HELLO HOMO Recovery and The Urge
Hello Homo,
I have a complicated relationship with substance use. This time of year has always been really hard for me. I’ve tried 12-step sobriety and harm reduction programs, but neither really stuck. I need a different approach to this. Do you have any suggestions?
Alex – Summit County
Hi Alex,
As soon as I read your question, I thought of Dr. Carl Erik Fisher, MD. He is an addiction psychiatrist, assistant professor at Columbia University, and author. I recommend his book The Urge: Our History of Addiction to all my clients, friends, and family who want to change their relationship with substances. Fisher possesses a crucial perspective on deconstructing our biases toward substances, understanding addiction outside of stigma or pathology, and cultivating awareness of intrinsic motivation and goals toward recovery.
Carl, thank you for taking the to talk. I am a huge fan of your book and know many people find it helpful. I first read it while traveling and couldn’t believe how many people commented on how much they loved the book too.
Carl Erik Fisher MD: Thank you, I wrote The Urge because I am in addiction recovery. I had a lot of questions about what it means when we say “addiction.” What is recovery? For myself, I found that looking to the history and other people’s stories and stories from diverse cultures and perspectives really helped me come to terms with my own addiction.
What are your thoughts on Alex’s question?
Yeah, I mean, that’s a tough one. And one a lot of people will find relatable. Before we get into it, I must give the usual disclaimer that I can’t provide specific advice to Alex. With that said, it’s really very common that people try different pathways to recovery and then have them not “stick,” so I want to validate that experience.
Alex is not talking about why he wants to change his relationship to substance use. Sometimes, it’s that missing piece that can be helpful, too. Reorienting to the point of it all, what is the “why” outside of the common assumptions people make about substance use? Often, with people in recovery, the point of it all is the why. But what are your thoughts on this?
I went right to thinking about coping; I wonder what the reasons for the substance use are. Thinking on a broader systemic level, we know LGBTQ+ substance use is often a coping mechanism to manage internalized shame and/or trauma, especially around the holidays. I like to unlock curiosity for, what is the use helping with?
Yeah, what’s the use for it? A really important question. I also give my patients a lot (of support) in the moment when they’re struggling with some sort of behavior that they want to change. It could be substances, or it could be other addictive behaviors. It could be checking out with the phone, gambling, or whatever. It’s all well and good to talk about relapse prevention and strategies for change, and at the same time, it’s very useful to get curious about how behaviors make sense and often solve a problem for people.
Barring all that, nobody is perfect, including myself. I am trying to limit my sugar intake. I’ll watch myself doing the thing (eating sugar) that I said I didn’t want to do. In that moment, I think, if you can wake up, you have the choice of asking, what is this doing, what am I looking for or grasping here? It’s not just an investigatory question; it is also a very practical question to get off autopilot and get some perspective on behaviors.
I appreciate how we are coming at it from many sides. What is substance use for? What’s the reason not to use a substance? How is it a form of coping? What is it coping with? We are taking a holistic approach versus thinking: “I am trapped in a hole; it’s my problem, and I am doomed to manage this for the rest of my life.”
Yeah, because that sense of isolation can intersect with the very real and sometimes specific isolation that people experience when they’re traumatized or when they come from marginalized communities (like LGBTQ+ populations). There is a poisonous level of isolation and loneliness to the point that the Surgeon General has declared loneliness a public health crisis.
At the same time, now that we are in the holidays, we’re saturated with these ideas and these messages that the holidays are supposed to be happy. Right? You’re supposed to have a lovely time. It’s really a very difficult time for people. I want to say that it is a really difficult time for a lot of people. And that’s OK.
It’s powerful to validate where someone is versus othering them for having authentic feelings, including cravings for use, especially during the holidays. It makes sense.
Thinking about Alex, he says, “I’ve tried these things, but neither really stuck,” and he asks for a different approach to recovery. So, I want to say directly that there are many different pathways to recovery. Harm reduction programs can mean a lot of different things. There is 12-step sobriety. There are other types of mutual help groups out there. There’s SMART recovery, which tends to be more psychologically focused and agnostic. There’s a whole bunch of religiously affiliated ones. There are different types of psychotherapies and medical treatments.
Because we have this legacy of one-size-fits-all treatment, people have this idea that I’m supposed to hit on the one solution, and then it’s supposed to stick. It really doesn’t work that way for a lot of people. People often have to try different approaches. It’s completely normal to experiment with different pathways (to recovery). That’s part of the process, and for many, relapse is a part of that process. That said, depending on the substance, it can be dangerous to relapse, so, I don’t mean to be cavalier about it. But there are many, many different options there, and I think the best piece of advice I ever got was to keep trying.
Yeah, I appreciate you also normalizing the cavalier quality that can come up with relapse as a part of recovery because that also could end someone’s life. At the same time, being humble about the actuality of relapse provides empathy for pushing up against and combating perfectionism with recovery.
I totally agree with that. In some recovery communities, people have started to say, “I have such-and-such amount of time in recovery,” rather than saying, “I have such-and-such amount of time sober.” The point of that is to say that all the time you’ve been engaged in the process, that’s already a win. Having difficulties, slips, lapses and what have you, don’t negate all the other effort you’ve made. We have to be clear-eyed about the process. If you are engaging in changing your relationship to substance, you’re in recovery.
Thank you, Carl, for sitting down with me to discuss this question, and thank you, Alex, for submitting it. Please follow Carl Erik Fisher on Instagram at @dr.carlerik; check out his website here. He has a great subscription newsletter, Rat Park with Carl Erik Fisher—and buy his book The Urge: Our History of Addiction.
Follow me on Instagram @holistic.homosexual for updates on my column, and stay tuned for the next HELLO HOMO!
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Disclaimer: Hello Homo is for informational and educational purposes and is not a substitute for mental health treatment. Hello Homo (Jesse Proia) is not providing mental health advice, diagnosis or treatment to readers. If you are someone you know is experience a mental health crisis or emergency, please contact 911, 988 or go to the nearest emergency room
