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Forget What They Tell You: Denial Can Help You to Recover From Addiction

Jabberwocky

Frumious Bandersnatch
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Intro: The Placebo Effect is strong with you my child!

Forget What They Tell You: Denial Can Help You to Recover From Addiction
Acknowledging your addiction problem is the first step to recovery, you will hear. But evidence shows that being saddled with an “addict” identity often harms people.


S. Peele | 11/5/14 said:
Chris drank recklessly throughout his 20s, often getting black-out drunk several times a week. One morning, in his mid-20s, he awoke after a particularly bad bout, horrified by what he could remember and how he felt, and terrified at the thought of what else he might have said or done. He started searching online for a local AA chapter—but then halted. “What am I doing?” he thought. “I’m no alcoholic.”

Right there, we recognize the narrative of the alcoholic “in denial,” the one who inevitably goes on to ruin and death.

But as we shall see, the evidence is clear that for people with addiction problems, identifying as an alcoholic or addict more often has an adverse effect than a positive one. Chris’s decision that morning probably saved him a great deal of suffering. Yet the denial-is-bad meme dominates our cultural perception of addiction.

Twelve-step Recovery Dominates the Narrative, Natural Recovery Dominates the Numbers

George Vaillant’s highly touted 1983 book, The Natural History of Alcoholism, followed the lives of men in two groups, one working-class (largely Italians and Irish), the other upper-middle-class Harvard students, for decades. He found that a decisive majority of alcoholics in both groups achieved remission on their own.

When I reviewed Valliant’s book for the New York Times Book Review I wrote, “The cases [Vaillant highlighted] belie the complexity of his research by emphasizing with monotonous regularity the need for an alcoholic to acknowledge he has an uncontrollable disease and to seek redemptive treatment for it.” That is, every person Vaillant (who went on to become a national board member of AA) describes in his examples either entered AA and recovery or else, if they failed to do so, ruined their lives with their drinking.

These narratives are par for the course. You are simply not “allowed” to describe a person who avoided treatment and AA and who survived, whether they reduced or eliminated their drinking or drug use. What is most challenging for Vaillant and the AA viewpoint is when these people reject the idea that they are fundamentally alcoholics or addicts.

This rejection of an addict identity applied to the former Chancellor of Schools for New York, Joseph Fernandez, for example, who quit his youthful heroin habit before achieving prominence, but was fired for discussing his drug use in his memoir. Fernandez didn’t call himself an addict.

Likewise, Ron LeFlore, an all-star center fielder for the Detroit Tigers who learned to play baseball in prison, used drugs as a teenager and took heroin and cocaine combinations daily for nine months before he was arrested for robbery. But he, too, decided he wasn’t really an addict.

Let’s return to Chris. Despite his seemingly having “hit bottom,” he continued drinking at more or less the same level. But as he entered his late 20s, his life gradually changed. He met the woman he married, settled into work he liked and made peace with his parents. He also began going out less, quit hanging out so often with heavy-drinking cronies and more often drank without getting drunk.

Years later, now a moderate drinker, Chris went with a friend to an AA meeting. He was struck by how much the first halves of the stories he heard resembled his own early drinking. “I could be one of these people,” he thought, “stuck in this world of alcoholism and recovery.”

What are we to make of Chris’s story? If you don’t follow the recovery narrative, your sobriety is questionable. A recent New Yorker interview with Billy Joel, deconstructed here, noted that Joel “rejects the AA approach and favors the kind of self-moderation that AA’s devotees cluck at.”

Yes Chris is typical. Reviewing the research on addiction and alcoholism that comes from the massive NESARC study of people’s life-time drinking and drug use, the highly respected British “Drug and Alcohol Effectiveness Bank” observed (in its October 30, 2013 bulletin):

“Why is addiction so often seen as a chronic disease? It could be because most of the studies and most dependent users who come to light derive from treatment services. Findings from the largest ever US national survey of drink and drug problems show that outside the clinic, remission was the norm.” [My emphasis.]

NESARC questioned 43,000 randomly selected Americans, compared with studies of treated alcoholics or addicts which rarely number more than a score or two of subjects. The NESARC subjects were asked how they drank or used drugs at the most extreme point in their lives, and about their drinking and drug use in the past year.

