Trauma is the Gateway to Addiction

The first time I heard the gateway theory of drug use was in the 1960’s in California. My older brother was on the high school debate team and was practicing his rebuttal to the proposition that marijuana use leads to hard drug use. His rebuttal was that mother’s milk leads to drug use, since all the hard drug users had started out on mother’s milk.

There is still talk today about “gateway drugs” which is not surprising since drug use, especially hard drug use (meth, opiates) has sky rocketed in the last decades. What’s behind this surge in drug use?

Going to Pot


Politicians especially like to suggest the gateway theory that pot use leads to heroin or meth. The theory suggests that if we are tough on marijuana then use of harder drugs will decrease. That simply hasn’t happened. The war on drugs seems to have increased the use of drugs. We have seen meth use sweep across the country and opiates have now killed more people than the AIDS epidemic did.

Law enforcement likes the pot gateway theory because being able to bust people for pot possession makes their job easier. So we continue to fill jails with pot and other drug users. Why is punishment not helping? Punishment doesn’t work because trauma, not pot nor mother’s milk, is behind the explosion of drug use in America. That is what the ACE study has revealed.


ACE stands for Adverse Childhood Experiences. The ACE study is a large longitudinal study co-sponsored by the Center for Disease Control (CDC) and Kaiser Permanente. It asks about ten types of negative childhood experiences and then tracks health outcomes.

The ACE study began in California when 17,337 people enrolled in Kaiser Permanente’s (a large managed healthcare provider) volunteered to take the ACE quiz and have their health tracked. About half the volunteers were female; 74.8% were white; the average age was 57; 75.2% had attended college; all had jobs and access to good health care through Kaiser Permanente.


The ACE questionnaire is simple. It asks about ten types of adverse experience that occurred before the age of 18 including physical neglect, emotional neglect, intimate partner violence, mother treated violently, substance misuse within household, household mental illness, parental separation or divorce, and incarcerated household member.

Each type of adverse experience is worth one point. You get one point whether the experience happened once or many times. As the ACE points add up so does the probability of drug addiction, suicide, social challenges, and a host of other health problems.

Life Sucks

The results are astounding, that’s why the CDC got involved as a co-sponsor of the study. 62% of the U.S. population have an ACE score of one or higher. According to the CDC, for every additional ACE score, the rate of number of prescription drugs increase six times, and early initiation into illicit drug use increases as well. Suicide risks increase. ACEs in any category increased the risk of attempted suicide by 2- to 5-times throughout a person’s lifespan. Women with high ACEs have more risky sexual behaviors, including early intercourse, having had 30 or more sexual partners, and perceiving themselves to be at risk for HIV/AIDS.

ACEs relate not only to alcohol abuse & illicit drug use, sexually transmitted diseases and suicide but also to:

  • Chronic obstructive pulmonary disease
  • Depression
  • Fetal death
  • Health-related quality of life
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Risk for intimate partner violence
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

ACE related research also shows that trauma predicts difficulty in regulating emotions and behavior, and that children with higher ACE scores struggle to learn and get along in school. Adverse experiences also tend to cluster, meaning that if you have one adverse experience you are likely to have another. Does this mean every alcohol or drug user has a high ACE score? No, there are alcoholics who have low ACE scores. There are also people with high ACE scores who function well. But such people are the exceptions and most with high ACEs can expect a life of poor health, drug abuse, and lower functioning.

It’s Not the Pot

We are still looking for the causes of addiction. We would still like an easy fix like keeping pot out of the hands of children. But the facts are that traumatic experiences, whether in childhood or adulthood, increase depression and anxiety. Trauma intensifies the need for self-soothing.  Trauma leads to the over-use of alcohol and other drugs.  We also need to understand that punishment for drugs increases the rate of addiction because punishment itself is traumatizing.

Next time you hear someone talk about gateway drugs, tell them about the ACE study, and tell them that trauma is behind most addiction. Tell politicians that reducing the stress on families will reduce trauma and drug use, and lower medical costs. Tell them it’s not pot (or mother’s milk) that leads to addiction, it ACEs. Show them the ACE study results. Help them connect the dots between trauma and addiction.    

Refuge Recovery: A Buddhist Approach to Recovery

From guest blogger: Sarah

This is the final piece in a series on recovery support options.

One of my stated reasons for not seeking help for my addiction to alcohol was that AA’s emphasis on powerlessness and surrendering to a Higher Power did not work for me, and it seemed to be the only support that was readily and widely available. Ultimately, my physical addiction to alcohol reached a lethal point so I ended up in treatment in the Pacific Northwest. I have come to believe this is one of the best locations on the planet to land if you are in early recovery.  Seattle is a kind of recovery “jackpot” where you can access any modality of addiction treatment available and almost every kind of recovery support community out there - and this is where I first learned about Refuge Recovery meetings.    


