A case for cannabis legalisation

Prohibition has made criminal syndicates rich and little else. The legalisation of cannabis will drive quality and variety, further blurring the lines between medicinal and recreational use.

On 17 April 2018, the Leader of the Australian Greens, Senator Dr Richard Di Natale, launched a drug reform campaign aimed at legalising recreational cannabis use for all Australian adults. The Greens propose creating a tightly regulated cannabis market, overseen by a new statutory body:

The Australian Cannabis Agency would be established to issue licenses for cannabis production and sale, act as the single wholesaler of legally accessible cannabis, carry out a program of monitoring and enforcement of premises of production and sale, and conduct ongoing review and monitoring of the regulatory scheme to ensure it is functioning optimally.

We would also establish retail stores to sell cannabis. These stores would require ID to enter and ban sales to anyone under the age of 18, sell only plain packaged cannabis (with visible health warnings) and require staff to undertake a responsible sale of cannabis course.

Growth of six plants at home for personal use would be permitted, but strict penalties would apply for unlicensed or underage sales, or driving whilst under the influence of cannabis.

The Greens argument, which I strongly support, is that prohibition has failed:

Criminalisation of the production and use of cannabis has caused multiple harms, including forcing people to live with criminal records for possessing only a small amount of weed, pushing cannabis users to purchase from drug dealers and consume a product of unknown strength and quality, and diverting money into the futile law enforcement response and away from drug and mental health treatment and education.

Federal Health Minister, The Hon. Greg Hunt MP came out and called for the Greens to dump the policy, stating that cannabis is ‘a gateway drug’ to methamphetamine and heroin use.

Dr Alex Wodak AM,  president of the Australian Drug Law Reform Foundation and one of the most respected AoD researchers in the country, argues that ‘cannabis taxation and regulation is an idea whose time has come’. He says that, ‘like the debate about same sex marriage, the idea will seem strange to some in advance but once the reform has been completed we will wonder why it took us so long.’

Dr Wodak provides a brief history lesson to show that the decision to ban cannabis in the 1920s was, at the very least, devoid of evidence. ‘There was no careful root and branch review of the evidence. Instead, Australia was represented at a League of Nations meeting in Geneva in 1925 where delegates from several countries decried the dangers of cannabis.’ Dr Wodak cites Robert Kendell in his 2003 article Cannabis Condemned:

“A claim by the Egyptian delegation that [cannabis] was as dangerous as opium, and should therefore be subject to the same international controls, was supported by several other countries. No formal evidence was produced and conference delegates had not been briefed about cannabis.”

Dr Wodak remarks:

Accordingly, the Commonwealth wrote to the states after the meeting instructing them to prohibit cannabis. This is the quicksand upon which the mighty edifice of cannabis prohibition in Australia was constructed.

From an international perspective, the Greens’ state-controlled proposal is similar to the model adopted by Uruguay in 2014, in which Uruguay legalised growing up to six plants at home, as well as the formation of growing clubs, a state-controlled dispensary regime, and the creation of a cannabis regulatory body.

By comparison, Colorado in the United States legalised the sale and possession of cannabis for non-medical uses in 2012, including private cultivation of up to six  plants, with no more than three being in flower at the one time. Colorado established a commercial market for consumers aged 21 years and over, as well as regulations for the commercial cultivation, manufacture, and sale similar to alcohol, for recreational use.

The prohibition effect: limited knowledge, quality and variety. Rich bikers.

Australian consumers’ knowledge of cannabis has been shaped by their experience of prohibition and is, in general, unsophisticated by international standards. Many Australians have experienced cannabis smoked through a bong with tobacco or rolled into a joint. Combustion, however, is only one way in which people consume cannabis products. Some Australians may have eaten decarboxylated cannabis in a cake or brownie. Comparatively few know that cannabis can be vaporised or used in concentrated forms such as dabs. Along with edible products, personal vaporisers have emerged as a preferred method of delivery for medicinal cannabis patients because there is no evidence they adversely affect the respiratory system.

Australian cannabis consumers distinguish between two types of cannabis: ‘hydro’, a catch-all term describing high-potency, indoor-grown hydroponic cannabis that can sometimes have a strong chemical odour and taste; and, ‘outdoor’ or ‘bush weed’, which is more commonly found outside of the major city centres. This is a false dichotomy.

In communities where both cannabis markets and consumer knowledge is more advanced, consumers choose between sativa dominant or indica dominant strains. These categories relate directly to the two major species, Cannabis sativa and Cannabis indica. A third species,  Cannabis ruderalis, is mainly used to breed autoflowering hybrids because of its unique ability to flower without a photoperiod cue.

Cannabis plants produce a unique mix of terpeno-phenolic compounds called cannabinoids. There are over 100 different cannabinoids that have been isolated from the plant, including the two most prevalent: the psychoactive delta-9 tetrahydrocannabinol (THC), and cannabidiol (CBD). CBD is not considered psychoactive and is being offered by doctors in the United States for its ability to reduce nausea and anxiety, among other things.

In jurisdictions where medical cannabis is legal, dispensaries fill prescriptions for specific strains of cannabis – for example, strains that stimulate the appetite and suppress pain, or relieve anxiety and stress. Medicine Man, a family-run business in Denver offers over 40 different medicinal and recreational strains, all varying in THC/CBD content and ratio, with wildly different terpene profiles.

Differentiation between medicinal and recreational strains is relatively arbitrary: popular medicinal strains such as G-14, Liberty Haze, Super Sour Diesel, Jamaican Lion and Girl Scout Cookies are equally, if not more, popular with recreational consumers.