Like Chris, they detailed their worst substance problems. Then they usually described their current moderate consumption—the most common outcome with alcohol—or, with cigarettes or other drugs, usually but not exclusively abstinence. But subjects like these who overcome substance problems rarely define their younger selves as addicts or alcoholics, or even acknowledge having had a problem!

Is this a coincidence? Or is refusing to define yourself as addicted in itself a key step that enables you to move on? Put another way, what are the costs of assuming the addict/alcoholic identity—including hindering, actually forbidding, you from becoming the person you would otherwise evolve into?

Compulsive Gambling: The Same Story

To help us answer that, let’s take a look at a non-drug addiction. NESARC also asked about compulsive gambling. Wendy Slutske, at the University of Missouri, analyzed gambling in NESARC.

First, Slutske noted, “Pathological gambling is described in DSM-IV as a chronic and persisting disorder.“ (Now, in DSM-5, such gambling is reckoned an addiction.) In reality, Slutske found, “A substantial portion of individuals with a history of pathological gambling eventually recover, most without formal treatment.” Why does that sound familiar?

What about “controlled gambling”—that is, recovering without abstaining? Slutske conducted another study in Australia. “In this general population survey, nearly all the pathological gambling recoveries were achieved in the absence of abstinence. Controlled gambling appears to be a popular road to recovery in the community.”

Slutske also conducted a longitudinal study of college freshman who were followed for 11 years and had their gambling assessed at four different points. “The most typical course of problem gambling across the four waves of this study was diagnosing at only a single time point rather than at multiple time points.”

This research found that people moved into and out of compulsive gambling so rapidly that such an addiction is the description of the young person at a particular point, and not a label designating who the person is.

Perhaps you would object that DSM has now mislabeled gambling as an addiction. Instead, stepping outside the boundaries of substance use makes it easier to recognize what is in fact the typical addictive pattern. As the NESARC researchers noted: “In most persons affected, alcohol dependence (commonly known as alcoholism) looks less like Nicolas Cage in Leaving Las Vegas than it does your party-hardy college roommate or that hard-driving colleague in the next cubicle.”

Alcoholic or Addict: Who, Me?

Are we missing the forest for the trees? That is, how do most addicted people who don’t receive treatment—that is, most addicted people—recover? And how do they view their recovery process?

In 1999, I participated in a conference in Switzerland for natural recovery researchers. (George Vaillant was also a part of this group of around 15.) University of Calgary psychologist David Hodgins described a study he conducted of people who had indicated in their responses to a scale of items in a survey that they had been compulsive gamblers, but no longer were. When Hodgins contacted these individuals for interviews, however, the “vast majority” denied they had ever had a gambling problem!

Hodgins thought that perhaps the original designation that these had been compulsive gamblers was mistaken. But Slutske’s study that followed people over years revealed that rapid shifts into and out of gambling problems are normal. So what Hodgins may simply have uncovered is that people avoid thinking of themselves as addicts…and most often this works for them!

The Benefits of Denial

Chris’s recovery was a) the way that most people go, and b) left him unencumbered with an identity as an alcoholic/addict. It did take him a number of years to mature out—social researcher Charles Winick’s term for natural remission from heroin addiction. But the advantage is that he is now a free man, able to lead a fully realized social, professional and personal life.

Winick identified this natural recovery process in 1962. Based on narcotics users in treatment, Winick noted, “there has been considerable acceptance in both lay and professional circles of the thesis that many addicts never stop using drugs, but continue as addicts until they die, except for unsuccessful attempts at withdrawal or for periods of enforced abstinence in jails or hospitals.”

Instead, scouring government records, Winick found that perhaps two-thirds to three-quarters of people with heroin addiction do recover, although it often takes a decade or more. Winick concluded that the minority who don’t mature out “decide that they are hooked, make no effort to abandon addiction, and give in to what they regard as inevitable.”

Several British studies have shown that outcomes for alcoholic drinkers depend on how they conceive of themselves and alcoholism. Jim Orford and Alistair Keddie found that patients’ “persuasion” that they could achieve controlled drinking or abstinence was most important for the outcome actually achieved. Nick Heather and colleagues found that drinkers who rejected the axiom “one drink, one drunk” were more likely than those who accepted it to drink moderately after treatment, no matter what their level of dependence.