Refuge Recovery is an abstinence-based program and addiction recovery community that practices and utilizes Buddhist philosophy as the foundation of the recovery process. Drawing inspiration from the core teachings of the Four Noble Truths, emphasis is placed on both knowledge and empathy as a means for overcoming addiction and its causes.  Meetings are peer-led and begin with a meditation, followed by a reading and then shared reflections from members of the group about the reading and how it relates to their own recovery, in the present moment.  Unlike 12-step meetings, people only identify themselves by their name, not as an addict or alcoholic.   

There are a growing number of Refuge Recovery meetings throughout the world, and in many locations in the US.  They have meetings both in person and by phone, and a searchable website to help you find one near you.  And if you don’t find one in your area, you can easily start one. You will also find a wealth of resources on their website including suggestions for meeting formats, inventory worksheets, podcasts and other resources.  

My first thought after learning about Refuge Recovery was “I wish I had known about this sooner.” I can’t help but wonder if I would have had a chance at sustaining sobriety sooner, had more recovery support options been readily available to me.  Who knows.  I do know that I’m happy to know about it now.  I know I’m happy that I got treatment.  I know I’m happy I learned how to make the 12-step program work for me through the course of that treatment (and am eternally grateful for it!). And I’m happy that my recovery can continue to deepen and expand into other communities like this one. 

Why I love AA

This is the second in a series on recovery support options.


I’ve noticed that people assume that I am against AA because I support and write about harm reduction, which includes not just abstinence but also moderation and reducing harm from ongoing use. In truth I am a twelve-stepper, but like AA co-founder Bill Wilson, I believe that many problem drinkers are not ready for abstinence or the effort it takes to work the twelve steps. I believe that encouraging a problem drinker to track and moderate their drinking will help them see if it is possible. If a problem drinker tries to moderate and finds that they can, as Bill Wilson said, my hat is off to them. Kudos!  If they find that they cannot limit their drinking I believe that knowledge will make them more likely to want to stop. If they find they can’t moderate and chose to continue heavy and harmful drinking, then the principles of harm reduction can help them lessen the damages of heavy drinking to themselves, to their families, and to their community. If you want to learn more about harm reduction click here. One last thought: it is with some trepidation that I break the 11th tradition of AA (anonymity at the level of press, radio, and films.) My belief is that AA is presently secure and stable enough to tolerate such a breach, and that should I get drunk AA deserves credit for the 34 years of continuous abstinence that I have acquired thus far with its help.

Why I Love AA, Let Me Count the Ways

First off, I love Alcoholics Anonymous the way you would love a weird uncle, your favorite one and the one people say you are most like. AA is full of odd balls, people you would never meet anywhere else. I was 29 years old when I joined in the 1980’s and once I got over the age and gender differences (mostly men, everyone decades older than me) I found a seat as comfortable as an old feather couch. I realized that odd balls are the norm in AA and that I fit right in. That was lucky because I had drunk my way into early late-stage alcoholism and desperately needed a place to rest.   

I also love AA because it gives me hope for humanity. It is a marvelous experiment in non-governance and democracy. As Bill Wilson wrote, “So long as there is the slightest interest in sobriety, the more unmoral, the most antisocial, the most critical alcoholic may gather round him a few kindred spirits and announce to us that a new Alcoholics Anonymous group has formed. Anti-God, anti-medicine, anti-our recovery program, even anti-each other—these rampant individuals are a still an AA group if they think so.” Wow! No one can throw me out of AA. AA is the only group I have ever known that is founded on absolute tolerance and which empowers each individual to claim it as its own if they chose to.

I love AA because it is both simple and deep. You can work the AA program just enough to stop drinking or you can use it to advance yourself to sainthood. It works fine either way. I love that the goal of AA is nothing short of a “complete psychic change” and that they provide a way to achieve such a change via working the twelve steps. AA’s 12-step program can help a person move from drunkenness to sobriety, from selfishness and self-centeredness to being of service to others; from running on self-will and self-propulsion to being guided by a higher power and supported by a community, a fellowship.   

I like that AA delivers. I was raised by atheists and scientists and was taught not to take things on trust. So as a senior in college I did my research project on the effects of the 4th and 5th steps (moral inventory and admitting wrong) on self-esteem. It was an 80-person study and there was a surprising difference between the self-esteem of those who had worked the 4th & 5th steps and those who had not. Working those steps tripled self-esteem on average.   