Dispensaries offer strains specifically bred to taste of citrus, tropical fruits such as mango, berries, pine and even cheese. These plants are bred for particular concentrations of naturally occuring terpenes in their flowers. The four most common terpenes found in cannabis are Myrcene (found in hops, mangoes, lemongrass, citrus, thyme and bay leaves), Pinene (found in conifers and some citrus), Limonene (found in citrus rind, rosemary and peppermint) and Linalool (found in mint, bay leaves, lavender and cinnamon).

In Australia, most of the hydroponic cannabis bought on the streets is produced by criminal syndicates, predominantly outlaw motorcycle gangs. These producers favour fast growing, high-yielding, high-THC strains with next to no CBD content.

The chemical taste associated with ‘hydro’ is caused by producers pumping as many nutrients into the flowering plants as they can to maximise their yield per watt of electricity used. Outlaw motorcycle gangs are not known for their subtlety. They do not take the extra week needed to ‘flush’ their plants with fresh water prior to harvest, which leads to the excess nutrients remaining in the plant’s flowers and leaves producing an unpleasant taste. It is this high-potency, foul-tasting, low-medicinal-value product that most Australian cannabis consumers are introduced to, often by the same people selling methamphetamine, pills of dubious consistency masquerading as MDMA, prescription drugs (Xanax and Oxycontin) and heroin.

Competitive markets drive quality and variety in produce. Uncompetitive markets, such as bikie monopolies, do not. Cannabis prohibition in Australia has succeeded in enriching organised crime and little else.

Jimmy

‘Jimmy’s a good kid’, scrawls my handwriting under a brown tea stain, ‘looks after his mum and little sister, working a shit job for worse pay. He always seems to be down on his luck’.

I met Jimmy in 2008 while I was doing ethnographic research in a New South Wales country town. As luck would have it, Jimmy and I also crossed paths in an alcohol rehab several years later in another country town about six hours drive inland.

Jimmy went to juvie in his teens after committing a bunch of minor misdemeanours culminating in significant time away from his family. His last crime was purchasing and being caught by the cops with a quarter ounce bag of cannabis.

Jimmy didn’t go back to school after juvie. When I met up with him years later, Jimmy was a shell of what he once was. He had broken both legs in a car accident and had become hooked on opiod painkillers, washed down with whatever was on special at the bottle shop. Jimmy was in rehab as a circuit-breaker for his ongoing legal and family problems. Still, we shared old stories and some laughs; hit the weights together and snuck cigarettes at the AA meetings.

Jimmy took his own life later that year.

Rachel

When I met Rachel she was 29, trying to establish her own small business. Rachel smoked bongs, which she believed helped her anxiety. She refused to take the new antidepressants prescribed by her doctor because she said her first prescription didn’t help her anxiety at all and caused what the pharmaceutical companies call ‘discontinuation symptoms’ when she stopped taking them. Rachel said that these symptoms, including vertigo, severe headaches, nausea and heavy sweating, left her in a constant state of panic and made it impossible for her to leave the house for a week.

Rachel preferred to grow her own bush weed because she was terrified of the people who deal hydro. When she was younger, living for a while in Redfern, she was scoring  from some guys in the Cross. One night, they asked her to come to a pub for a drink. She woke up many hours later looking down the barrel of a video camera documenting her rape by multiple assailants.

Gateways and other hyperbole

Minister Hunt’s response to the Green’s policy proposal is unfortunately characteristic of much of modern Australian politics which appeals to emotion first and intellect a distant second. Hyperbole works only when people do not question the underlying assumptions being proposed.

It is true that cannabis prohibition can be a gateway to other drug use precisely because it forces consumers onto the black market. Consider Rachel’s horrific experience of having the date rape drug, Rohypnol, slipped in her drink by her dealer. Or consider that Jimmy maintained his opioid addiction long after his doctor stopped prescribing him Oxycontin because he already had access to a black market network.

The majority of people who use cannabis do not go on to use other, so-called ‘harder’ substances that are physically addictive (including alcohol, which is legal). In the United States, the 2014 National Household Survey on Drug Use and Health found less than half of Americans aged over 12 had tried cannabis, while less than 15 percent had used cocaine and less than 2 percent had used heroin. In general, only 10 to 20 percent of those who try alcohol and other drugs get hooked.

While cannabis may cause cross-sensitisation to other drugs, alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like cannabis, also regularly used prior to a person progressing to other, more harmful substances.

There is a growing body of research supporting an ‘anti-gateway’ hypothesis, which proposes that cannabis use can provide a way out for people suffering from physical addictions to alcohol, and other recreational and prescription drugs. One recent study surveyed medical marijuana users in Canada,  and found that 87 percent of participants used it to replace alcohol, prescription opioids or other recreational drugs. 52 percent reported that cannabis helped them reduce alcohol use, while 80 percent reported using less prescription pain medications.

Final word

As medical cannabis reform gathers pace there will be increasing pressure on the government to open up its very restrictive regime to a wide variety of medical conditions. Indeed, the line between medical and recreational use is arbitrary, and does not reflect the reality of how people consume cannabis: most self medicate with the same substance they use for recreation.

If we turn to the the potential benefits, legalisation in Australia would reduce the costs of drug enforcement, taking the pressure off police, courts and prisons, and customs. It would limit the income of black market cannabis suppliers, including outlaw motorcycle gangs, and would raise substantial revenue through tax receipts at a time when the Commonwealth is struggling for tax revenue. Lastly, legalisation would create a functioning market in Australia, providing quality and variety, and a safe way for consumers to purchase their drug of choice.

FYI: relationships are hard

Getting sober is not always raindrops on roses and whiskers on kittens. Sometimes being an adult really fucking hurts.