Also in the UK, sociologists have investigated the need for addicts to create new identities in order to overcome their addictions. The title of one such study is “Addicts’ narratives of recovery from drug use: Constructing a non-addict identity.” In 2011 I debated the co-author of this research, Neil McKeganey, in Scotland. I emphasized harm reduction, while McKeganey pressed for abstinence. Nonetheless, the difference between the US and UK is indicated by Neil’s use of the word “recovery” as a conclusive state of being, not a tentative one that an addict must forever work at “one day at a time.”

Traditional American recovery advocates hold that even if these individuals can quit their addiction, they are still addicts: their identities cannot change. As Ilse Thompson and I emphasize in Recover!, going this route means that you are convinced that you are an addict or an alcoholic and conform to that role. You can never escape your disease. For Ilse and me, the best—and most common—route to recovery is growing into a non-addict life that allows your identity to evolve.

Those who escape the addict identity—or people like Chris and the recovered gamblers Slutske and Hodgins studied who refuse to take on this identity at all —often have the freedom to become like those they see drinking around them at a restaurant with spouses and friends, or to spend an evening playing cards or at a casino without going hog wild.

Inculcating an addict identity prematurely, on the other hand, as the burgeoning recovery high schools and college recovery dorms do for teens and 20-year-olds, is the best guarantee that people won’t attain that freedom. How would following such a path have impacted those 20-somethings in the NESARC study who time proved were like the “party-hardy college roommate” who then settles down?

Too often, we teach exactly the people most likely to outgrow addiction to see themselves as addicts who must live walled-in lives forever. This process seems guaranteed to short-circuit growth out of alcohol and drug dependence.

Is this really the advance in recovery that addiction advocates claim? I call this early-age labelling the “Invasion of the Body Snatchers.” Here is one “coming-out-as- addict narrative” from a 21-year-old which, typically, the interviewer praises to the sky:

“You were the first-ever president of the student recovery group at Penn State University,” I said to a woman I’ll call Sarah. “That meant you were one of the first people to talk publicly about your own addiction in a university with almost 100,000 undergraduate students. And you were only 21 years old. How did that feel?”

She was surprisingly blasé. “I kinda compare it to coming out [as gay]. I came out in high school and there was nobody else then, either.” I considered the comparison for awhile after we spoke, thought it was a good one. A few weeks later, I learned that October 11 was National Coming Out Day.

The best known book about a high-school and college-style alcoholic is Koren Zailckas’s Smashed: Story of a Drunken Girlhood. Zailckas describes a girlhood from 16 on where she was regularly—sometimes it seems perpetually—drunk.

Zailckas quit drinking after college, but she didn’t go the recovery route and refuses to call herself an alcoholic. The result is antagonistic reviews of her book like this one on Amazon: “She is so obviously an alcoholic that she really does a disservice to other young women reading this book because she leads one to believe that AA is not necessary.”

People tell us such stories all the time. We have recounted the narratives of Fernandez, LeFlore, Joel, Zailckas, Chris and Hodgins’ subjects (incidentally, these individuals represent Latino, African-American, Jewish, Lithuanian-Sicilian, and Anglo ethnics, a sampling of world cultures). We just refuse to listen to them!

Of course, there are people for whom this outgrowing might never happen, or would be a long-term, precarious struggle. But this group of persistent (NESARC calls them “chronic”) alcoholics and addicts is far smaller than assumed. One person who believes he is such an irresolvable case is the drug czar, Michael Botticelli. He has every right to make this decision. But, more often than not, people who reach this conclusion are wrong: They are in denial.

Denial-Call-Out-for-Post.jpg


Conclusion

So, when someone says: “The first step in recovery is to acknowledge that you have a problem and that you’re an alcoholic or an addict,” your answer should be, “That’s simply not true—and making that decision might haunt the rest of my life.”

You might say, “I’m not telling you what you should do. But I am, nonetheless, reserving the right to be me.” As Zailckas put it, “That identity didn’t feel true to me, so I didn’t write it. I also think the brand ‘alcoholic’ prevents a lot of people, especially young people, from seeking (non-AA) help or even reevaluating their relationship with alcohol.”

If you feel that you are capable of dealing with your problem yourself, without entering addiction treatment or joining a support group, pursue that path. You do so by living your life fully while protecting yourself and those around you, holding yourself accountable, but not encumbering yourself with superfluous, negative presumptions about who you are.