I like that the two founders were so different. Dr. Bob was a steady quiet man while Bill Wilson was a brilliant creative screwball. Between the two of them they sorted out a way out of chronic alcoholism. Before they came along we were destined to die as drunks. Before them the best the medical community could do for alcoholics was aversion therapy, electroshock therapy or permanent commitment to a sanitarium (if your family could afford it).

I love AA meetings. Where else could I hear the inner workings of so many minds and hearts? Last week I heard a man describe how he used honesty to con people. He said, “I would go into great detail about something bad I did so they assume I am that honest about everything.” I am often surprised by people in AA. I started a women’s speaker meeting once and learned that the gal I had sat next to for months played the saxophone in a symphony. My sponsor turned out to be a world-class knitter. (Now I’m a knitter too.) I especially love that there are all sorts of meetings and types of meetings. In some cities there are meetings so rough you would warn your sponsee not to go to them. Some meetings are run by a “preaching deacon” who wants tells you what to do. Those meetings I avoid. My favorite meetings are those where homegroup members have a sense of humor, and where there is a wide spread of time in the program. I need to learn from new comers and have the support of old-timers (even though I am one!).

Perhaps most of all I have loved the people I have gotten to know in AA. That includes Tattoo Bob, a yo-yo champion and metal worker, who was proud that people assumed him to be an ex-con (he wasn’t), and Dwight, who I though was a college profession but turned out to be an elementary school teacher. Dwight has a dry and exquisite sense of humor. I was touched to learn that he had taught several adults to read so they could read the AA literature on their own. And Jimmy D, a man who scared me deeply when I first met him. He wore a crew cut, was a butcher by trade, and had the voice of an Army sergeant. One day when I had six months of sobriety, Jimmy D. put his hand on my should and announced to some other old-timers, “I think this little girl is gonna make it.” That was a profound moment for me. I still cry when I think of it.  I’m lucky I made it. I’m lucky Jimmy D. and the other old timers cared enough about a young hippie like me to make me feel welcome.

These days there are a lot of other alcohol support groups. I’m glad they exist.  I don’t think many of them existed when I needed help. I’m lucky I thrived in AA—not everyone does—and I’m glad I am still sober after all these years. AA is worth giving a serious try. No one feels comfortable entering a room of strangers, so don’t expect to like it at first. Try a variety of meetings and stick with the one you like best (or hate least) for a month or two or three. If it doesn’t help find another support group such as SMART or Refuge Recovery. (My friend J.J. found that AA made him want to drink so he quit on his own. He has a few decades of sobriety now.)  In this day and age there is no need to die a drunk, although many do.

I like AA best of all the support groups because it provides social, spiritual and moral change and a way to stop drinking. Alcoholism is a lonely disease—your best friend is your bottle, and AA provides friends who don’t drink. Spiritual change is optional in AA. More and more meetings for atheists and agnostics are being formed. I had stepped onto a spiritual path before joining AA and found that it improved my relationship with God. That said, my favorite meeting is one for atheists, agnostics and “freethinkers”.  Moral change is important for alcoholics. It isn’t that alcohol is evil, it’s that as a disinhibitor. We do shitty things under the influence, and feel badly about what we did. AA gives us a way to let go of that burden and the self-loathing that goes with it. AA is how I not only stopped drinking but also how I became a good and useful person. So thank you, Bill and Bob.  

StopDrinking on Reddit

This is the first of a series on recovery support options.

I heard about the StopDrinking conversation group on Reddit from one of my recovery coaching students. I checked it out and was surprised that it had more than fifty thousand members. That was eleven months ago. Now StopDrinking (SD) has more that ninety thousand members. Why is this conversation group so popular? Is is effective? Here is what I found.

Round the Clock

One distinct advantage of StopDrinking is that you can find support at anytime of day. Think you're the only one awake at 3 am and wanting a drink? Type a post and within minutes you’ll receive encouraging words. Bored with sobriety on a rainy Sunday afternoon? Read about other people’s struggles and remember why you don’t drink, or post your angst and read the responses.

Self Study

Not all of the members are currently sober. Some come simply to observe or “lurk”, to find out if other people have found a way to stop drinking and, if so, how did they do it? StopDrinking offers a comprehensive overview of what others did to stop, what got in their way, what it’s like to relapse, and how long someone has gone without drinking.  Many members use a badge that gives a day count. Some SD members watch for months or years before giving abstinence a try.