Earlier this month, my marriage of seven years came to an end a week shy of our eighth wedding anniversary. While this was not unexpected (one cannot plumb the depths of alcoholism and addiction without it wreaking havoc on close personal relationships), my wife’s decision has knocked me off balance. However, I refuse to harbour any ill feelings towards her and am committed to ending our marriage as we started: as best friends. To achieve that goal, while staying away from alcohol, I need to Do The Next Right Thing (or DTNRT, if you like acronyms).

DTNRT

The million dollar question at this point is: How do I know if I am responding to a situation in the right way? In AA’s Step 4 we conducted ‘a searching and fearless moral inventory of ourselves’ and then admitted all our bad behaviour and character defects to another person in Step 5 (and God, if you believe in one). These steps are important because they allowed me to identify the qualities I admire in others, to reflect on my strengths and weaknesses, to identify situations and relationships that place me at risk of relapsing, and to learn when I am behaving in a way that doesn’t reflect my personal values.

When I was at a low point last week I rang someone close to me for support and, instead of finding a sympathetic ear, I received two full barrels of anger, a torrent of abusive text messages and nine missed calls while I was at work the next day. Unsurprisingly, I was angry and upset by this person’s behaviour. Fortunately I had the smarts to call my sponsor. We decided I should block the offending phone number until temperatures returned to normal, and to resume the relationship when I am on a more solid emotional footing.

Sometimes doing the next right thing is as simple as not responding to anger with anger, or attempting to find a point of agreement in an argument. At other times DTNRT is pausing when agitated or not having the final say in a conversation.

In the case of my marriage breakdown, DTNRT is about me being supportive of my wife’s decision, and to accept that she needs to grow in her own way, even if it causes ripples in my present circumstances. After all, I owe my wife my life. If making this transition in our relationship easy is what I need to do to make an amends for the harm caused by my drinking, then that is what I need to do.

No person is an island

Given the set of circumstances described above, my first instinct is to withdraw from social relationships. There is sadness there, and quite a bit of grief. That is understandable. But, if history is any lesson, I don’t fare well when I withdraw from society and attempt to do life as a solitary organism. We humans just don’t work like that.

When I was drinking and times got tough, I would dream I was marooned on an island with perfect waves and a never ending supply of rum. Instead, I found myself lying in bed at 4pm on a Tuesday afternoon with a cask of wine wondering if I had any relationships left.

The point is that, as social creatures, we need human contact.

So, instead of fleeing down the coast with a dog, a tent and a surfboard, I stuck it out this weekend and went to a bunch of AA meetings. I even went to a punk rock gig on Saturday night, drank soda water and laughed my head off with another AA member. It was good. The best thing was that I woke up Sunday morning with no regrets.

Oh, and real footy’s back. Not that thing with the round ball and the play acting. Or the other things where large men run straight at each other. No, Australian Rules! Go the mighty Cats!

Take your medicine: how a spiritual program can work for atheists

Q. How can an atheist follow a spiritual program of recovery without his or her head exploding in a puddle of existential goo? A. Start by accepting you don’t have all the answers and then fake it till you make it.

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I’ve mentioned previously that, when I first encountered the fellowship of Alcoholics Anonymous, I saw the word God scrawled across the calico banners on the wall and pretty much ran screaming into the sunset. Well, that might be a slight exaggeration, but you get the drift. Contempt prior to investigation is probably closer to the truth.

One would have thought that as an anthropologist – someone who is trained to identify their own cultural biases, and who is fascinated by the human condition in all its forms – I would have had a more open mind about this. But no, I chose to put my preconceptions ahead of sobriety and it nearly killed me. After all, I hadn’t believed in a God in more than two decades. Why start now?

I was baptised Anglican in a rural community. I went to Sunday school, youth group and was eventually confirmed as a 13 year old kid with pimples who could eat the flesh of Christ and drink his blood. It was about the same time that we were being introduced to biology at school, including the legendary story of Charles Darwin’s journey of discovery in The Beagle. Needless to say, the story of how finches evolved on remote islands seemed more plausible to me than any of the magical horseshit I was hearing or reading on Sundays. Still, the Minister had a drop-dead-gorgeous daughter, so I hung around the Church like a bad smell until I discovered beer and Saturday Nights.

Later, I nurtured resentments against ‘the Church’ for a whole swag of reasons, real or imagined: Religion is a drug that keeps populations subjugated; Christian people are duplicitous; Catholicism is institutionalised tax evasion and child abuse; etc., etc., etc. Worse still, I looked down my nose at people who believed in something spiritual and sometimes got into heated, drunken debates with Christians, armed with so-called reason and a quick, nasty wit.

Then I plunged headfirst into rehab and received my first real introduction to AAs 12 Steps, half of which appeared to exclude athiests:

  • We need a ‘Power greater than ourselves’ to cure our insanity (Step 2)
  • To get well, we have to ‘turn our will and our lives over to the care of God as we understood Him’ (Step 3)
  • After all that, we then had to admit to God all of our wrongs (Step 5), become willing to have God remove all our character defects (Step 6) and humbly ask Him to remove our shortcomings (Step 7), and
  • Practice prayer, every single day (Step 11).

Unsurprisingly, I spent most of the long hours in rehab wrestling with AA’s God concept figuring out how I could bypass the spiritual aspects of the program. While I didn’t have a religious experience, rehab did give my body and mind a chance to dry out, and my loved ones a break from having to deal with my bullshit.

It took three weeks for me to bust after rehab, which took my tally of sober days up to 60. This was the longest I had been without alcohol in my system for more than two decades. I suppose we could call that a success.

Willpower?

If you’re reading this and you don’t have a problem with alcohol, you may think that alcoholics just suffer from a lack of willpower. In response: imagine you wake in the morning after one of your best friends’ weddings in a resort town. You have spent a considerable amount of money to get and stay there, and it was a rare chance to see your old mates together again before they run off and breed. You were so excited to see everyone that you got completely carried away drinking expensive wine and can’t remember anything after the sun went down. Your partner, who will not speak to you for many hours yet, eventually informs you that you were found by the police half stumbling/half crawling down a road in an 80km/hr zone. You’d probably vow off the grog for a while, if not for life. And, you’d mean it too.

