The 4 Necessary Discussions for Recovery – (The 4 Flat Tires)

Of necessity there will have to be discussion of matters medical, psychiatric, social, and religious. We are aware that these matters are, from their very nature, controversial.  (Alcoholics Anonymous pg 19)

If you are going to talk recovery, you have to talk about things going on with the body, things going on with the mind, things that contribute to your addiction socially and about your spiritual health.  Let’s take a brief introductory look at these areas and give them some thought.

MEDICAL – the body is a very important area as far as recovery.  There are physical aspects to drug and alcohol recovery that are fairly obvious such as withdrawals, changes in eating habits, liver issues and on and on that must be addressed.  A person in recovery from drugs and alcohol must get ongoing medical care and be diligent in regularly visiting the doctor.

Beyond all of that there are physical aspects of recovery that go beyond drug and alcohol addiction that are common to all addictions.  There have been studies on gambling addiction such as those done by Illinois Institute for Addiction Recovery, the National Institute on Alcohol Abuse and Alcoholism and the Emotion Neuroscience Centre at the Massachusetts General Hospital that suggest similar responses in gambling addicts that are using no drugs or alcohol as those found to be major factors in why some drug addicts and alcoholics use.  The point research is starting to point to the fact that other (non-chemical) addictions can have similar physical traits as chemical addictions that must be considered.

Another point in terms of the physical discussion is the positive and stress managing benefits of healthy amounts of exercise and healthy diet management in recovery.   Emotions and so on can be managed quite a bit by simply getting on an exercise program and making some dietary changes.

PSYCHIATRIC – On a very basic level it is often the case that there are some pretty heavy psychological or emotional issues that either led to or result from heavy addictions.  The idea of getting professional help for these issues is something that all of us going through recovery have to remain completely open to.

There is also this idea of being “dual diagnosis.”  I am always astonished by the number of people in recovery who go on for years using and when confronted with the idea that they might be bipolar they respond with something like, “Yeah, a couple of doctors have told me that, but I don’t believe them so I ignore them.”   Please do not ignore things like this!  If you do not trust the clinician that is giving you such a diagnosis, the proper response is not to just ignore such things.  The proper response is to get second, third or more opinions.  If you don’t like or trust clinicians, find one that is friendly to the type of recovery you are working and try to work through these things.

There are cases where a main push for the person to partake in whatever addiction he or she prefers is based largely on some psychological issue that he or she is “self-medicating.”  The addiction may be directly self-medicated such as the depressed person using a stimulant or may be more indirect such as the person simply partaking of the addiction to keep his or her mind distracted from something mentally tormenting.

There is also some overlap with the physical aspects of recovery in that some levels of the psychological issues common to many in recovery can be somewhat managed through exercise and dietary changes.

SOCIAL – There are many social aspects to addiction that must be addressed and so many possibilities it’s ridiculous. There are some more obvious like the person who is raised in an abusive home with one or more parents who are addicts. This person may grow up to have the symptoms of what has been termed an ACA or ACoA (Adult Children of Alcoholics or of Addicts).  There are people who come into recovery with damaged marriages and relationships of all kinds that must also be repaired.   In some cases these are environments where there are others still using and this person is trying to go through recovery.

There is also the way that a person has learned to interact with others in general during the period of addiction and the various cycles associated with the addiction that must be unlearned if they are unhealthy.

RELIGIOUS – For some the words religious and spiritual have some clear definition, for others these words present an alien concept.  No matter how you are looking at these words, this is an area that must be addressed.    This requires letting go of whatever you have believed before and looking at this all with fresh eyes. 

If this is not clearly defined to you, consider the amount of recovery information that says you should seek this “spiritual awakening” (as outlined in Step 12 of Twelve Step programs).

If you feel this is clearly defined to you, can you be open to the idea that your understanding might be wrong or incomplete.  It is possible that that is why your understanding has not provided you with what you need for recovery.

There is a lot more that can be stated about these areas and the work in these areas.  The real importance is to not only discuss these four areas, but to work in all four areas.  Think of recovery as trying to get a car moving that has four flat tires.  Many people in recovery try to just focus on one area of recovery which is like inflating one tire and expecting it to be just fine.  You have to put air in all for tires to get going.  If you don’t you may get going a bit, but the end result is like one of those police chase shows we see on TV where the police put out spikes to pop the tires of the person.

Many in the field specialize in one are or another and ignore the other areas assuming that work in their area of focus is all that is needed.  Take the medical, why is it that there are so many cases where smokers using patches or alcoholics using drugs such as Disulfiram (which often induces vomiting etc.) still use.  It is often not because these things do not deal with the physical aspects of the using, it is because there are other contributing reasons for using that are not addressed.

Or the counselor who works with someone in addiction on all his or her issues, making great progress only to find that person smelled or saw the chemical or object related to his or her addiction and used without thought.  The physical craving may have been overpowering and extremely hard to resist even with a far more stable mental state.

No matter how you cut it, the truth is there is a lot to not only discuss, but to work on in recovery.  Four of the most necessary for all of us are what is happening in our bodies, our minds, areas of our social life (past, present and future) and our spiritual life. 

It may not be all or nothing, but it seems to be all or ‘nothing lasting’ for many in recovery.