AA’s Grandchild

While StopDrinking has no relation to Alcoholics Anonymous, SD certainly has learned from AA experience. Both have a singular goal of not drinking. Both support anonymity. Both use a “one day at a time” approach. Both are supportive and encouraging. Both encourage speaking in “I” statements and sharing experience, not advice. (I got dinged once for saying “That’s scary!” to one woman’s very high blood alcohol level at time of DUI.) StopDrinking differs from AA in that it offers no specific way to stop other than doing just that. “I will not drink with you today” is SD’s supportive slogan that many end their posts with. There are no steps or traditions, just the wisdom and support of the members. I rarely see the word “alcoholic” or “alcoholism” on StopDrinking posts. Some members make reference to “meetings” but those may be SMART meetings, or Refuge Recovery, or Celebrate Recovery, or AA meetings.

What Members Like Best

I asked members what they like best about the SD community. I got 16 answers and will post a few here. One person with a star badge for four month of sobriety says, “I joined this community a few months before I actually stopped drinking. It gave me the push I needed to finally take the first step, help with resources to keep me firm on the path... and comfort in knowing that I'm not alone on the journey.”

Another says, “This is the most useful [tool] for me. Reading, posting, commenting, connecting, commiserating, celebrating - all of it helps.” 

An observer said a few days ago, “I see all the excuses I've made for years. I'm not sober yet, but I know I want to be and I've been able to take days and weeks between drinks. I loaded up with sparkling water and I stopped buying beer. I avoid situations where I might get trashed. I have extreme respect for my sober friends and I see them as examples for my life. All of this is due to being exposed to an environment where everyone is encouraging me, everyone had been there before, and everyone knows I'm not perfect.” His/her badge now says two days.

Another person wrote, “This is my main support group and I don't use anything else. What I like best is the camaraderie. We all have one goal in common and we help each other achieve or maintain that goal. I don't feel weird or out of place when I talk about what led to my sobriety, or what my life was like when I was still drinking because we all have our own horror stories. Sometimes I will comment when I am feeling strong, and hope that my comment will reach someone who may be struggling. Because when I am struggling, reading through stories and comments makes me feel strong again.”

From another with four months, “The badge is a big, big motivator. Seeing others having to reset keeps me scared and honest. The honest stories about slips, relapses, sobriety struggles, and realities, both good and bad, of not drinking. I like that it's called "stop drinking" rather than "sobriety" because for many of us, we aren't ready emotionally on day one or day ten to say "sober" is just "not drinking for now". That is a very important distinction to me and I think to many others as well. There is complete lack of the judgement, sniping, and second guessing that goes on in a lot of communities. It's almost 100% support and that is wonderful. The tips and tricks I learned from seasoned members have been SO helpful. "Play the tape" has saved my raggedy butt many, many, many times.”

One of These Days

StopDrinking provides a safe place for those not drinking today, and encouragement for those who are hoping  to be able to stop someday soon. Some members have 2 days or none, some have years and years. StopDrinking didn’t exist when I needed help. If it had I might have stopped years sooner. I’m glad it exists, the StopDrinking family on Reddit. My hat is off to you, and I won’t drink with you today.

Harm Reduction May Have Saved My Life

I didn’t hear about harm reduction until I had more than a decade of 12-step recovery. Like many 12-steppers I found the idea of harm reduction scary and threatening. Still, I strived to be open-minded and to avoid contempt prior to investigation, so I read several books on the topic. In doing so I found that I had actively practiced harm reduction as a young drinker and drugger and that it probably saved my life.

According to Wikipedia, the central idea of harm reduction is the “recognition that some people always have and always will engage in behaviors which carry risks, such as casual sex, prostitution, and drug use,” and the main objective of harm reduction is “to mitigate the potential dangers and health risks associated with the risky behaviors themselves.”  Dangers and risks are considered in terms of affect on the individual, the family, the community, and society at large.

Dr. Norman Zinberg’s model of Drug, Set, and Setting.

Drug Set Setting.jpg

One of the important things I learned while reading about harm reduction was Dr. Norman Zinberg’s model of Drug, Set, and Setting. Zinberg did not believe that drug effects are simply a function of biochemistry. He believed that problems with drugs and with drug experiences result from interaction between the three areas. Solutions can be found by making positive changes in these areas. Let’s look at each of these areas and then I’ll describe the choices I made that kept me alive.  

Drug refers to the type of drug itself, potency, purity or what it is cut with, route of ingestion, legality.

Set (originally “mindset”) refers to the person, including characteristics of race, culture, support, mood, beliefs, emotional strengths or weaknesses, coping skills, motivation, health, gender, body size, etc.