This exact situation happened to me. I vowed off grog and I meant it too. Like AA’s founder Bill Wilson, I woke up and meant business:

This had to be stopped. I saw I could not take take so much as one drink. I was through forever…

Shortly afterward I came home drunk. There had been no fight. Where had been my high resolve? I simply didn’t know. It hadn’t even come to mind. Someone had pushed a drink my way and I had taken it.

While recovering from drinking to blackout and being rescued by the police, I went out with one of my mates to get groceries. Ten minutes later I had a can of ‘Dark and Stormy’ in my hand, the first of many hangover cures consumed that afternoon.

Like Bill, my best efforts kept achieving the same result and it never took long for the wagon wheels to fall off.  For example, while I was on medical leave to ‘sort out my drinking’, I’d give my partner all my cash, credit and debit cards before she left for work. When she returned, without fail, I would be falling-down drunk.

I spoke to my best mate the other day – a prodigious and regular drinker – but not an alcoholic. He just had a month off the grog and he said it suprised him how easy it was. I was dumbfounded. I asked him if he had trouble sleeping or was irritable. He said no more than usual. I congratulated him, but not before telling him I thought he was an alien from outerspace.

We alkies have plenty of ‘willpower’, the problem is that it is directed towards drinking. Take away our wallet and access to money, we’ll still find a way to get drunk. A recent review of neurobiological advances from the brain disease model of addiction shows that addictions have not only changed our brains’ reward and decision-making centres, they have increased our reactivity to stress and given rise to negative emotions and dysphoria (researchers call this an ‘antireward system’). This means that, ‘in addition to the direct and conditioned pull toward the “rewards” of drug use, there is a correspondingly intense motivational push to escape the discomfort associated with the aftereffects of use. As a result of these changes, the person with addiction transitions from taking drugs simply to feel pleasure, or to “get high,” to taking them to obtain transient relief from dysphoria.’ So, its not a question of willpower, we just aren’t like normal folk.

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Gift of Desperation

Apparently fate had decided that I needed to become broken just enough to come back to AA with an open mind: I needed to become desperate enough to suspend my preconceptions about the program, including the fear I might get infected by some virulent strain of Godbotheryitis and turn into Ned Flanders.

In AA, we call this the Gift of Desperation (G.O.D. – see the theme here?! )

The following extracts from my journal provide a pretty good indication of my headspace before and after I arrived at my personal rock bottom. For context, the first extract from August 2014 was written by an active alcoholic who has just had a major relapse at work, and was looking to get his employer off his back by having the AOD doctor write a letter of support. The treatment plan included relying on an alcoholic self-administering a drug that causes life-threatening side effects when it is mixed with alcohol. The second extract, recorded three months later, was my first attempt to write about my rock bottom, still shaking after five days in blackout.

12/8/14

Appointment with Dr XXXXXXXXXX today. I need a plan of treatment and support and a letter to Human Resources after my last bust at work.

After appointment: plan is:

  • Six months of self-administered Antabuse (Disulfiram) 250mg daily.
  • No benzos, opioid painkillers or any other sedative style or potentially addictive drugs.
  • Regular counselling.
  • Engage with and attend AA.
  • Daily diary and journaling (i.e. this)
  • Check out SMART recovery – good for athiests?
  • Read, write and learn more about WHY I drink like I do.

Feel like a big weight is off my shoulders now that I have spoken to the doc and have the letter for work. Back in the pool swimming today!

 

5/11/14

First day sober, shaking, fearful of my own shadow, jumping at the groan of trees in the wind. Sweating buckets haven’t eaten. Lost litres of fluid in tears. Probably should hydrate.

Stopped taking Antabuse around the 31st and had a light beer but immediately had acetaldehyde reaction, got flushed, heart palpitations, etc. so backed off. Relapsed proper on the 1st and all hell broke loose. From then, piecing together events gets too hazy: at least three bottles of vodka, two boxes of cask wine…who knows what else? I didn’t turn up for work again Tuesday 4th (Melbourne Cup Day) and got my formal, final written warning from work this morning.

Somewhere in there I had a massive argument with XXXXXXXXXX and fear that relationship is over. I also seriously considered stringing up a rope in the garage, but was way too pissed to even make it that far. Fear is pretty much all I’m made of today.

I’m done.

Acceptance

Soon after I penned the above entry into my journal I walked into a meeting of Alcoholics Anonymous and haven’t had a drink since. What changed?

Quite a few things actually. I’ve written previously that I needed to own my alcoholism before I could even think to  change my maladaptive behaviours. This acceptance meant that I  walked into that meeting knowing, without a shadow of a doubt, that I am an alcoholic and that my life had become unmanageable. I knew then, as I know now, that everything good in my life could be taken away in the blink of an eye if I have another drink. This is another way of saying I had succeeded in taking AA’s first step.

Second, I did the opposite of everything I had done before when I attended meetings. Instead of sitting in the corner and not making eye contact with anyone, I shook the hand of the first person I saw and when I was asked to share, told everybody present about what a horrid fucking mess I was in, cried some tears and humbly asked for their help with snot running down my chin. I walked out with a bunch of phone numbers and got a sponsor shortly after.

Third, when people said I didn’t have to believe in any Gods or Goddesses to succeed in the fellowship, I listened to them. I asked them how they interpreted AA’s steps to make meaningful changes in their lives and did what they suggested.