If you are encumbered by such a negative, addict identity, don’t lose heart. There are ways to get rid of that identity, and I intend to write about them soon.
http://www.substance.com/forget-wha...can-help-you-to-recover-from-addiction/15042/

As fucked up and unethical, immoral as it may be, I have never heard, seen or encountered any person who knowingly used heroin, with the understanding and all the baggage that voluntarily using heroin so oft will come with, actually end up "addicted" to it in any sense of the word. Just like how PM patients often do not become "addicted", or even dependent in the normal sense of the concept for us junkies. Knowledge can certainly carry with it power - the power of stigmata, the destroyer of self.

Anywho, enjoy! :)

P.S. BTW I wouldn't call it denial as much as giving in. Why, you ask?

In assuming the identity of one who was in denial, you deny your true self.
As hard as it might have been, as painful, as much harm you might have done yourself and others, reducing your history into mere escapism and denial.
In doing so you deny your own true self, a Multidimensional Self, a self much, Much more than drug use or any one or two things you might have done.
You, your history, is so much more.
If you take the easy way out, and give in to denial, you begin to destroy yourself.
Not until you rejoice, reclaim and restore your own self, your true essence of being, is it probably if at all possible to live a life worth living.
Because this measure is a rubric you must find, although not alone - as you never are alone.
Do not assume the role others seek to place you in.
Do not give in to anyone just because it has been said that it's the only way, the one true path.
There is no only way.
There is no one true path.
True is for you to find, up to you to create so that you may move forward and thrive.
Become determined to find your own path in this world, be determined to strive for it.
Do not bemoan or sacrifice anything in your life, at least not for the sake of anything but for the betterment of your own present self, all that makes up your present world.
Live now and live on!
As you lived then, just better now.
Amen.


Thanks for listening <3 take donations in the form of emoticons. Just leave them in your post here. Thank you. %)
 
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Another great article from Mr. Peele. :)

There certainly allot to be said for denial. Kinda seems like the recovery business is the one in denial these days or actually may have been for awhile.

The mind is such an amazing thing. We really end up choosing so much of life. Whether its what we are currently experiencing or what we are going to experience, both are astronomically dependent our thoughts.

We have all chosen to have bad days. Some little hiccup is followed by anther little hassle, is followed by grain of bad luck. Maybe we are a little short on sleep and anxious about some nonsense at work, but the moment has come. The moment we choose to decide to have a "bad day."

Sure the baby vomited on the dog, which in turn shook gerbers pureed spinach and a whole bottle of formula over us and the entire kitchen. Sure we were wearing the only acceptable clean cloths we had for the big presentation and they were instantly rendered unsalvageable. Sure we are now wearing a pair attic sented slacks from the seventies, their sent mingling with the smell of horseradish and pineapple pot roast radiating from the Farlec fitting dress coat, hastily borrowed from the eccentric neighbor with ancraophobia.

As we sprint for the last bus that has a snowballs chance in hell of delivering us to the meeting on time... we hear the crotch of the pants rend wholly from the gangsters holster to belt buckle. Its right then, when we find ourselves sporting disco fever chaps, three steps away from the bus and eternal everlasting salvation. This is when we declare to the great spirit of the universe, that heartless cruel omnipotent deity who nonchalantly reigns such misfortune and misery upon us for perverse entertaiment , that we are having a bad day and we are buckling down for the hell to come.

From this moment on, even though we probably will not encounter any more real significant adversity that day, our minds will seek it obsessively and find it everywhere.

Many times what we expect to happen does. If we predict some event in the future to be the worst thing in the world, it often will be.

Being told and choosing to belive that there is no cure for addiction, that we are resigned to fight this throughout our whole lives.. can we ever RECOVER.

Believing we are doomed to sustain an unavoidable never ending fate of more severe relapses.. until we eventually sucome to this hopeless "progressive" phenomenon... do we end up playing a starring role in a fictitious tragedy we wrote for ourselves.

Believing that if we indulge in anything but abstinence.. just a little slip.. that we reactivate a disease so powerful that we are powerless against it and will spiral uncontrollably, at break neck speed, and be driven right to our DOC or another addiction. Does believing this create the foretold results.

Like so many people my first approach to treating my addiction was the fellowships. I had a real hard time wrapping my head around, trusting, and believing in what i was being told.

When I expressed that what they were feeding me was not going down well, I was told thats "just your addiction," "your addicted and have lost your sanity," "you tried it your way look where it got you." It was not any of these things. The reason the red flags went up was because they were warranted.