Setting refers to when, where, and with whom one uses, what sort of support exists, stresses in one’s life, attitudes of others toward use - including political and cultural.


Let’s start with Drug.  I was 14 years old the first time I saw someone passed out with a needle in his arm. He was in a friend’s apartment and I remember looking carefully to see if he was dead. When I saw he was breathing I wondered if I should call an ambulance, but that might not be the right thing to do. Fortunately he woke up moments later. Even so, I decided that I would not shoot heroin or use needles.

I came to the same conclusion about methamphetamines, then called “speed,” which I rubbed into my gums a few times and liked the effects. Several of my friends got strung out on speed. I watched them lose weight and develop paranoia. I quit using speed after my friend Eddie, a splendid fellow, got so crazy he thought we were being followed. We were taking a walk together and he took me through so many alleys and roundabout detours that I got lost. When we got to his friend’s apartment I had no idea where I was. Eddie split soon after and I was in the embarrassing situation of having to ask for a ride home. I wasn’t old enough to drive.

One time when I was eighteen or so, I was drinking in a downtown bar that had an upstairs disco dance floor. Sitting at the bar, I watched a friend climb the spiral staircase only to see him pause halfway up then fall backwards down the stairs. I spent the next twenty minutes asking his friends what he had taken. I wanted to make sure I never took what he had taken. It turned out he had taken “sopers” also known as Qaaludes, a barbiturate-like drug so destructive it was actually taken off the market.   

The one drug I didn’t know to be afraid of was alcohol, though a friend died choking on his own vomit - his friends didn’t know to lay him on his side.


Set, especially mindset, was something I considered when using LSD. The first time I tripped was at a Janis Joplin concert, and while I had a pleasant experience I could see how it could be awful if you weren’t in a good mood. After that I was selective about when, where and with whom I tripped on LSD. I only used LSD occasionally and with careful planning. I didn’t like to drink when I was tripping and I wanted to be in a safe place for the whole experience.  The last time I took LSD I was on a beach in Florida with a friend. Our plan to spend the night in a tent ended around 4 a. m. when the no-see-em bugs invaded our tent and bit us until we left. My friend had been drinking and so I drove until we got onto a very long bridge. Looking ahead, the converging lines of the bridge narrowed down to a pinpoint. I was afraid to drive into the nothingness and came to a stop in the middle of the bridge. I was shaking. My drunk and tripping friend had to take over the wheel. I would be afraid of driving on bridges for the next decade and never used LSD again.


Setting, especially with whom and where I drank and drugged, was an important part of how I avoided harm. As William White describes in his new book, Recovery Rising, I was aloof “from all but a small circle of friends with a high threshold for deviance.” My friends over the years were an interesting assortment of artists, musicians, bikers, lawyers, gays, and hippies. They were typically four to ten years older than me and a bit protective. They didn’t want me to get in trouble (especially when I was a minor) for their sakes as well as mine.

Setting, in terms of where I drank, became a problem for me as I got older.  I was a daily drinker by the time I was seventeen. Men began trying to pick me up in bars and often succeeded. I solved that problem by changing the setting of where I drank. I started drinking in gay bars because the men weren’t interested in me and I wasn’t interested in the women. I had standards for those I chose to drink with. If they couldn’t hold their liquor, if they slurred their words, if they got obnoxious or violent, and especially if they were bad drivers when under the influence, then I wanted nothing to do with them.  Despite those standards I would drink heavily and harmfully until I had drunk myself into early late-stage alcoholism by the age of twenty-nine.

It never occurred to me that it would be alcohol that would take me to my knees. I didn’t think of it as dangerous. I didn’t make sensible rules for myself such as “don’t drink when you’re angry or tired.” That said, I’m lucky to be alive. My drinking buddies (except for two) are either dead or in AA. My drug-using buddies are mostly dead also, including my sister. They died of overdoses, suicide, Hep C, etc. Still, somehow, despite my excesses and the company I kept, I was able to survive. I believe its because I practiced harm reduction—even though I had never heard the words.

A Philosophy About Addiction

I am in the process of articulating a clear philosophy about addiction and its causes and cures.  This is a first draft of that philosophy.

1. People take drugs for a variety of reasons — especially to feel or function better. So many Americans (more than half) use legal or illegal drugs that drug use is now the norm. 

2. The medical society (not the legal system) should be the first responders for those who overuse or get in trouble with alcohol and other drugs. Medical care, not punishment, is needed.

3. Earlier and better care and earlier — and better education — is needed. Useful education, not just warnings, and not punishment, will help drug users make better-informed and safer decisions about their use of drugs. Better care includes recognizing and responding to the brain health needs of our citizens.