Fourth, I kept going back to AA meetings. I learned to appreciate Nestle Blend 43 freeze dried coffee and Arnott’s Assorted biscuits, and realised that the more I listened to other people’s stories, the less I spent worrying about having another drink or losing my job. In the process of doing this, I stopped isolating and became a human being again. Time, as they say, is a great healer.

Lastly, I learned to meditate and *gasp* pray. Not the ‘Sky Daddy strike down my opponents so I can win the tennis tournament’ type of prayer. No, these prayers are all about forcing a change in perpective in me. If I’m feeling resentful at someone, it was suggested to me that I ‘pray’ for them: visualise all the good things that I would wish for myself, and then project those feelings onto the other person – e.g. that miserable, stinking bastard who cut me off in traffic. If I do this for long enough, sometimes through gritted teeth, the feelings of anger and resentment slip away.

Final word

Australia is a proud, successful multicultural society whose religious beliefs have become more diverse over the past 50 years. While half of Australians identify as Christian, other faiths like Hinduism, Sikhism, Islam, and Buddhism all increasingly common religious beliefs. The Australian Bureau of Statistics reports that, in 1966, Christianity (88 per cent) was the clearly the main religion. By 1991, this figure had fallen to 74 per cent, and then to 52 per cent in 2016. Catholicism is still the largest Christian grouping in Australia, accounting for almost a quarter (22.6 per cent) of the Australian population. Those reporting no religion was higher than the number of Catholics in 2016 at 30 per cent.

The fact that there are now more atheists than Catholics in Australia is notable, reflecting a trend that has been happening for decades. Those reporting no religion increased from 19 per cent in 2006 to 30 per cent in 2016.

It is within this context that a number of secular, athiest, agnostic, humanist, and freethinker AA meetings have sprung up in the eastern cities, offering hope to people like me who use their athiesm as another excuse to keep drinking. This is a welcome development in Australia and elsewhere that shows that the fellowship is being responsive to Australia’s changing community, in line with it’s first tradition that ‘the only requirement for membership is a desire to stop drinking’.

 

 

Muddy boots

We struggle in the mud of last night’s rain,

While fearing the long dry season to come.

We move in forgotten spaces. In long grass,

Behind corrugated iron sheets brown with rust.

The rumpled mess in the doorway on a congested street.

Would a coin help or hinder? Would it really matter,

When the next drink is as inevitable as the last?

Some keep tip top, topped up by day,

Comatose at night. Absent to loved ones, but resolute.

Denial is a river in India. Oh how we laugh,

Then cry as we hide the bottles under the sink.

We can’t live without it, live with it or live at all.

The choice seems simple, but the path so worn and furrowed,

Leads us, guides us towards the status quo.

We all have to make a choice: whether to run,

Or turn and face life on life’s terms. So come with me,

Let’s get those muddy boots off. The kettle’s on.

AA member survey

AA estimates that it has between 18,000 and 20,000 members and about 1,800 Groups in Australia. AA doesn’t keep records of its members or formal statistics of its membership; however it does conduct surveys from time to time. These surveys provide a picture of how AA is performing, and how it can improve.

Recently I reviewed Dr Joseph Nowinski’s popular science book If You Work It, It Works! The Science Behind 12 Step Recovery (2015). One of the book’s primary sources of data was periodic AA member surveys from the United States, including the years 1977 to 1989, 2007 and 2011.

This data is important because it shows how AA has changed in the United States since 1977. For example, women’s participation has increased to one third, while people reporting drug addiction in addition to alcoholism has increased from 20 percent in 1977 to nearly half in 1989. One of the interesting things Nowinski found was that AA’s method and message has remained remarkably consistent: if you want to get sober go to meetings, join a home group and get a sponsor.

In Australia, the most recent AA member survey was conducted in 2006, which is a bit rubbish really. Prior to this, the surveys were conducted every four years. The results will be published in November, so expect a full wrap-up and some preliminary analysis here on socialdrinking.blog just in time for the silly season.

If you are an AA member in Australia, get your response in quick as the survey closes at the end of March!

Details as follows:

Australian Fellowship Survey

The Australian General Service Conference 2017 has asked that this survey be extended to March 30th, 2018.

Please pass this message on to your AA contacts, who may not have participated in this initiative, and to pass this message on to their own AA contacts.

The survey can be found and completed at: https://www.surveymonkey.com/r/S26J52S

Notes on a meeting

A couple of guys in white collared shirts are having a laugh and a cigarette on the footpath, the adjacent building casting cool shadows in the early evening summer sun. I walk up, make some small talk and ask how their day is going. I’ve long since quit tobacco, so I don’t linger and head inside.

The group meets for one hour each week in a small room at the back of a local-government administered community facility. There are three core members of the group who have taken on the responsibility of keeping the doors open each week. This requires a number of tasks to be completed, including picking up the keys and opening up, welcoming newcomers and visitors, chairing the meeting, bringing and setting up the tea, coffee, biscuits, literature, collecting donations, putting out the chairs and, later, packing up.

People who attend the meetings always help out where they can, for example washing up coffee cups and stacking chairs. In the old days, the ashtrays had to be emptied too. These are what we call in AA ‘esteemable acts’: actions that build one’s self confidence and self-esteem through being useful to other human beings. Esteemable acts also include smiling and showing interest in other people, rather than ignoring them.

AA understands that when we value ourselves, we are less likely to drink or to behave in ways that are unhealthy to ourselves and others. In short: doing esteemable acts, like saying g’day to someone new and offering to make them a cuppa, helps us stay well. So, that’s what I do.

How do you take it?

White with one thanks.

Biscuit?

Members drift in and out of groups. Sometimes, there are more members of this group than there are service jobs to fill. At other times, such as now, there is little redundancy and therefore more responsibility is needed to be taken on by the three members. In practice, these are simple tasks. But the important thing is that they get done, by someone.

