3. Alcoholism pioneer focuses on addicts' inability to relate

By Tom O'Connell

Alcoholism pioneer Stanley Gitlow, M.D., of Mount Sinai Hospital in New York, once thought alcoholics were basically insane because they kept repeating self-destructive behavior. But later he realized that what they were doing had a purpose. They were trying to cope with life in their own way, even though it turned out to be harmful.

Seeing that addiction was a poor and painful substitute for healthy relating, he came up with a new definition: "Addiction is a disease in which any technique for adapting to life is used other than interpersonal relating." Gitlow sees addicts as unable to relate. Then, feeling blocked, they retreat into isolation with their addictive substitute for relating.

To describe the addiction cycle, he uses the analogy of a crooked cookie cutter that keeps stamping out crooked cookies. Since addicts are immature emotionally, instead of dealing with a challenging situation through healthy relating, they take out their crooked cookie cutters and revert to familiar addictive behavior. Obviously, this behavior conflicts with the job of personal growth that needs to be done. So they stay stuck.

Instead of dealing with inner issues that need to be resolved, addicts act out. And in their arrogance, they become isolated as they lose the ability to relate in a healthy way to self, others, and God. This isolation is devastating. So Dr. Gitlow's first step in the recovery process is to "fracture the isolation." That's where mutual help groups such as A.A. come in. "We learn by metaphors," he says. And sharing stories in groups is central to that education process. "Your alcoholism teaches me about mine. We relate to others to understand ourselves."

When Dr. Gitlow directs his alcoholic patients toward Alcoholics Anonymous, his prescription includes several bits of instruction. "Attend from one to three meetings a day until you find the meetings you feel comfortable with. Then never miss a meeting. Don't leave town for six months. Arrive at the meeting first. Always sit in the first row. Say something. Anything!" Dr. Gitlow's prescription is not vague. He tells patients that when they are at a meeting they should introduce themselves to others, volunteer to do something, stay for coffee, leave last, and never leave alone.

How long should they do this? "Until you like it." According to Dr. Gitlow, the appropriate therapy for alcoholics is a combination of abstinence and relating to others in A.A. And what better people to relate to than others who have the same condition?

To avoid relapse, he stresses the need to recognize emotions and fears and then connect thoughts to feelings right away. Describing isolation, he says it usually comes from feeling heartsick and unloved, and feeling as if we've been pushed away. Then, to deal with the emotional pain we choose the drink, drug, or other addictive behavior.

Gitlow explains that in therapy, insight comes in spurts. And insight is what leads us to make healthy changes. But when a person returns to drinking, overeating, or other addictive behaviors, new insight is aborted, changes are delayed, and growth is stunted.

What's the aim of recovery? It's built into Dr. Gitlow's definition. Recovery is  about adapting to life, meeting life on life's terms, doing what needs doing, and avoiding life-damaging behavior. It's about endings and new beginnings.

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