Updating My Files: “New” Paradigms, Damage Control, It’s All About Regulation

As an inveterate bookworm and student, I am reading all the time, and there is never enough of it—Oy vey. But what a wonderful problem to have when compared with the years of slogging to get through the day. However, with all that I read, it is not that often that I learn something that really changes my way of thinking. Not only new information, that is easy, but actually making use of it differently or relinquishing old, often long-held views. Over now close to forty years of sobriety from alcoholism, I have been entrenched in an admittedly “orthodox” 12-step rigidity. Not the “God” part, which trips up many people. I resolved that right at the start. But rather a hardcore abstinence-only program.

Of course, a severe black and white perspective readily suited me. I was always an “all or nothing” kind of girl and defaulted to a hungry “more is better.” I remember from an early age my mother trying to teach me the word “moderation.” 

That’s a pretty big word for a little girl. I never quite got it and probably still don’t, or not enough. However, now I understand it more in terms of regulation versus voracious greed or wild overzealousness. Total abstinence from alcohol was infinitely easier than trying to figure out how much was enough or too much, i.e., to self-regulate, so I grabbed on to that one for dear life.

 I was always an “all or nothing” kind of girl and defaulted to a hungry “more is better.” I remember from an early age my mother trying to teach me the word “moderation.” 

Some people resort to entering a convent, the military, a cult or an authoritarian party or regime because all the decisions are made for them. There, they don’t have to assess or conclude what’s “just right,” like Goldilocks. I admit that some of that was in play during my political activist days when ideology was strictly prescribed, and political correctness was fundamental to having any sort of value at all. To this day, I am most comfortable in tight-fitting clothes: they seem to contain me and keep me from blowing apart from the inside. Similarly, I recently discovered that a weighted blanket has a similar “holding” effect. I continue to have a tendency to “color outside the lines.”

From the beginning, we all need a mom, not least because a good mom is regulating and teaches regulation. Comfortable in one’s own skin, one can live, love, “pursue happiness” with all that means, create, learn and take pleasure in life. A history of childhood trauma and/or neglect puts one on a relentless quest to find it. I think of the 23-year-old that I was, 98 pounds, on the couch with my cat Marti, drinking a quart of Old Crow bourbon straight each night single-handedly; it was $6.95 a quart then. Marti, named for the Cuban National Poet, Jose Marti, lived to 22. I always said she was like a mother to me. Really it was all an endless quest to find that elusive calm in the war-torn world of my body. Marti certainly helped, and so much of addiction boils down to that.

The dictum to “just” stop, or “just say no!” (a day at a time of course) was not easy but simple, and much easier than finding my way with food, which could never be relinquished entirely, or not safely.

From the beginning, we all need a mom, not least because a good mom is regulating and teaches regulation.  Comfortable in one’s own skin, one can live, love, “pursue happiness” with all that means, create, learn and take pleasure in life.

I have since learned several sobering “new” to me facts about alcohol. According to World Health Organization data, alcohol is one of the world’s leading causes of death, behind tobacco which amazingly is still a great killer. Alcohol kills not only in its insidious damage to the body and brain, but DUI car accidents, behavior and crimes committed under the influence, not to mention the suicides of not only the drinker, but collateral loved ones whose lives with that person have become unmanageable. 

Alcohol also causes more brain damage than any other drug, and neuroimaging shows the blackened tissue, which is the poisoning and deterioration caused by inflammation and dying cells. No other drug, neither medical nor recreational, shows that kind of wreckage.

And finally, a measure I had not actually pondered before: damage is measured not only by a substances’ impact on the individual user but on others and the world. How many children and spouses are neglected and abandoned every day due to addicted or substance-abusing parents? How many were molested, raped, beaten or in some other way violated by someone who might have much better judgment or control if not intoxicated? It goes on and on. And in this tally, alcohol wins by a landslide in terms of how widely one person’s substance use reaches. More reasons to be grateful, I was able to stop at 28 before doing more damage! Unfortunately, a hugely profitable industry holds it in place. Prohibition failed. Culture, tradition and culinary aesthetic make it essential to find a way at mass level, to regulate and self-regulate. Of course, this would have to include, at least where possible, addressing the myriad realities that would inspire an individual to “escape,” even if momentarily.