There are other members of the group who have drifted away. Some may have drunk again. Some may have moved to another town, or just to the other side of this one. Some may have even got the shits and developed a resentment against the group. It happens.

It is an open meeting, which means that anyone is welcome to come along and listen. However, only those people who identify as an alcoholic are called on to share. As the group is self-supporting in line with AA’s traditions, only those who identify as alcoholics are asked to give coin donations at the end of the meeting. If a friend or family member comes along in support of a newcomer, for example, it is considered inappropriate for them to contribute a coin to the basket at the close of the meeting.

Usually, no more than 15 people attend this particular meeting, which means that everyone gets a chance to share for a few minutes (going on for more than 5 minutes in a full room is considered poor form).

Some groups take a tougher line than others on asking addicts to share, although most of the addicts that come to this meeting identify primarily as alcoholics and are always called on to share.

We start with introductions, sitting in a circle.

The famous ‘hello I’m … and I’m an alcoholic’.

Some add their length of sobriety in years or months or days. Others mention where their home group is located and when.

This particular meeting starts with a reading from AA literature and then members get to riff on the topic or to share their experience, strength and hope in recovery. Usually it’s a bit of both.

Once everyone has had a chance to share, the meeting is closed with a reminder of AA’s principle of anonymity. The basket is passed and each person throws in a few coins, some gold.

We join hands, as the embodiment of strength in unity, and recite the serenity prayer.*

There are some announcements, including one about an upcoming camping weekend away. Coffee cups are washed, chairs are stacked. Hands are shaken, hugs given, laughs had. Phone numbers are exchanged. Some friends head off for another coffee.

The shadows have lengthened as the butane flames lick paper and tobacco.

I leave feeling better than before. More level. The right size. Just for today.

* ‘God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.’ Personally, I prefer meetings that close with the secular Responsibility Pledge: ‘I am responsible. When anyone, anywhere reaches out for help, I want the hand of A.A. always to be there. And for that, I am responsible.’

Book review: the science behind 12 Step recovery

Nowinski’s excellent popular science book If You Work It, It Works! The Science Behind 12 Step Recovery (2015) makes it pretty clear: AA only works if you participate.

Dr Joseph Nowinski’s name came up a bunch of times when I was doing research into international best practice in treatment and support for alcoholics and risky drinkers.  I was completing this work at the same time my drinking was at its white-spirit-worst and, because of that, I nearly lost the job for good.

In fact I’m pretty sure Nowinski’s Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence(1999) was even on the shelf when I was poking around in the literature cupboard at my last rehab. By that stage I had decided AA was definitely some kind of cult. Why else would people willingly go out of their way to help perfect strangers? Surely they had some other motive?

It turns out they did have an alterior motive. But they weren’t trying to sell me salvation proportionate to my income. No, helping others made them feel better.

Nowinski

Project MATCH :/

Dr Nowinski contributed to Project MATCH (1989-97), the largest alcohol treatment trial ever conducted involving 1726 alcohol dependent volunteers over several treatment sites in the US. The aim of Project MATCH was to find out if different types of ‘alcohol abusing or dependent patients’ respond differently to the most widely used treatments for alcohol dependency: Cognitive Behavioral Therapy (CBT), Motivation Enhancement Therapy (MET) or Twelve-Step Facilitation (therapists introduce patients to AA, explain some of the concepts and get them to attend meetings. The focus is on AA’s steps one to five).

Project Match’s data dissapointed a lot of people in the addiction and recovery field. It reinforced what many suspected: that matching the right treatment to individual alcoholics is difficult, and that treatment outcomes are similarly dissapointing across the board. In other words, Project Match didn’t offer a silver bullet for treating alcoholism.

Yet, the fact that a treatment protocol based on AA’s 12-steps – an unscientific, quasi-religious oddity – could achieve similar results as CBT and MET was notable, given that AA costs nothing to taxpayers and provides critical post-intervention (e.g. hospital E.R., detox, rehab) support in the community.

AA only works for those who take action

The title of If You Work It, It Works! is intentional because, as Nowinski points out, only half of us who attend AA stay active in the fellowship after three months.

I recently lost 20kg because I changed my diet and started running. Thinking about it didn’t get me healthy.

Nowinski analysed AA member surveys to find out what actions people take in AA to stay sober and found attending at least two and preferably three meetings a week, joining a home group, and getting a sponsor were the top three responses. These same three actions kept me sober in my early days of sobriety.

Nowinski examined a range of research on AA attendance and involvement, and treatments that encourage AA attendance. The results show that:

  • Getting into some form of counseling and starting AA at the same time is a winning combination if you want to stay sober.
  • Getting involved in the AA Twelve Step fellowship leads to superior results than simply attending meetings.
  • Identifying yourself as an AA member makes a positive difference.
  • Therapy that actively facilitates AA involvement is superior to treatment that does not include this focus.

He also notes that there is a spectrum of alcoholism and problem drinking and that, for some, controlled drinking may have its place after a period of conditional abstinence.  For those like me, who have tried and failed at controlled drinking and have ridden the ‘just one’, drink-drank-drunk *crash*, remorse cycle so many times the very idea of controlled drinking is laughable, Nowinski says that abstinence should be ‘the most appropriate goal’.

How it works

1. Social networks

Like me, Nowinski attributes much of AA’s value to the relationship between social networks and recovery. He uses a number of published studies to show how both involvement in AA, and the people in an alkie’s regular social network, are critical to long-term recovery. AA involvement seems to act as a buffer, particularly where a person’s regular social network includes frequent or heavy drinkers. Some people use AA as an alternative social network, particularly when there is always drink at home. I’m lucky that my immediate family are not huge drinkers and my best mates, while still capable of epic feats of party mayhem, are generally pretty sensible and respectful of my non-drinker status.

