Addicts have a hard time being happy with just what is. We’re always chasing what’s just around the corner—the next drink, the next hookup, the next get-rich-quick, big-money scheme. The notion that someone can be content with what’s right in front of them—like, say, a tumbler of whiskey they’ve been nursing all night—strikes us as almost literally insane. It took me nearly three years—years spent frantically making amends, digging out of debt, getting a job and then starting a website and then working impossible hours to prove to everyone that I was back—to realize that not everyone has this force pushing them from behind. Not everyone who binge-watches Netflix shows is an addict, but I’m willing to bet—based on no scientific evidence, just my own observation—that people who can turn off the TV on a cliffhanger are less likely to feel the need to drink an entire bottle of whiskey. I’ll probably never enjoy that lack of turmoil I imagine normal people feel when they walk away from a half-empty glass, or turn off the TV because it’s their bedtime, but I’m learning that there’s more than one way to be. I can even fake it when I need to.
The weirdest thing about not drinking, when drinking has been your primary occupation for nearly a decade, is how many things feel like you’re doing them for the first time. First kiss. First job interview. First time around people who are smoking pot. First move into a new apartment. First furniture not purchased on a drunken impulse or dragged in from the street. First time quitting a job. First sex. First unrequited crush. First boyfriend who has never seen you with a drink in your hand. First time actually paying off a debt, then another, then another, then all of it. First trip through airport security. First international flight. First time being stopped by security in another country because of a mysterious shape in the lining of your suitcase, which you cut out to find an ancient Jack Daniel’s bottle. First time finding that sort of thing remotely funny.
There are lots of things you give up when you stop drinking, too. When my phone flashes with a text at six in the morning, I don’t have to worry that I said something stupid the night before, or that it’s Josh asking if I’m going to be able to make it in to work today. When I get a letter in the mail from my health insurance company, I don’t throw it in the trash because I know it’s just another bill I can’t pay. When I fuck something up, I don’t think, “There goes my last chance,” or “They know I’ve been drinking,” or “I guess I need to blow my brains out.” I think, “Whoops,” or maybe, “I’ll have to make up for that and make sure it doesn’t happen again.” Sobriety makes you think boring shit like that. It also makes you realize that if you got through all that, you can get through anything.
I see this all the time. Someone I know who had been sober about three years told a room full of women that she still had one “reservation”—one reason to drink that she held in reserve. “If my mom dies,” she said, “I don’t know what I’ll do.” Two years later, she was in a meeting when she got the call. I saw her the following week. She didn’t drink. I’ll confess I haven’t been through anything like that yet. But I have been cheated on, lied to, and rejected. I’ve lost work because of my reputation as an unreliable lush, and I’ve been told to come back in a couple of years, once I’ve proved myself a little more. I’ve been the target of a couple of intense online harassment campaigns, and had my share of scary run-ins with people who think they have the right to grab me, or back me into corners, or scream in my face because they disagree with my opinions. I’ve been excluded from events because nondrinkers make a surprising number of people uncomfortable, and I’ve lost touch with people I thought were friends. None of that stuff is easy, drunk or sober. The difference when you’re sober is that you actually deal with it, instead of adopting a false bravado and figuring out who else to blame.
If you want to, you can also start looking for things to be grateful for—not as difficult as you might imagine, especially if you spent your last few years passing out at bus stops and waking up in emergency rooms. Depending on your baseline, just waking up in your own bed with dry sheets might be a triumph. Or check this out: If I hadn’t lost my job, I probably wouldn’t have stopped drinking when I did. (I’m not talking about rock bottom. I’m talking about my external motivation not to go to treatment: How could the magazine possibly function without me, the least functional person who had ever darkened their doorstep?) If I hadn’t had a few months of unemployment to force me to come up with some structure for my days (including those early, blind-mouse days, when I would write “brush teeth, shower, go to noon meeting” in a notebook and cross them out), I wouldn’t have had time to shake my brain cells back into their places and figure out what I wanted to do next. If I hadn’t gotten a job that took up only thirty hours or so a week, I wouldn’t have been able to start my blog. If I hadn’t gotten two years sober, I wouldn’t have had the guts to quit that job and strike out on my own. Best-case scenario, I would have gone back to PubliCola, groveled at James’s feet for a couple of years, then quit after realizing he’d never trust me, no matter what I did. Do I know that any of those things would have happened? No, but finding serendipity in events you can’t control is a choice. Sometimes that means cutting your losses and moving on, and sometimes it means jumping off a ledge even when you don’t know what’s down there.
My life today doesn’t have the kind of drama I once craved. I have a boyfriend who isn’t a musician or married or an alcoholic. He isn’t unstable or erratic, and he doesn’t manipulate me into feeling like I can’t live without him, or vice versa. I work at home, on my own terms, and have more freedom than I ever imagined would be possible when I was struggling to show up at my office job and praying no one would notice I was drunk. I travel constantly, trying to make up for all the time when I thought travel was for people who had their shit together. I don’t worry unreasonably about going broke, or ending up homeless, or any of the things that I used to avoid thinking about by drinking. I pay my bills, don’t have debt, and try to avoid extravagant purchases. I show up for friends now and try to make up for all the years when I didn’t. It sounds like my life is boring, but it really isn’t. What was boring was the years I spent watching my world get smaller and smaller, until I barely existed.