4. The explosion of drug use, which started in the 1950’s and blossomed in the 1960’s, reflects societal angst and biopsychosocial needs. When human needs are met, drug use decreases. A reduction of drug use will only happen when our citizens are happier and feel more secure.

5. Not just dealers make money off of drug users. Pharmaceutical companies promote drug use and make billions, as does the liquor industry. Many others owe their living to drug users, especially within the legal and forensic systems, including judges, lawyers, parole officers, privately owned prisons... The same goes for treatment centers.

6. The War on Drugs is a misnomer; it should be called “The War on Drug Users” because it is a war on half of American citizens. War is an alienating activity. It requires making some group the enemy — in this case drug users. We alienate drug users by labeling them as criminals and putting them in a cruel and unusual environment called prison. Prison is a highly stressful environment that causes PTSD and teaches anti-social behaviors. Prison sentences for drug use damages not just individuals but families and communities. Racism is often an element in who gets punished for drug use.

7. There is evidence that a stressful infancy or childhood creates changes in the brain that predisposes many to drug addiction and other diseases. Unless basic societal changes are made — including redistribution of wealth, access to education, meaningful employment, recreation, and safety — we will continue to have rampant drug problems throughout society.



From Lousy to Pretty Darn Good: The Fine Art of Recovery Coaching

I once got referral from a therapist about “Beth”—a 19 year old who had relapsed after in-patient treatment for drug addiction, including alcohol, pot, and meth. I was told that Beth was on several medications for bi-polar, ADD, etc., that she lived with her divorced mother, was unemployed and currently drinking and smoking pot, and had a history of cutting. Would I be willing to coach her?

Beth doesn’t sound like an ideal coaching client, does she?


Help with Addictions

People call me when they know someone who needs help with recovery from addiction. I coach people to decide whether they want to stop using alcohol or other drugs, or make a plan to cut back. I coach people to decide if they want to use 12-step or other social support, whether they want to go to treatment, or make changes on their own. I help those who stop, cut back, or are coming home from treatment, to stay on track and achieve goals that are now options in recovery.

I saw a lot of red flags with Beth. I’m a professional coach, a recovery coach, and so I screen every client. The screening standards I learned is that to be considered coachable, the potential client must be able to participate in the generation of solutions and strategies and be able to engage in self-discovery. They also need to be able to relate to the coach as an equal partner, or, if they are young as Beth was, and not inclined to see adults as their equals, to understand that equality is inherent to the coaching relationship and over time recognize and cultivate the power of their equality. Beth agreed to meet by phone. The first time we talked she was scraping out a pot pipe, hoping to get a buzz.

Getting High—Choice or Compulsion?

We talked for a few minutes about the futility of trying to get high on the residue from a pot pipe, and also about the difference between choice and compulsion in regard to drugs. We set a time to talk about the possibility of working together. Neither of us were sure that coaching was suitable or a good idea, Beth because she already had a therapist and a psychiatrist, me because I didn’t know if she was coachable.

To Coach or Not to Coach?

Many coaches assume that a person who uses alcohol or other drugs addictively is simply not coachable. They think coaching is about helping people get from good to great, and they forget that addiction affects all levels of society. Addiction is not restricted to any class, race, religion, or level of intelligence. There are many high functioning people who drink too much, or use other drugs excessively. How can a coach know who is coachable? By screening each prospective client.

A Place of Her Own


I teach my Recovery Coach students to screen all their clients. Here is how I screened Beth: When we met I asked her what she would most like to change about her life; what, if she achieved it, would make her feel satisfied with her life. Beth thought for a moment and said that if she lived in her own apartment, rather than with her mother, she would feel much better about her life. I asked her what would need to happen for her to live on her own. Beth said she would need to take her own meds (her Mom was waking her up to take them on time) and get a job.

Beth was jazzed about getting help to move to her own place so we talked about how we might work together. We discussed what was expected in coaching and agreed to give it a try. I let her know that I would not be able to coach her if she came to calls intoxicated, missed calls, or did not seem to benefit from coaching.

Progress Report

That was four years ago. It took a few months to get her on her feet and employed. Today Beth lives on her own and has three full years of abstinence and participation in Alcoholics Anonymous. She is an excellent employee and last year she finished a yearlong trade school with high marks. She still has a psychiatrist and a therapist; I am still her Recovery Coach. I am proud to have coached her from lousy (using drugs, sleeping all day, unemployed) to pretty darn good (drug-free, industrious, employed). Beth loves being clean and sober and having a Recovery Coach. We are working on the next phase of her life. I think of it as the phase from pretty darn good to great.