Interestingly, problem drinkers in a person’s social network exert a more powerful and negative influence on recovery than non-drinkers. In other words, surround yourself with drunks and you’ll probably end up just that – drunk. Surround yourself (at least some of the time) with AA members and you’ll probably stay sober. Dead simple.

2. Spirituality and sponsorship

As a scientist, Nowinski doesn’t engage in spiritual or theological argument. Instead, he presents published studies that have examined the role of spirituality in recovery. Obviously there are limitations in this data because concepts like spirituality are open to interpretation – particularly by sick people responding to surveys. The studies show that greater involvement in AA leads people to become ‘more spiritual’ over time, which is, in turn, positively associated with sobriety. This is not suprising, since AA is a program that emphasises the benefits of spirituality, particularly prayer and meditation.

The other aspect of AA’s spirituality Nowinski finds beneficial is the focus on personal values and self-reflection. He concludes that ‘spirituality, as it is reflected in AA’s emphasis on honesty, humility, and personal renewal, as opposed to formal religious observance, may be the key dynamic responsible for this change’ (p.148).

Nowinski’s message is clear: AA spirituality is not about joining a cult or a church. It’s about ‘pursuing a life of meaning and values. These include honesty, the courage to admit to shortcomings, humility, and altruism. Within the AA culture these values are demonstrated through action’ (p. 160).

Studies on sponsorship are pretty unequivocal: getting a sponsor early greatly increases your chance of not drinking again. However, this effect seems to decrease with time. Nowinski says that the adage ‘better late than never’ probably applies here, and I have to agree with him.

3. Neurological factors

Alcohol kills brain cells. That bit we knew already. But, if you drink like I did, it also greatly increases your chance of suffering from depression and/or anxiety, as well as PTSD and schizophrenia. The point is that most alkies seem to have some sort of psychiatric comorbidity or dual-diagnosis to party with their alcoholism and other addictions.

Nowinski reviews the evidence on recovery for alcoholics with dual-diagnosis and finds that, as long as people work their AA program, these illnesses ‘do not appear to consitute a major barrier to recovery’ (p. 181).  He concludes that recovery (and particularly Twelve Step recovery) has healing powers of its own.

Is it worth reading?

In a word, yes. Nowinski’s book is:

  • a much needed kick in the pants for alcoholics like me who forget to put in the action each day. Treatments for diabetes and heart disease are never effective 100 percent of the time, because they are dependent on whether or not a patient follows the treatment recommended by their doctor. As Nowinski puts it: ‘the best we can say, then, is that these treatements are likely to work if the individual works them’; and,
  • an excellent introduction to the medical literature on alcoholism and recovery, which shows that AA has some good, recent scientific studies supporting its approach to recovery.

Working with others

Alcoholism is a chronic, relapsing condition that, if left untreated, can be fatal. The main treatment I and millions of others around the world find effective is to work with fellow alkies and follow a few very simple principles based on honesty and respect for others. But, for me, it’s primarily about a unique human connection – one that is based on empathy. Or, as the old timers say, ‘the magic happens when one alcoholic works with another alcoholic’.

A great example of this is found in the AA Big Book in chapter 11 (pp.156-8). The story refers to Bill and Bob’s first visit to a guy who would become AA’s third member; a visit that resulted in AA’s first group at Akron, Ohio in 1935.

Bill W and Dr Bob had only just figured out that they needed to ‘keep spiritually active’ by working with other alcoholics, so they called up a local hospital and spoke to the head nurse:

They explained their need and inquired if she had a first class alcoholic prospect.

She replied “Yes, we’ve got a corker. He’s just beaten up a couple of nurses. Goes off his head completely when he’s drinking. But he’s a grand chap when he’s sober, though he’s been in here eight times in the last six months. Understand he was once a well-known lawyer in town, but just now we’ve got him strapped down tight.”

…Two days later, a future fellow of Alcoholics Anonymous stared glassily at the strangers beside his bed. “Who are you fellows, and why this private room? I was always in a ward before.”

Said one of the visitors, “We’re giving you a treatment for alcoholism.”

Hopelessness was written large on the man’s face as he replied, “Oh, but that’s no use. Nothing would fix me. I’m a goner. The last three times, I got drunk on the way home from here. I’m afraid to go out the door. I can’t understand it.”

For an hour, the two friends told him about their drinking experiences. Over and over, he would say: “That’s me. That’s me. I drink like that.”

The man in the bed was told of the acute poisoning from which he suffered, how it deteriorates the body of an alcoholic and warps his mind. There was much talk about the mental state preceding the first drink.

“Yes, that’s me,” said the sick man, “the very image. You fellows know your stuff all right, but I don’t see what good it’ll do. You fellows are somebody. I was once, but I’m a nobody now. From what you tell me, I know more than ever I can’t stop” At this both the visitors burst into a laugh. Said the future Anonymous: ‘Damn little to laugh about that I can see.”

The two friends spoke of their spiritual experience and told him about the course of action they carried out.

He interrupted: “I used to be strong for the church, but that won’t fix it. I’ve prayed to God on hangover mornings and sworn that I’d never touch another drop but by nine o’clock I’d be boiled as an owl.”

Next day found the prospect more receptive. He had been thinking it over. “Maybe you’re right,” he said. “God ought to be able to do anything.” Then he added, “He sure didn’t do much for me when I was trying to fight this booze racket alone.”

Bill and Bob continued to work with the man, and after three days he had become ‘willing to do anything necessary’, including to give his life to the ‘care and direction of his Creator’.

That afternoon he put on his clothes and walked from the hospital a free man…He never drank again. He too, has become a respected and useful member of his community.

Eight decades have passed since two alkies working together became three, then four, and now millions worldwide. And yet, the story remains relevant.