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Recently, I had an opportunity to revisit the old Recovery Centers of King County building where I went to detox back in 2014—the detox center of last resort, where the orderlies barked instructions like prison wardens and my roommate taught me to make a pillow out of towels. The occasion was the grand opening of a new detox and treatment center in the same building, and I was there, this time, as press. I made it all the way inside and to my chair before I realized I had been there before. Everything looked different—everything, that is, except the tiny, fenced-in yard where the patients had been allowed to go once an hour to smoke. Looking out at the courtyard from a room that had once been the center’s cafeteria, but was now swarming with elected officials, medical professionals, and other members of the press, I had a sense memory so strong it took my breath away, of the first time I stood out in that courtyard and tried to fill my lungs with oxygen through all the smoke. A young woman with elaborate eye makeup was talking about her plans to go back home to her drug-dealer boyfriend as soon as she got out. A guy was complaining about getting robbed the night before. I was standing on the outside of the circle of smokers, hoping someone would come over and talk to me.
I never felt like I fit in at RCKC, with all the homeless people and junkies and kids with ankle bracelets who were only there because they had to be, but of course I did. I knew it then, when I lined up for vitals check at the single metal chair by the entrance, where the nurse yelled at me for leaning into the men’s quarters to grab a pillow, and I knew it now, looking down the once damp, dripping hallway at a set of brightly lit new rooms with wood-grained vinyl floors, all ready for the first crop of addicts and drunks to stagger to their metal beds with their thin plastic mattresses. During a quiet
moment on the press tour, I snuck into one of the empty detox rooms—I knew, as the rest of the press didn’t, that there were no locks on the doors—and poked my head into the bathroom. I wanted to see if they still had the shitty, unbreakable metal mirrors. The mirrors had gotten an upgrade—no more distortion—but they were still unbreakable, and I looked at my reflection and gave myself a thumbs-up. It isn’t often that you get to visit a dreadful moment in your past, walk right on the site of events you never want to live through again, and see how everything has changed, and how much you’ve changed. I walked back to the old nurses’ station, where the new treatment director was taking questions. I raised my hand.
“What did this place used to be like?”
After Rock Bottom
Why me?
That’s the question most alcoholics ask themselves, once they’ve gotten past denial and acknowledge to themselves that they don’t process booze like other people.
Prior to the mid-twentieth century, when the American Medical Association first defined alcoholism as a disease, doctors and theorists of all stripes offered a wide array of explanations for why some people became alcoholics (or dipsomaniacs, a fun nineteenth-century word that would also be a great name for a punk band) and others didn’t. Doctors seeking a medical explanation believed that alcohol poisoned human cells in a way that produced dependence. Others, including religious leaders, believed that alcoholism was caused by a genetic moral deficiency that could only be addressed through eugenics—that is, denying treatment to alcoholics as a way of weeding them more quickly from the gene pool. And proponents of psychological theories, like Sigmund Freud, believed that alcoholism could be blamed on bad mothers; one Freud follower, Ernst Simmel, suggested that drug use was “an effort to resolve castration anxiety,” by symbolically poisoning the source of that anxiety, the alcoholic’s mom.
Alcoholics Anonymous came on the scene in 1939 as a progressive alternative to quack remedies and loopy Freudian theories. It was written primarily by Bill Wilson, a self-sabotaging stock speculator who was hospitalized four times for alcoholism before stumbling on the idea that peer support could help chronic alcoholics recover. (Later still, he became an advocate for LSD as a treatment for addiction, an idea that is gaining mainstream acceptance today.) Beginning with a letter from the doctor who had met Wilson at Towns Hospital in New York City and judged him untreatable, Dr. William Silkworth, the book establishes that alcoholism is a disease that is chronic, progressive, and fatal: chronic, because no “real alcoholic” can ever go back to being a normal drinker; progressive, because it only gets “worse, never better,” even during periods of abstinence; and fatal, because untreated, it will lead to an untimely death.
Modern definitions of alcoholism are not all that different from the one AA came up with in 1939. The National Institute on Drug Abuse describes addiction succinctly as “a chronic, relapsing brain disease that is characterized by compulsive [substance] seeking and use, despite harmful consequences.” The first part is key: Alcoholism causes physical changes to the brain’s structure and how it works—not only reducing the amount of mood-balancing chemicals the brain naturally produces (substances like dopamine and serotonin, which help prevent mood swings and provide mental energy and stress relief), but also changing the structure of the brain’s reward system so that those chemicals, known as neurotransmitters, no longer reach their target receptors, making it harder and harder for a person to feel pleasure without the addictive substance—and, eventually, making it extraordinarily painful, psychologically as well as physically, to function without it.
