Generativity - The Summit Of The Recovery Pyramid

We have reached the peak of the Recovery Pyramid! This level of the Hierarchy of Recovery is called Generativity. This term was coined by the Psychologist Erik Erikson, to identify the final goal  in life. Maslow said the ultimate goal is Self Actualization, Erikson said it is Generativity. Erikson identified choices at every stage of life, the final choice being between Stagnation and Generativity. In old age we can either stagnate or give back. Giving back a lifetime of knowledge and wisdom to younger generations is Generativity. I chose this term for the peak of the Recovery Pyramid because giving back is the ultimate expression of recovery. Giving back is how we actualize our recovery.

Maslow posited the percentage of people who achieve Self Actualization as being below 1% of the overall population. The percentage of recovering people who reach Generativity is much higher than that. For people working a 12 step program this is the stage of recovery in which they work their 12th step. Carrying the message of recovery and living a principled life turns out to be the secret to happiness.

As the addict or alcoholic descends the Lowarchy of Highs he becomes more and more dependent on fewer and fewer people. Eventually there are only one or two people left to depend on (Mom and Dad?) and the addict has a parasitic relationship with them. This devolution to parasitism is not only ended it is reversed in recovery. At the top of the Recovery Pyramid the former parasite is transformed into a nurturer. She now has something to give and she comes to realize that giving is the most rewarding thing she can do.

Just as in Maslows Pyramid, in the Recovery Pyramid every level must be in place in order to reach the apex. Achieving Generativity depends on maintaining Abstinence, Support, Belonging and Accomplishment.

How long does it take to reach Generativity? In some ways it begins almost immediately. This is because people in an organized recovery program, such as NA or AA, are all their to help each other. Newcomers are just as necessary as old timers. The process begins right away but it deepens and becomes more intuitive as recovery progresses.

I hope everyone reading this gets to experience Generativity. When you do, you will know how important we are to each other.






Russell P. Mai, LCDC, AAC

Accomplishment - Recovery Is getting Really Good!

Accomplishment, is the level on the Recovery Pyramid corresponding to the Esteem level on Maslows Pyramid and the Performance Highs level on the Lowarchy of Highs. Using drugs for a Performance High wound up diminishing our esteem both in the eyes of others and ultimately our self esteem. The achievements we make in recovery constitute the Accomplishment level of the Hierarchy of Recovery.

Accomplishment is how recovering people restore their esteem, both self esteem and the respect of others. When a recovering person knows she is able to achieve more because she is in recovery, it makes staying in recovery more important, more satisfying, more rewarding. Without Accomplishment recovery would hold less value.

Recovery is progressive and sustained recovery typically involves more achievement than intermittent recovery. Even so it is important to recognize that Accomplishment begins immediately for those entering a recovery program such as AA or NA. At a persons first meeting they are offered a "desire chip" in AA or a "beginners" key chain in NA. Picking up one these tokens of commitment is a significant Accomplishment.

With each milestone of recovery (30, 60, 90 days then six months, nine months and one year) the newcomer experiences a significant achievement. The tokens she collects have no intrinsic value but they are priceless to her. The first time he identifies himself as an alcoholic at an AA meeting is an achievement. Chairing a meeting is a big deal. When people talk at meetings others keep quiet and listen, respect seldom given in other circumstances.

Accomplishment is not limited to the confines of recovery programs. When a recovering addict regains the trust of her family this is an Accomplishment! When a former drunk who used to come to work late and hungover, now shows up on time and ready for work this is an Accomplishment! A father keeping his promises to his children when he had always let them down before, this is an Accomplishment! Former liars who are now honest have achieved something very important!

The Accomplishment level of the Recovery Pyramid is not about making a million bucks! (Although it's fine if you do.) It's not about getting a PhD. (Although it's fine if you do.) What it is about is those little one day at time achievements. It is about those do the next right thing achievements. It is these every day achievements which lead to respecting the person you see in the mirror in the morning. The addict who used to see a no good SOB in the mirror and now sees a decent human being has achieved something important. The alcoholic who could not stand herself and now enjoys her own company has achieved a miracle!