But I choose to belive what they were telling me. Because i choose to buy into it, I started seeing they were right. I saw it everywhere. I was sold.. well that is until I found myself struggling like they said I would. Until I fell off the "pink cloud" like they said I would. Then I slipped and had a few beers and lo and behold I went right back into hard use.. not as hard as before and it was not progressive:sus:
Maybe "treating" addiction with brainwashing is a bad idea.. what happens when the brain wash is washed away and the untreated addict is revealed.. sounds like back to business as usual to me.

This time I no longer belive those concepts and others.
This time those concept's predictions have not come true.

By remaining in "denial" we are able to escape some very negative outcomes.

"pink clouding it" is an interesting concept. I'm still "pink Clouding it" and have no intention of ever coming back down.. though I call it recovered.

Another good article over at substance called for us to take back recovery. We should consider letting them keep recovery. We should claim recovered instead.
 
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^
Ahh, great article. Thank you for sharing NSA. He is a friend I follow on Facebook.
 
Very interesting indeed!
Great logic. It´s so clear when he puts his thoughts all together.
:)
 
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HOW DAAAAAAAAAARE YOU GIVE NSA CREDIT FOR THIS OR ANYTING ELSE HE MAY HAVE DONE IN THE PAST GOD DAMN IT - DAMN YOU ALL TO FIRE AND BRIMSTOMLE

j/k... j/k ;) ure still mah hero mang <3
 
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Should i post my poetic rant there in Words? Think it's word worthy anyone?
 
Thanks for posting this article.

I have heard that the majority of people get sober on their own, or quit drugs and alcohol on their own, and without the help of NA/AA, detox/rehab, etc.

However, if someone does need detox/rehab, or NA/AA to get stable and sober I don't see anything wrong with this as we're all different.

I have abused alcohol, and other drugs that's for sure. I did not however get physically addicted to alcohol or those drugs though. I don't drink now but that's mainly because I don't go to bars or hang out with friends who I would drink a lot of alcohol with while out at parties or bars. I did not go to AA/NA since I was living in a small town at the time, people talk, and I didn't want everyone knowing I was drinking so much then. When I stopped drinking alcohol 2+ years ago I had stopped using everything else, and I would sometimes drink on weekends but never to the point of puking or blacking out, and I stopped since a friend of mine died, I didn't take her death well, and drinking alcohol would not have helped at all then. I also was told by alcoholics and people who have been to AA/NA that if you can quit on your own for at least 30 days then you're not an alcoholic.
 
However, if someone does need detox/rehab, or NA/AA to get stable and sober I don't see anything wrong with this as we're all different.

This. Horses for courses.

I have patients who have curbed their unhealthy habits with twelve-step programs, with non-mainstream approaches, and with willpower alone. I have no evidence to say that one of these approaches is better for anyone than another. It really depends on what kind of person you were before you began your abuse, why your habit escalated to an unhealthy level, and what kind of setting you'll be [re]entering into (i.e. with what sorts of stressors and social obligations) once you've curbed your abuse.

I'll say this, though. I've seen AA/NA/GA work most effectively for people who:
1) come from families and ethnic groups that appear to have a strong genetic predisposition for abusing what they abused
2) inhabit a social milieu where use of what they abused tends to be all-or-nothing (i.e. abuse or abstain), and moderation is rare and doubted
3) more or less need active and documented involvement in a 12-step group to regain their social, professional, and/or legal good standing

I've seen willpower alone work best for, well, pretty much the opposite of the above. This sort of person, stereotypically in my mind, comes from a background where moderation is tolerated or even encouraged, but abuse is uncommon and definitely not tolerated. Such a person typically inhabits a close-knit family and social circle who accepts them unconditionally, lovingly but firmly steers them in the direction of cutting down, and gives the former abuser many healthy joys to live for. In many such cases, the shame that might be brought upon the social group by the abuser attending meetings and publicly self-identifying as a lifelong addict far outweighs the perceived benefits to the individual. In short, the former abuser is cut a deal: "We'll take you back and set you on the right path, and even defend your reputation, as long as you agree to follow our guidance and never go public with your former ways." That's a pretty good offer, if you ask me.

In which case, maybe "willpower alone" is a misnomer. I have a feeling it's often, "the right kind of social supports".