Michael Pollan’s latest book, This Is Your Mind on Plants, has a long section on caffeine. What I found most interesting was the history of how coffee affected industry, the industrial revolution, and the world political economy. Well worth reading! And we, or at least I, had not thought so much about caffeine as a “drug.” But meanwhile, in the private laboratory of my own brain, I have had to look at it as such. 

One of the ways I have grappled with my complicated sleep issue (and the “challenges” of sleep will be a topic of its own blog on another day!) is with my afternoon coffee. I also began to notice that if I woke up and had my morning cup too early, by early afternoon, I would have one of those scull-cracking headaches right in the middle of my forehead, the undeniable battle cry of caffeine withdrawal. So the afternoon cup became medicinal in more ways than one—Oy vey. I am back to being that rat on the wheel, trying to stay ahead of the breathless chase. And although I don’t believe in the rhetoric of the “addictive personality”, I know all too well about the deep-seated dysregulation of early attachment trauma.

I knew that to begin to ratchet down the caffeine headache loop and ultimately eliminate it, I would have to find a much better way to manage the sleep issue (which I am constantly working on anyway) and also endure the discomfort (agony?) of weaning myself off. That is no fun at all. Although my own alcohol withdrawal is a blurry memory, not only because it was so long ago, but due to the addled brain I would remember it with, I do remember one of my very first mental health jobs in a methadone clinic. It was there, with a clearer head of my own, that I was to learn most vividly about “dope-sickness.” So, facing the prospect of enduring headaches without relief, or perhaps relieved in some other undiscovered way, was daunting. That is precisely what keeps all addicts on the wheel. And it is reminiscent of the age-old attachment theory dilemma without solution when the source of comfort/relief and the source of devastation and/or terror reside in the same package, human or otherwise. All the more reason why we need a more regulated world, in all the ways, regulated relationships, self-regulating individuals.

Harm Reduction

Here is where I began a subtle process of “changing my mind.” I heard expert drug researcher David Nutt (what a great name for a psychiatrist!) talking about “Harm Reduction”. When I first started hearing people talk about this “new” approach alternative to total abstinence, I balked, trying to conceal my skeptical contempt. My “todo o nada” all or nothing sensibility was roused. However, Nutt is not only extremely knowledgeable but personable and experienced at talking to people about delicate, often highly personal and controversial topics.

According to Nutt’s data (culled from his talk at the recent Addiction and Imagination Conference):

“…reductions in consumption gain much greater value in terms of health than you might imagine if the curves were linear. If you go from someone drinking 100 grams of alcohol a day, say a bottle of wine, to just 50 grams a day, you would lower their consumption by 50%, but you reduce their risk of death by eight times. And even if you reduce consumption at the top end by 10%, you actually reduce the risk of death almost by twice. So this is why any reduction in drug consumption is hugely important and that’s why harm reduction approaches are likely to be the most powerful ones in terms of mitigating the harms of drugs.”

As many of us know when learning regulation, harm reduction paradigms are not “pie in the sky.” But perhaps, I must also consider they are also not another money-making gimmick like the latest in an endless stream of commercial diet schemes, but rather a viable interim option. I have actually “updated my files” to incorporate them. Even this old dog can learn a new trick now and then!

In an Imago Therapy conference, I attended probably thirty years ago, I learned a quote that I have never forgotten, although I can’t for the life of me remember the name of the speaker or of the First Nation tribe that originated it. However, the words have stayed with me, and I even made a colorful wall hanging with them, which is hanging in my office: If you think you know me, you have stopped my growth in your presence. My interpretation: If you hold me to what I said or believed thirty years ago, or last week, or even yesterday, you are closing off the possibility that I may be growing all the time in our relationship. So, harm reduction is an important consideration. So there you have it: Addiction 101! 

But as for me, well, I will stick with total abstinence and neurofeedback!

Each time I write a blog, I always try to think of a song that I love that goes with what I’ve written. Today’s is I’m So Glad by Fresh Cream. I love this song, although sadly Eric Clapton has his own story about addiction.

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

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