Aside from my wish to resurrect the phrase ‘as drunk as a boiled owl’, this is one of my favourite sections of the Big Book because it provides hope to those of us who are still suffering and can see no way out.

Most of the people I know in AA who have been to a rehab or detox have also drunk either on the way home from their treatment, or soon after. Just like our formerly-respected-lawyer-Anonymous #3. I did too, on two separate occasions. When we discuss these events we speak of unnatural, sanitised environments that do not prepare us for life after our time in confinement is up, certainly not if we return to our communities with no lifelines (I have many AA members’ numbers in my phone who I can call on at any time). This phenomenon – the relapsing nature of the condition – continues to challenge the medical profession and policy-makers alike.

But, for eight decades, AA has been keeping people sober on little more than a pay-it-forward faith in something more powerful than the individual.

The Big Book likes to call this something God. Today, AA teaches that it just has to be something other than ourselves. Even the AA group – a thoroughly humanistic Higher Power if ever there was one – can be this special something.

But, most of us have found that we can’t just rely on gods and goddesses to get us well. We have to put in some work too.

 

The knife

I’ve just spent some time at my folk’s place in coastal Victoria, Australia. It was my annual, seasonal ritual delayed: family (and dogs) converging for ham and plumb pudding in the second week of January. The sun was hot and the March flies (who clearly don’t give a toss about human inventions like the Gregorian Calendar) were hungry for blood.

My parents gave me a knife as a sort of weird family heirloom, given that it was thrown at, and narrowly missed, my grandfather during a post-footy game riot in Melbourne’s Western Suburbs not long after WW2.

Pa was a VFL (aussie rules football) club champion during those years. A quiet family man and boilermaker – not the type to attract would-be knife throwing ninjas, but a prime target for pissed idiots nonetheless.

The knife has an iron cross and some other etchings, suggesting it was made for the German army, most likely the Luftwaffe or so I’ve been told. Anyway, it has the balance of a throwing knife (the chips out of the bone handle suggest it has seen some use).

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My grandparents old house was up for sale, a few doors down from my parent’s place and where my dad and aunt grew up. Apart from a lick of paint, the house and large block of land with the tennis court my Pa built remains unchanged and miraculously undeveloped.

I had a walk through the ‘classic beach shack’ and viewed the realtor’s slick promotional video for the sale, complete with aerial drone footage. I’m not sure what Pa would have made of all that fuss. He was a no-nonsense kinda guy.

Going home always seems to bring back memories.

I had my first alcoholic dream in what feels like an eternity the other night: the full-bore, wake up in a cold sweat, dry mouth, heart palpitations, ‘oh fuck I’ve drank’ panic. In the dream, I was drinking in my old haunt, at the pub down the road from my folk’s place, and got so pissed I couldn’t climb the hill to get home. The road turned into a vertical cliff face before the dream dissolved and the panic of a bust subsided into lingering feelings of remorse and guilt.

During my 20s  and early 30s I used to go to that pub with the intention of having a couple of drinks. Instead, I routinely woke up on various mates’ couches among the empty bottles, ciggie butts and drug paraphernalia – evidence of the previous night’s hedonism. On those mornings, that damn hill felt like a cliff face.

Fortunately, I don’t plan on scaling any cliffs today. Just some hills with the scent of eucalyptus in the air.

One day at a time (still)

Kermit

I had to come home early from my planned trip away because I needed to get my back fixed (official story) and my head fixed (most importantly). You see, if I drink again I’ll end up back on the couch passed out most of the time, which is about the worst thing you can do for a crook back.

The back took 35 minutes with the physio.

The head? I’ve been to a bunch of meetings and spoken with other alcoholics. I’ve gained a fresh perspective and have become right sized again. Not a mean, small little man who is resentful when things don’t go his way. Or the grandiose, obnoxious oaf. Just right sized.

I have also finished an inventory and have realised a few things:

1 I am still an alcoholic and even if I don’t drink today, my addiction is still there lurking. Like a fucking lurker. If I don’t treat it, I turn into an asshole and nobody needs that.

2 The symptoms of my untreated alcoholism, for example feeling restless and irritable seem to increase as I take more things for granted. My sponsor said to start doing a gratitude list again, so I have. Right now, I’m grateful I’m not dead in a ditch, am living in Australia where I don’t have to worry about getting shot walking down the street, and for mangos. Mangos are amazing.

3 When I’m not working my program I tell more people, more regularly, to fuck off. This is unfair to them and marks me as someone incapable of polite conversation. I will also busy myself taking other people’s inventory: I’ll believe it is my right to find the error in someone else’s ways and (worse still) I am arrogant enough to think I can change them. Rather, I should concern myself with cleaning up my side of the street in personal relationships. After all, the only person I can really change is myself.

The other night I went to a meeting in a small coastal town, which was unlike any other I have ever been to. It seemed to be operating more like a personality cult than a healthy AA group, with one guy completely dominating proceedings, including sharing and questions and answers from the floor. I heard that the group doesn’t encourage newcomers to share, with the message they have nothing useful to contribute. What a load of crap.

I believe newcomers are the lifeblood of meetings. I still attend meetings every few days, when I can, to remind myself that I can’t take my eye off the ball. Don’t get me wrong, newcomers aren’t like poverty porn. There is no voyeurism in AA. I just need to hear their stories and see their shakes to remember my own worst moments. To feel my own worst moments.

I also believe AA is at its best when its traditions are observed, particularly the principle that the group is more important than the individual and that no-one is ‘in charge’ in AA. Still, I bit my tongue: it is up to the group to work it all out.

I just wish I could bite my tongue more when I speak to loved ones and people that piss me off in the street.

In sum: AA is not just about putting down the bottle. It’s about learning to live without alcohol. I need to be willing to change the way I think about things and how I react to situations.