The twelve-step programs are certainly not for everyone, and quite possibly not the majority of abusers. I am against attendance at meetings being mandated, by any authority, for anyone. (I say the same for any institution dedicated to the cessation of addictions or compulsive behaviors, mainstream or otherwise, by the way.) After all, attendance in twelve-step programs was never designed to be mandatory, or tracked. The programs' charters clearly state that the only requirement for membership is a desire to quit. And as for attendance being monitored or documented, yeesh, does anyone know what "anonymous" means anymore?! Governments, employers, and professional licensing bodies abuse the twelve-step programs (what irony!) to cover their asses, because they're free, abundant, and old, not because they necessarily fit.

In any case, I'm happy to see this thread free of the no holds barred, antireligious-flavored twelve-step bashing that used to be the norm here on BL. I have a hard time completely rejecting a path away from an unhealthy habit that clearly does work for some people. I just think more research needs to be done as to the type of people who tend to benefit, or not, from them.
 
Me too! An addict is not who I am.... I'm more than that.
It's very pathologizing.... Outdated and not necessary to label myself to stay off opiates.
And this doesn't mean I'm in denial. :) lol I know this today, and chose not to be defined and separated from society with a term invented years ago. Same goes for DSM dx. People may have a diagnosis, but it's not who they are as a human being. <3
 
As fucked up and unethical, immoral as it may be, I have never heard, seen or encountered any person who knowingly used heroin, with the understanding and all the baggage that voluntarily using heroin so oft will come with, actually end up "addicted" to it in any sense of the word. Just like how PM patients often do not become "addicted", or even dependent in the normal sense of the concept for us junkies. Knowledge can certainly carry with it power - the power of stigmata, the destroyer of self.

Everyone ik that does heroin was fully aware of the consequences and risks, and out of my 4 close dope buddy's 3 out of 4 are dependent and 4 out of 4 are addicted.

I disagree with this article if I don't admit I was addicted than I'd never stop using drugs. To admit I was addicted does not define my whole person that's just silly. Right now I don't say I'm actively addicted to drugs but I'm in recovery and dependent on my medications that help me not use and be a happy functional person.

NSA said:
Being told and choosing to belive that there is no cure for addiction, that we are resigned to fight this throughout our whole lives.. can we ever RECOVER.

I'm diagnosed as an addict and was never told there was no cure. I've been told with the proper amount of therapy and medication, it can be managed and even cured. I went to a 6 day detox and am in an intensive outpatient.
 
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Part of the rationale I've heard for "once an addict always an addict" has to do with the psychology of habit formation (in the general sense, not just with drugs). Once you've cut a trail in the woods, it will become overgrown again if it isn't maintained BUT will never be as difficult to reestablish as the first time you cut it, if you have the opportunity to do so. This becomes even more true the more trodden the trail becomes, to the point where a very well trodden path can still be recognized and followed centuries after falling into disuse.

The problem with this analogy (as presented by recovery group lore), is that just because there's a well trodden path that you're used to taking, doesn't mean you can't learn to traverse the same territory by a whole new path. It's just that it's a lot of work to establish a whole new path from scratch, and seeing as how there's an easy-to-walk and very familiar path right nearby, you have to be awfully motivated, and you'll be sorely tempted to say "fuck it" and take the old familiar route when you're not feeling your best.

I bet if you talk to someone who drank frequently and heavily for years, and now drinks lightly and moderately, you'd find that that transition necessitated them "starting over", as it were, with alcohol, and re-learning from scratch how to appreciate its effect and integrate that appreciation into the rest of their lives. I bet you'll find that especially for the first few years after giving up heavy drinking, they avoided it altogether whenever they weren't feeling strong, calm, and in control. And still might.

It's all the harder with a substance like heroin, since there is no socially sanctioned or traditional pattern of moderate use in our culture, and it would be hard to go back to it even once without encountering a lot of the old triggers and associations. A notable exception though, which proves my theory, is how most US soldiers who abused heroin or opium in Vietnam did not bring their habit home with them, or successfully made the transition from abusers to chippers once they came home.
 
A notable exception though, which proves my theory, is how most US soldiers who abused heroin or opium in Vietnam did not bring their habit home with them, or successfully made the transition from abusers to chippers once they came home.

Wasn't there a study which demonstrated that those who stopped using heroin (I hate the word "clean" in this context) in Vietnam had a much higher rate of not using it when they returned home, compared to those who returned home with an active habit or in withdrawal/immediate post-acute withdrawal?
 
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