be a viable alternative to abstinence for those who are not able, or do not wish to stop using psychoactive substances completely.’
Reiman also reports that some dispensaries (read: shops that sell medical grade pot) organise their own 12 step groups, citing ‘potential conflicts between the use of medical cannabis and philosophies of recovery programs such as Alcoholics Anonymous’.****
Time, and further studies, will tell if cannabis becomes a common maintenance therapy for alcoholics in jurisdictions where it is legal, and is similarly accepted in AA in the same way as pharmacological interventions are viewed as part of a complimentary, ‘whatever it takes’ pragmatism of 12 step recovery. I suspect this may be a way off, certainly in Australia
It is with great delight that I share the following traveller’s tale:
I met a Canadian in Palestine 3 years ago. She told me she met in England a middle aged man who introduced himself as “I’m a recovering academic.”
Thanks Mick Taussig 🙂
* Deborah Dawson, Risë Goldstein and Bridget Grant, ‘Rates and Correlates of Relapse Among Individuals in Remission From DSM-IV Alcohol Dependence: A 3-Year Follow-Up’, Alcoholism: Clinical and Experimental Research, 31, 2007, pp. 2036–45.
** See, for example: National Collaborating Centre for Mental Health (UK), Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence, NICE Clinical Guidelines, No. 115, Leicester (UK), British Psychological Society, 2011. Chapter Seven reviews and makes very limited recommendations for the use of pharmacological interventions in the treatment of alcohol use disorders.
*** Dirk W. Lachenmeier and Jürgen Rehm, ‘Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach’, Nature, Scientific Reports 5, Article number 8126, 2015.
**** Amanda Reiman, ‘Cannabis as a substitute for alcohol and other drugs’, Harm Reduction Journal, 6:35, 2009. An example of a rehab facility utilising this method and philosophy is also located in California: https://highsobrietytreatment.com/about-us/