Cold Feet

Committing to a 12-step Program

A client of mine (let’s call him David) recently returned from completing an elite professional degree. He had also achieved more than a year of sobriety. When David first got sober, I don’t think either of us imagined him coming so far in such a short time. At that time, he had been in treatment for several months, and although he’d had some periods of sobriety, he had recently suffered a severe relapse. He came to the clinic suffering from psychotic symptoms and an infected abscess from IV drug use.

We almost never discharge people for using drugs or alcohol. That would be like a cardiologist refusing to treat because of high blood pressure. But when it is clear that someone is getting worse, not better, we do require them to enroll in a higher level of care. When our medical director and I met with David, he refused to enter residential treatment. He said he’d already been to the best residential treatment centers in the country and that they hadn’t helped him. We told him that acute illness requires acute care (no matter how many times) and that we could no longer offer ineffective treatment.

On our way out of the medical director’s office, I invited David into mine to make one last plea regarding residential care. Instead, David made his plea: “Give me one more week. I will stop using. If I don’t, I will go to residential.” Although there had already been several “one last week”s in this relapse, David had never agreed to such a clear contingency plan. I told him: “Sure. I’ll see you at our regular time next week.” The rest, as they say, is history.

In his prior attempts to get well, David, had avoided 12-step participation. He suffered from fairly severe social anxiety and stuck to treatment meetings despite frequent recommendations that he engage a 12-step program. This time around, he overcame his reluctance and began to attend 12-step meetings with fellow clients in treatment. Eventually, he got a sponsor, and when he moved to finish his professional degree, he immediately found a home group, attended multiple groups per week, and continued working the steps.

When David returned home, he was proud of his accomplishments and of his recovery. He continued to be actively engaged. But when I asked him about AA, he made a curious assessment: “It has helped me stay well but I am not into it the way that others in AA are.” As we explored this sentiment, it struck me that I was talking to someone who had been engaged to get married but was now having cold feet. After a year of sobriety, the novelty of AA had worn off. At the same time, David had not been engaged in AA long enough to form an attachment that will only develop over the course of years.

Consider three hypothetical young men in different stages of romantic relationship. The first is just falling in love. The second has been dating his romantic partner for 18 months and is considering marriage. The third has been married for 10 years. Bachelor #1 is in the attraction stage of relationship. No natural process mimics drug intoxication more than biological attraction to a potential sexual partner. Over time, however, the infatuation wears off and a more critical perspective develops. Bachelor #2 is beginning to see the negative aspects of his partner just as pressure mounts for him to commit to the relationship for the long haul. Our third young man is likely to have gone through similar periods of doubting before committing to marriage. When the first flushes of romance wore off and day-to-day patterns became the main substance of his relationship, he had to decide whether the shared life, values, and familiarities of his relationship were worth sacrificing to other potential relationships.

David had returned home in the stage of doubting, when the romance of AA had worn off and the prospect of sitting in meetings week afer week, year after year with a random group of men, drinking bad coffee and rehearsing the same ritualistic stories had started to seem undesirable. Yet David could not deny that this group of men and the tradition they represent had been essential for him to reclaim his life and future. Like a bride at the entrance to the wedding aisle, he was feeling nervous about committing to the good, the bad, and the ugly of committed 12-step recovery.

For persons who reach the cold feet stage of recovery, I don’t have a prescription. Your life and your commitments are your own and every commitment comes with both a price and a promise. But to paraphrase a 17th century philosopher: What do you have to lose from committing to a program and community that supports you in developing a life of honesty, reflection, generosity, friendship, and humility? Even if you could have stayed sober another way (and there’s not a lot of evidence you could), the way you’ve embarked upon has more to offer than just sobriety.