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A client of mine (I’ll call him Peter) recently returned from completing an elite professional degree. He had also achieved more than a year of sobriety. When Peter first got sober, I don’t think either of us imagined him coming so far in such a short time. He had been in treatment for several months, and although he’d had short periods of sobriety, he had suffered a severe relapse. He presented at the clinic with drug-induced psychosis and an infected abscess from IV drug use.

We almost never discharge people from our program for using drugs or alcohol. That would be like a cardiologist refusing to treat a patient because of high blood pressure. But when it is clear that someone is getting worse, not better, we do require them to transition to a higher level of care. When our medical director and I met with Peter, he refused to enter residential treatment. He said he’d already been to the best residential treatment centers in the country and that they hadn’t helped him. We told him that acute illness requires acute care (no matter how many times) and that we could not ethically offer ineffective treatment.

On our way out of the medical director’s office, I invited Peter into mine to make one last plea that he enter residential care. Instead, Peter made his plea: “Give me one more week. I will stop using. If I don’t, I will go to residential.” Although there had already been several “one last week”s in this relapse, Peter had never made such a clear behavioral contract. I told him: “Sure. I’ll see you at our regular time next week.” That day marked a turning point in his recovery.

In his prior attempts to get well, Peter had avoided 12-step participation. He suffered from severe social anxiety and stuck to treatment meetings despite frequent recommendations that he engage a 12-step program. This time around, he overcame his reluctance and began to attend 12-step meetings with fellow clients in treatment. Eventually, he got a sponsor, and when he moved to finish his professional degree, he immediately found a home group, attended multiple groups per week, and continued working the steps.

When Peter returned home, he was proud of his accomplishments and of his recovery. But when I asked him about AA, he made a curious assessment: “It has helped me stay sober but I’m not into it the way that others are.” As we explored this sentiment, it struck me that I was talking to someone who had been engaged to get married and was now having cold feet. After a year of sobriety, the novelty of AA had worn off, but Peter had not been engaged in AA long enough to form the type of attachment that develops over the course of years.

Consider three hypothetical young men in different stages of relationship. The first is just falling in love. The second has been dating his romantic partner for 18 months and is considering marriage. The third has been married for 10 years. Bachelor #1 is in the attraction stage of relationship. No natural process mimics drug intoxication more than biological attraction to a potential sexual partner. Over time, however, the infatuation wears off and a more critical perspective develops. Bachelor #2 is beginning to see the negative aspects of his partner just as pressure mounts for him to commit more deeply to the relationship. Our third young man is likely to have gone through similar periods of doubting before committing to marriage. When the first flushes of romance wore off and day-to-day patterns became the main substance of his relationship, he had to decide whether the shared life, values, and familiarities of his relationship were worth sacrificing to other potential experiences and partners.

Peter had returned home in the stage of doubting, when the romance of AA had worn off and the prospect of sitting in meetings week afer week, year after year with a random group of men, drinking bad coffee and rehearsing the same ritualistic stories had started to seem undesirable and inconvenient. Peter could not deny that this group of men and the AA tradition had helped him reclaim his life and his future. But like a bride at the entrance to the wedding aisle, he was feeling nervous about committing to the good, the bad, and the ugly of committed 12-step recovery.

For persons who reach the cold feet stage of recovery, I don’t have a prescription. Your life and your commitments are your own and every commitment comes with both a price and a promise. But to paraphrase a 17th century philosopher: What do you have to lose from committing to a program and community that supports you in developing a life of honesty, reflection, generosity, friendship, and humility? Even if you could have stayed sober another way (and there’s not a lot of evidence you could), the way you’ve embarked upon has more to offer than just sobriety.

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Ned Presnall

Ned is Executive Director of Clayton Behavioral and Adjunct Professor at Washington University in St. Louis, Missouri. He presents widely on the topics of addiction, mental health, and Medication Assisted Treatment. Ned is passionate about reducing the stigma against persons with addiction and against Medication Assisted Treatment through discourse and public engagement.


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