The Personal and Professional Potential of Addicts

The ICF defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” Active addiction drastically interferes with reaching personal and professional potential. Recovery Coaching helps people deal with the barriers caused by active addiction and move forward personally and professionally. Those who resolve their addictions have the potential to get from lousy to great. It may take time to get to great, but it is entirely possible, and with the help of a trained Recovery Coach, it happens more quickly with fewer setbacks.

The Advanced Skills of Recovery Coaching

To be effective as a Recovery Coach it is important to have advanced skills in coaching to increase motivation and confidence. People whose lives have been affected by addiction often have below average self-esteem. Their motivation can waiver along with their confidence. Persons facing addiction or in recovery need to be coached by persons who are effective at finding and leveraging strengths and can be patient with those whose beliefs about themselves change from day to day and week to week.

Coaching From "Who Me?" to "Free at Last"

It is also important to be able to coach change effectively all the way from denial (“Who me?”) to thinking about it (“Yes, but…”) to setting recovery goals (abstinence, harm reduction, etc.), and on to planning, action, and maintenance (“I’m free at last”). And sometimes relapse and starting over. Relapse is common in persons trying to change their habits with alcohol and other drugs, yet there is promising clinical evidence that coaching reduces relapse.

Developmental Coaching

Those who want to work with addiction recovery clients must also be prepared to coach both general development and awareness. People who have spent years living in active addiction often have gaps in their development. They may be very good on the job but a poor communicator at home. Or they may have great interpersonal skills but be lousy at handling money. Recovery Coaches work with their clients to leverage their strengths while identifying the places where they struggle. We also coach to increase awareness of choice and responsibility so our clients can identify and meet their needs, rather than turning to addictive substances when uncomfortable feelings come up.


Professional Recovery Coaches are highly trained coaches with advanced coaching skills that make it possible to help persons facing addiction make significant progress towards good and great lives. We screen our clients for coachability and only work with those who can identify achievable goals and co-create the coaching relationship. Recovery Coaches have advanced coaching skills in building motivation and confidence, and in coaching for awareness and development.

Learn more about me and my experience as a coach.

Learn more about Recovery Coaching and upcoming trainings

The Weird Way We Treat Alcoholics

To understand the weird way we treat alcoholics lets imagine how diabetics would be treated if they got the same care as alcoholics.

First of all, diabetics would get no help until they were ready to accept abstinence. They would need to agree to eat no carbs at all. Their diet would be limited to meat, eggs, vegetables, and yogurt. If they refused to accept the MEVY diet we would say they are in denial. They would need to hit bottom: perhaps a diabetic coma or losing a toe will convince them to avoid all carbs. There would be no help early on. Pre-diabetic symptoms would be ignored, and the diabetic would be on their own until they were ready to accept the carb abstinence diet.

It sounds ridiculous doesn’t it? Who would expect a diabetic to never eat another carbohydrate? Yet that is how the disease of alcoholism is treated. We have a “one size fits all” approach to the treatment of alcoholism. We don’t help alcoholics unless they are willing to quit. According to the Center for Disease control, as reported in the CASA study Addiction Medicine: Closing the Gap Between Science and Practice, 73.2% of diabetics receive treatment for their disease, while only 10.2% of alcoholics ever receive treatment.

There were approximately 88,000 alcohol-related deaths in 2016. I wonder if there were more options available, over-drinkers might seek help earlier. As a former over-drinker, I could have used some early education about alcohol. Here are two things I wish I had known.

1. Females do not process alcohol as well as males.

If a woman and a man of the same body weight drink the same number of drinks per hour, she will become more intoxicated. Women who over-drink are more likely to become pregnant, and to pick up sexually transmitted diseases.

2. I would have liked to have been taught the basics of moderate drinking.

Like many, I tried for years to control my drinking — without the basic knowledge of how to do that successfully. I did not know how to track my blood alcohol level, or how to measure and track my drinks. I will never know if I could have successfully moderated my alcohol intake. If I’d had that information when I drank, I could have figured out in a few months if I was capable of it. To me this is an important point, that most over-drinkers do try to manage and control their drinking, but without some basic education they often flounder for years on end. With education, a problem drinker can give moderation a try and see if they are capable of controlling the amount they drink. If they succeed, great! If they learn that they cannot, most will opt for abstinence. A minority will choose to continue heavy and harmful drinking and for them some education about reducing harm would be useful.

