Afraid to Recover?
We are familiar with the phenomenon of resistance to recovery, which may be due to several reasons. Firstly, the denial of addiction is part and parcel of the disease itself, and this denial may be due to unconscious factors. Even after the alcoholic or chemically dependent person has overcome the denial, there may be the apprehension of no longer having recourse to the chemical crutch to help one over difficult or stressful moments. In some cases, addiction has become a way of life. One young woman wished to leave treatment precisely because she was concerned that the program might be effective. “If I can no longer drink or use drugs, what else is there to do?” she asked. We can undoubtedly add to this list of reasons for reluctance to abstain from alcohol or chemicals.
Another reason which may be operative and which may sometimes be overlooked is that the chemically dependent person may actually be afraid of being well. It is precisely because this seems to be absurd that it tends to be overlooked, but if this fear is not dealt with in treatment, a major obstacle to recovery may persist and contribute to relapse.
A 26 year old woman who was admitted for detoxification asked whether she could have psychological tests performed to determine whether she had sustained brain damage. She was assured that there was no reason to suspect brain damage and that testing was not necessary. The following day she asked to have an electroencephalogram (brain wave study) and was again assured that there was no need to test for brain damage. What emerged was that she actually hoped, as well as feared, that she would be found to have sustained brain damage. As terrible as brain damage might be, it also had a redeeming, albeit pathological, value. She would then be able to say to everyone, “Quit bugging me! Stop expecting anything of me! I cannot recovery because I am brain damaged. I do not have the capacity for sobriety.” In addition to warding off those who tried to help her, she would also not have any expectations of herself. She could then continue in her addiction, undisturbed by both her conscious and well-wishers.
People who have sustained physical injuries and who receive ongoing compensation may continue to have symptoms for a very long time, simply because the persistence of symptoms is profitable for them. This phenomenon, known as “secondary gain”, does not mean that the person is “faking” symptoms. Rather, the body can become conditioned or trained to produce some kind of reward.
“Primary gain”, in contrast to secondary gain, is the advantage that accrues bring being sick, not from external sources, but from the patients own psychological and emotional makeup. For example, a person who feels guilty may continue to have pain, because this may serve as an atonement for his “sins”. Being well means that one has to function, to perform, and to accept responsibility. For some people this is too great a challenge and they may prefer to be “sick”, even though the latter is distressful.
The fear of being unable to function in a healthy manner is generally due to two factors. The first is essentially a matter of habit. We often retain a familiar behavior pattern even if it causes suffering, rather than change to a less painful behavior if the latter is unfamiliar. Youngsters who run away from a brutal household often return of their own accord with full knowledge that they will suffer, because that with which they are familiar is more tolerable than the unknown. For the person accustomed to being sick, healthy functioning can be very threatening.
A second factor, of at least equal and perhaps greater importance, is the profound feelings of inadequacy which are so prevalent in chemically dependent persons, and which do not allow them to consider that they might indeed be successful. They are so convinced of failure that they feel it is useless to try. They feel an attempt at anything is certain to fail, and since failure will only result in more distress, why try?
Some alcoholics have a patterns of succeeding at a job or venture only up to a certain point, and then doing something that sabotages or ruins everything. It is often said that people such as this are afraid of success. This is true. The reason for this fear often is that success will bring additional demands for performance and acceptance of responsibility, which may be so threatening to the individual that he escapes by scuttling the project.
Some alcoholics who are treated by psychiatrists especially if the latter are not well-versed in the treatment of addictive diseases, may actually rejoice in receiving a psychiatric label, even if it be “schizophrenia' or “major affective disorder”. By the same token, they are apt to shun a treatment approach that diagnoses then as “just alcoholic”. They prefer the psychiatric diagnosis for two reasons. Firstly, the burden for recovery from a psychiatric illness rests on the psychiatrist, whereas the alcoholic, it rests on patient, and it is always more acceptable to shift the work load onto someone else. Secondly, a psychiatric diagnosis gives the individual a rationalization why he cannot remain abstinent: he is just too sick to become sober! He thinks that when his depression or other condition improves, then he will be able to do without chemicals. What is not realized by both the doctor and the patient is that as long as he continues to drink and use chemicals, he is not apt to get better.
The fourth of the Twelve Steps in AA requires that the alcoholic make a “fearless moral inventory”. This implies that there is something frightening about an inventory, and most people will say that they fear that a thorough inventory will reveal many of their unpleasant personality traits and character defects which they are reluctant to confront. This is not necessarily so. There may be an even greater fear of discovering one’s personality assets and character strengths, because awareness of these imposes upon one the obligation to cope with reality rather than to seek the comfortable escape into the oblivion of alcohol and drugs. Many alcoholics and addicts already know their character defects. In fact, they imagine they have weaknesses which do not exist. It is more likely they are unaware of their strengths, and strange as it may seem, may refer to remain unaware of them.
Alcoholics frequently point to various “reality” problems that they feel are major obstacles to successful performance. These may well be plausible, but are often nothing other than rationalizations.
As a child I used to love to row, but I was not permitted in a boat unless accompanied by an adult. I therefore used to get into the boat while it was fastened securely to the pier, and then I could row to my heart’s content, since there was no way the boat could move into dangerous waters.
When one feels threatened by moving out into the world, one may throw a rope around a pole and fasten oneself securely, so that one can go through the motions without actually going anywhere. The alcoholic does this when he ties himself to past events, such as rejections, failures, or resentments. He says “I cannot function because I cannot get over my wife leaving me.” What may be more correct is that since he has a fear of normal functioning, he seizes onto the rejection as a reason for his lack of performance. He cleverly reverses cause and effect.
This fear of being well must be confronted in therapy. It must first be identified, and then pointed out to the patient. There are usually multiple incidents in the patient’s history that the therapist can use to elaborate this problem to the patient. Association with recovered persons who had a similar pattern and succeeded in turning their lives around is an invaluable resource. Patients who are in ongoing therapy need to be given special attention once they have begun to function constructively, for it is then that the risk is the greatest.
Finally, therapy directed toward building self-esteem which can complement the achievements in the Twelve Step recovery programs, will also provide additional self confidence that can help avoid the reoccurrence of the “scuttling” phenomenon. The vicious cycle wherein each failure depresses one’s self-esteem and thereby paves the way for precipitating additional failures can then be reversed, so that each complimented achievement enhances the self-esteem and encourages one to new efforts at growth.