Under the Influence, a primary text in the 12-step world, maintains that alcoholism is, “in the main, hereditary,” and that genetic factors are “a primary determiner of who becomes alcoholic.” The 1981 book, which was based on research its author, James Milam, self-published in 1970, goes on to argue that alcoholism is caused by an enzyme imbalance in the livers of people with a genetic predisposition to alcoholism. Consider it a hearty grain of salt that Under the Influence also argues that racial susceptibility to alcoholism is based on how long a culture has been exposed to alcohol, a theory that has been widely discredited.
Today, the National Institute on Alcohol Abuse and Alcoholism estimates that genetic predisposition accounts for between 40 and 60 percent of the risk of alcoholism; the rest is the result of environmental factors, such as the age a person starts drinking, family dynamics and trauma, cultural norms, exposure to stress, and access to social and community support. “Age of first use,” according to a 2012 study by the National Center on Addiction and Substance Abuse at Columbia University, is “particularly predictive” of who becomes an alcoholic; 96.5 percent of people who develop alcohol use disorders started drinking before they were twenty-one, an age when the brain is still developing and more susceptible to addictive substances. Drinking at a young age can create a kind of positive feedback loop by slowing the development of the prefrontal cortex—the impulse-controlling, decision-making part of the brain. Compounding this problem, brain scans suggest that many alcoholics and addicts may have smaller prefrontal cortices to begin with, which translates to sensation-seeking behavior and problems with impulse control.
The association between trauma in childhood and later addiction has also been well documented. If you experienced physical or mental abuse as a child, you’re more likely to develop a substance-use disorder such as alcoholism; you’re also more likely to develop a drinking problem if you were uprooted a lot as a kid, making it hard to form lasting friendships and connections to a community. Gabor Maté, the Canadian physician and addiction expert, believes that all addiction is caused by childhood trauma, and while this view is pretty controversial in the addiction and recovery field (critics call it reductive and fatalistic), a major study of seventeen thousand middle-class Americans (the Adverse Childhood Experience, or ACE, study) concluded that addiction is an adaptation to childhood traumatic experiences, and that “unrecognized adverse childhood experiences are a major, if not the major, determinant of who turns to psychoactive materials and becomes ‘addicted.’” People who experienced trauma as kids, in other words, are more likely to turn to substances for relief, usually when they’re in their teens, and addiction isn’t so much a brain disease or a mechanistic interaction between neurotransmitters and substances as “a readily understandable although largely unconscious attempt to gain relief from well-concealed prior life traumas by using psychoactive materials.”
But what about people like me—people who drank as teenagers or preteens, stopped drinking, and then picked up again as adults? Researchers have found that “late-onset” alcoholics—those who abstain or drink normally for many years before tipping over the edge into alcoholism, like I did—generally become alcoholics not as the result of genetic predisposition, but because of some circumstance or event in their life (divorce, job loss, major physical or psychological dislocation) that throws them off balance and leads them to drink more and more, until they become addicted. Women are also more likely to become alcoholics later in life; in one study, the average age when women became “problem” drinkers was forty-six, compared to twenty-seven for men.
Statistically speaking, women are still less likely to develop alcohol use disorders than men, and more likely to suffer serious health consequences, like nerve damage and cirrhosis, when we do—the result of social conditioning in the first instance (historically, drinking to excess wasn’t considered “ladylike”) and biology in the second (our bodies are smaller and contain less water than men’s bodies, so alcohol affects us more, and we progress from heavy drinking to addiction more quickly than men do, a still-mysterious phenomenon known as telescoping). We can’t do much about our biology, but we can decide whether, and how much, to drink, and we are choosing to do so more and more. In a massive 2016 analysis of international studies on drinking, researchers concluded that women born after 1991 are almost as likely to drink, and to drink prob
lematically, as men born during the same period. That’s a remarkable transformation from the situation one hundred years earlier, when men were more than twice as likely as women to drink alcohol, and three times as likely to have a drinking problem.
Perhaps because medical practice is slow to catch up with epidemiological trends, women’s alcoholism still is frequently misdiagnosed by family doctors and therapists, who often point to depression or anxiety, rather than substance abuse, as the source of women’s problems. My own primary care doctor, a woman, never thought to question my self-reported drinking—“about two drinks a day”—even when I showed up in her office with an endless series of mystery ailments that could all be explained by the gallons of wine and vodka I was pouring down my throat. Women—already judged more harshly than men for engaging in risky sexual behavior (Slut!) and failing to conform to traditional gender roles (She’s going to regret not having kids!)—also suffer disproportionately from the stigma that clings to all alcoholics. The stereotypical male alcoholic is a tragic figure, driven to drink by a terrible childhood or a bad home life or genetic factors beyond his control. At best, he is a creative genius; at worst, an abusive boor. But what is the stereotypical female alcoholic? A crazy bitch. A hot mess. A train wreck. A bad mother. Pregnant alcoholics, in particular, face such intense stigma that they often hide their drinking or decline to seek treatment, leading doctors to misdiagnose pregnant alcoholics and contributing to some forty-two thousand cases of fetal alcohol syndrome a year.
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