Translate this blog.

Thursday, November 1, 2012

Alcoholism and Addiction

It's the same thing, alcoholism and addiction, really. Same illness, just a different substance. Then add on to this category the process addictions: gambling, spending, sex, porn, eating disorders like bulimia and anorexia. Let’s also recognize the binge- purge cycle associated with gender dysphoria where one acquires a wardrobe appropriate to our true gender identity and then in a fit of guilt and shame throws it all away, only to repeat the cycle by acquiring another wardrobe.

“The National Institutes of Health (NIH) estimate that 7.3% of the general public abuses or is dependent on alcohol, while 1.7% abusesor is dependent on non-prescription drugs. Eight percent (8%) of study participants reported currently using alcohol or drugs specifically to cope with the mistreatment that they received as a result of being transgender or gender non-conforming, while 18% said they had done so in the past...” ( :2011).

How is addiction defined? Essentially, an addict continues in the behavior  involving  a substance or process  even when it creates painful consequences for an individual and the individual continues to engage in the use of the substance or behavior despite those consequences. What are the life domains involved where one experiences negative consequences that indicate an abuse or addiction?

1.     Legal: This could be a result of illegal behavior such as driving under the influence, possession of a substance, or other illegal acts that bring law enforcement attention.

2.     Emotional: Depression, anxiety, obsessive compulsive disorders, and Post Traumatic Stress Disorder. Many of these are a result not just because a person’s physical body does not match the person’s gender identity, but because of emotional, physical and sexual abuse the individual may experience simply because they are transgendered.

3.     Financial: Money spent on substances or process addictions, divorce, custody battles, clothes that can’t be afforded, or to replace what was purged, as well as so many other issues.

4.     Spiritual: the sense that we are alone, isolated and having no connection to others. It may be a result of being rejected by our faith if we are raised in the church.

5.     Health: These are consequences of illness or accidents that are a direct result of abusing substances or engaging in compulsive actions without regard for their consequences.

6.     Social: Broken relationships with friends and loved ones as a consequence of behavior under the influence that is painful or otherwise hurtful to others. 

In the past 11 years, working with substance abuse patients, I have known well over 100 people who have died due to overdose, accidents, illnesses contracted as a result of drug use, and suicide. Most of them were very nice people and their loss of life is tragic. The collateral emotional damage to their loved ones cannot be underestimated. 

Our community has a suicide attempt rate of 41%. Those who abuse substances have higher suicide rates than the general population. It isn’t a surprise that substance abuse plays a large role in depression and suicide. Those of us who are of transgender experience most often are no strangers to depression, myself included, though my depression stems from other issues in addition to having lived years in varying degrees of denial about my own identity. I thank my God and my wife and friends who love me that I have never been to the point where I considered suicide, but I, like many have had bleak dark days when I wished I had never been born or were dead. Now that I have accepted myself and am transitioning those dark days are fewer and fewer. 

When I worked at Bryce Hospital in Tuscaloosa, Alabama (my spiritual home!) I worked with the forensic unit that housed people found Not Guilty by Reason of  Insanity by the courts for varying offenses, some serious, some not of such consequence, but all the crimes were felonious. When I got there and was assigned to the unit, I was told essentially “Here is your unit. Do what you want with the programming”. It had the longest length of stay of the chronic units for several reasons. Some of them were because of the heinousness of the offense, other reasons included they had not had a unit director to provide structured therapeutic treatment for that patient population. Other patients’ offenses were not that severe and were candidates to be returned to the community.

To cut to the chase, I developed programming that allowed many of these patients to progress to the point that they could be placed back in the community and I did indeed start placing them back in to structured living placements or returned to live with their families. Unfortunately, they would stop taking their prescribed medications and abuse drugs and alcohol. Then they would be recommitted to the hospital, most often in a psychotic state or severely depressed, or manic. Typically, they were only out of the hospital for 30 to 90 days before they were returned. 

My graduate program did not include any classes on substance abuse treatment. That was not unusual for that time. So I had to educate myself about substance abuse treatment. In the course of this self-education process, I learned for the first time about 12 step programs. Alcoholics Anonymous was the original 12 step self-help program and was founded by Bill Wilson and Dr. Bob Silkworth. I also studied materials from the Hazelden Foundation, our nation’s premier institute of treating addiction and educating professionals such as myself on how to treat alcoholism and addictions. I also attended 4 days of training at the Alabama School of Alcohol and Drug Studies. I developed the first dual diagnosis (mental illness and chemical dependency) in a state hospital in Alabama and was also the first to bring AA and NA into a state hospital in Alabama.  

People on my unit began to recover from alcoholism and addiction and began to successfully be placed back into the community without returning to life in an institution. It is one of the accomplishments in my life that I am most proud of. 

What I have taken from this is the importance of 12 step programs. The 12 step self-help program has saved the lives of more people and can be applied not only to alcohol and drug dependencies, but to the process addictions. In fact, it is my belief that anyone can benefit from practicing principles of the 12 step program whether you have an addiction or not. They teach you to rely on a higher power; however you may define that to be. They teach you to take stock of yourself, recognize the problem areas of your life and how to address them. They teach you to make a list of those you have hurt in one way or another and to make amends to them when it does not hurt the person you make amends to further. They teach you how to not harbor anger and resentment and how to resolve these issues. They teach you how to improve your relationship with others and your higher power and how to learn to become serene by accepting things you can’t change, changing what you can and recognizing what can be accomplished and what cannot. 

Are the 12 step programs for everyone? No. There is no one size fits all solution to our problems. Not everyone can benefit from the 12 steps, but by and large, the 12 steps help more people than anything else in overcoming addictions and compulsions. 

I have said this for years: Psychotherapy and medications treat depression and anxiety more effectively than either alone, borne out by study after study to the point it is irrefutable.  If someone came to me and said “Sherri, I can either pay you $100.00 (USD) for each hour of therapy or I can go to AA, (NA, or whatever 12 step program addresses the issue at hand) which is free, but I can’t do both, I would send them to the 12 step program to try first. That means its money out of my own pocket, which is a very high endorsement. It’s not about my self-interest, it’s about getting people help so they can be who they are authentically and be happy and healthy. 

I personally estimate that12 step recovery programs can be of benefit to 85 to 90% of people who participate in them. There are 10 to 15% of people who for whatever reason do not find them helpful. Whatever you decide to do if you have an addiction or a dependency of some sort, never give up in your struggle to overcome it. You deserve so much more than having to live with the despair of chemical dependency or with a process addiction.  

To find a local meeting here are some links:

Alcoholics Anonymous:

Narcotics Anonymous:

Sexaholics Anonymous:

Gambler's Anonymous:

Sex and Love Addicts Anonymous:

Al Anon:

Overeaters Anonymous:


Codependens Anonymous:

 A Christian oriented 12 step program:


1 comment:

  1. Thank you for much to learn about...sigh...