Accomplishment is a very rewarding stage in the Hierarchy of Recovery, but it is not as good as it gets! We'll look at the peak of the Recovery Pyramid next time.








Russell P. Mai, LCDC, AAC

Belonging - Where Thriving In Recovery Begins

Previously I described the first two levels of the Recovery Pyramid, Abstinence and Support, these two levels constitute survival level recovery. Survival level recovery is bleak at best. It is doubtful that any but the most stoic individuals would find it tolerable for long.

The next stage in the Hierarchy of Recovery is Belonging (in the language of AA "Fellowship"). Failure to achieve a sense or feeling of Belonging in recovery is a prime reason people relapse, especially within the first year or two of recovery. Belonging is essential to most people. Without a sense of belonging the addict feels isolated. He is like a fish out of water. She no longer fits in with her old drinking buddies but also feels like an alien in her AA group.

Belonging requires trust. We do not get a warm fuzzy feeling from hanging out with people we mistrust. Superficial friendships feel contrived and hollow. Nobody really enjoys making small talk. With real friends silence is often quite comfortable. The only way this happens is through trust and trust requires vulnerability. Trusting a person means feeling safe being vulnerable to that person. This means taking a risk. To trust you I must risk becoming vulnerable with you. People unwilling to risk vulnerability to the appropriate people will never thrive in their recovery.

The addict who does not have a sense of Belonging in his NA group will probably start hanging out with his old running buddies. The alcoholic who feels alienated from AA members will go back to her favorite bar. The addict hanging out with her old friends will feel isolated from them. The alcoholic sipping Diet Coke at the bar will be bored and lonely. The only cure for this sense of isolation will be getting drunk, or getting high (maybe both), going for the Acceptance High. Soon they are back at the bottom of the Lowarchy of Highs.

The only real solution is to get vulnerable with the appropriate people. Most people in early recovery would like this to mean a husband, wife, boyfriend or girlfriend. This understandable desire is invariably misguided! Our enablers cannot offer real Support, neither are they prepared to shoulder the toxic burden resulting from an addict or alcoholic dumping their shame and guilt into their codependent lap for safekeeping. The appropriate people are others in recovery. They must not however be sex partners, this sort of putrid intimacy results in mutual hostage holding.

The addict/alcoholic freed of his secrets breathes free for the first time. The facade of false pride once toppled lets out the septic secrets whose stench has poisoned her every breath. We move from survival level recovery to thriving in recovery.

It is no surprise that many recovering people report finding a sense of Belonging after completing a fifth step. After sharing the "exact nature of all these wrongs" with "another human being" they experince profound trust. With profound trust comes a profound sense of Belonging. It is a big, big risk but it is totally worth it!

Walking into any AA group or any NA group anywhere in the world and knowing you belong (not some abstract knowing but realizing to your innermost self that you fit like a glove) is something everyone in recovery has available to them. All it requires is the courage to trust the friends you are yet to meet! Recovery is not for faint hearts.

Next time, Achievement (I can hardly wait).








Russell P. Mai, LCDC, AAC

Support - Stage Two On The Recovery Pyramid

Support is the second stage of recovery. The truth of course is, Support is so necessary for sustaining Abstinence that, these two stages of recovery are practically simultaneous. Support on the Recovery Pyramid corresponds to the Safety and Shelter Needs on Maslows Pyramid. In recovery these needs are called Support. Long-term Abstinence without Support is extremely unlikely, in fact it is virtually impossible to remain substance free without some support system. Support systems vary widely in intensity and frequency. Early Abstinence is a time for more Support.