There are other reasons why over-drinkers don’t seek or get help sooner. One reason is that the medical field ignores the problem. According to the CASA study, 2/3's of over-drinkers are in contact with a primary or emergency care about twice a year, yet physicians neither notice nor respond to the identifiable and treatable signs of addiction. This means that the person with the disease of alcoholism has to advance to late stages before the problem is noticed or addressed by the medical system.

Alcoholism is more likely to be noticed by the penal system. 44% of referrals to publicly funded treatment come through the court system. Employers make less than 1% of referrals to publicly funded treatment, while private insurance covers only 20% of the total costs of treatment for addiction.

Getting help for alcoholism is a challenge for most. Early help is practically non-existent. 90% of the treatment centers are abstinence-based and 12-step oriented. Even if a person is willing to go, the cost of private pay treatment is prohibitive for most. For publicly funded treatment there are often long waiting lists, lack of childcare, and numerous rules and regulations to be followed. And if treatment is available, practitioners with little or no medical training provide it.

If we treated diabetics like this it would be considered unethical. They would have to wait until their symptoms are dire to be noticed. They would have to break a law to get help. They would have to agree to eat no carbs in order to get in or stay in a treatment program. As the CASA study concludes,

“There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards.”

I hope someday there is earlier and better care for alcoholics. I hope there is education that will help over-drinkers determine earlier whether they can control their drinking. I hope that someday the medical system, not the penal system, will notice, provide, or refer over-drinkers to better sources of care. I hope that moderation and harm reduction education will be commonly available for those who are not ready for abstinence. Mostly I hope that the weird way we treat alcoholics will end. 

Sponsor-caused Relapse


A friend in AA told me recently how a woman in his home group relapsed. Let’s call her Sue. Sue had completed an inpatient treatment program, found work and a place to live and had six months of abstinence when she took her first trip in recovery, all the way to Alaska. The flight layover was in Seattle, Washington where the gal saw her first pot shop and legally bought a marijuana brownie, which she ate later in her hotel room.

The next morning Sue caught an early flight to Alaska, visited friends, enjoyed nature, went to meetings, and had a great ten day trip. She was pleased to have made it home safe and sound and excited to tell her sponsor about her trip. She even mentioned the marijuana brownie and was stunned when her sponsor said she had lost her sobriety. The sponsor told Sue that her six months off alcohol no longer counted because she had used a mind-altering drug. Sue was shocked, got flooded with adrenaline, and said, “In that case I might as well drink.” She hasn’t drawn a sober breath since.

I wish this were the only sponsor-caused relapse that I have heard of. Unfortunately this kind of thing is fairly common. Let’s look at what happened here, consider the sponsee’s losses, and think about how a sponsor could handled this situation in a way that didn’t lead to relapse.

Desire and Unity

In my opinion the sponsor forgot the third and first traditions. The third tradition says that the only requirement for AA membership is a desire to stop drinking. This sponsee had six months of continuous abstinence from alcohol. She had a desire to stop drinking and so was a member of AA-- even as she ate the pot brownie.

The first tradition states that personal recovery depends on AA unity. There was nothing unifying about telling a new comer that she had lost her sobriety when she had not had a drink. There is no step or tradition that suggests sponsors should punish or humiliate their sponsees. In fact it is quite the opposite. The first tradition says AA “jealously guards the individual’s right to think, talk and act as he wishes.”  So why was a member shunned over a marijuana brownie? How could a situation like this be handled differently? How could this sponsor have corrected an erring sponsee in a way that doesn’t result in relapse?  

A Softer Voice

The sponsor could have thanked Sue for having the courage and honesty to tell her about the marijuana brownie. She could have congratulated her on staying away from alcohol during her trip but let her know that the brownie was a bad idea. She could also tell her sponsee that many would not consider her “clean and sober” since she had used pot. She could have said the important thing was that Sue had not taken a drink, and warn her that using pot again would interfere with her recovery.  

First Do No Harm

Why is it so important that sponsors be gentle with their sponsees? Well, research shows that the more confrontational a counselor is with an alcoholic client the more that client is drinking a year later. A year later! I believe the same applies to AA sponsors. Sponsors should avoid taking a hard or judgmental line with their sponsees. If a client gets drunk after you have confronted them you need to change your methods. As Sue’s story shows, a sponsor can badly harm a newcomer.

Before telling her sponsor about the pot brownie, Sue had an AA home-group, a community she belonged to, a job and safe place to live, six months of sobriety from alcohol, and pride and dignity. Now she is drunk, unemployed and living on the street. That’s an awfully high price to pay for a marijuana brownie. I believe that sponsor-caused relapse is preventable and avoidable. Sponsors have a responsibility to help not harm those who come to them for support. Judgment and confrontation have no place in sponsorship

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