Support needs can vary a great deal. Some people may need an initial Support system which includes around the clock medical observation. This is rare but, using a residential substance treatment program as an initial Support system is pretty common these days. The rule is it is far better to have too much Support as opposed to not enough. Not having enough Support after all can be fatal! Halfway houses are Support. These examples are temporary Support. No one is going spend the rest of her life under medical observation. No one is going to live out his days in a residential treatment center. The same goes for living in a halfway house, nobody does that forever! Long-term Support is essential but such intense Support systems as the preceding are not practical lifelong answers to this need.

Guys like me (Counselors or Therapists) typically recommend AA and NA as Support. We do this for a number of pretty good reasons. For one thing AA and NA are ubiquitous, if you need a meeting most likely you can find one. Major cities have thousands of meetings each week, small cities have dozens, and even small towns will support one or meetings on a regular basis. Another reason we recommend AA and NA is these are Support systems that know how to actually be supportive. It would be great if family members and our old running buddies could be a Support system. They cannot. The reason they cannot is they do not know how to be supportive, they are great at enabling but no good at all as a Support system. The final reason for using AA and NA as Support is they are probably going to be essential to meeting the needs on the upper levels of the Hierarchy of Recovery. Therefore it makes sense to use them as Support, after all you are going to wind up using them anyway.

Recall that the first two levels on Maslows Pyramid encompassed the survival needs. The first two levels on the Recovery Pyramid encompass the needs which must be met in order for recovery to survive. Most people do not want to live at the level of mere survival, they want more. Just surviving kind of sucks! It is the same with recovery. Survival level recovery kind of sucks too! Don't settle for it. Your recovery deserves to be on a loftier level. We'll look at the first of these higher level recovery needs next time.








Russell P. Mai, LCDC, AAC

Abstinence - The First Stage Of Recovery

The first stage of recovery is Abstinence. People often confuse Abstinence with recovery. Actually Abstinence is only the first stage of recovery. Abstinence is the foundation upon which recovery is built. Abstinence is not easy. People in recovery have all the same needs as everyone else, all the needs on Maslows Hierarchy of Needs. In addition to those needs people in recovery have recovery needs which are peculiar to them and not to ordinary people (here ordinary means people unaffected by addiction).

At the bottom of Maslows Pyramid are the Physical Needs (food, water, oxygen). The Physical Need at the bottom of the Recovery Pyramid is Abstinence. If a person is starving he needs food, if he is dieing of thirst he needs water. The answer to meeting his needs per Maslows Hierarchy is to fulfill them. But what if the person is an alcoholic and his thirst is for another drink of liquor? What if he's an addict and hungers for his next fix? What then? This is where the Hierarchy of Recovery starkly contrasts with Maslows Hierarchy of Needs. The Hierarchy of Recovery instead instructs the alcoholic to ignore her thirst to let it go unquenched. It tells the addict to starve herself of drugs. This is a tall order to meet!

Abstinence is so difficult that recovery programs such as Alcoholics Anonymous and Narcotics Anonymous encourage their members to take it "one day at a time." Sometimes they encourage newcomers to abstain for just an hour even five minutes at a time! Whatever it takes to lay a foundation for recovery is what must be done. Abstinence alone is not likely to be sustainable. Next time we will look at Support the next level of the Recovery Pyramid.





Russell P. Mai, LCDC, AAC

The Anesthetic Highs

The Anesthetic Highs are the final stage in the downward progression of addiction. When we think of anesthetics, we think of pain killing drugs. That is not precisely how I am using this word when describing this final stage of addiction. Take a look at the post on Maslow's Pyramid. The bottom level of Maslow's Pyramid is the level of Physical Needs (food, water, oxygen). A person dieing of hunger is in pain, hunger pain. A person dieing of asphyxiation is in pain too, and so is someone dieing of thirst. These are the types of pain that motivate addicts to seek an Anesthetic High.

An alcoholic is a man dieing of thirst. Water will not quench his thirst. Neither will alcohol but, the alcoholic thinks it will, if he drinks enough. A drug addict is a woman starving for a drug. Her hunger is insatiable but, she nevertheless uses more and more drugs in a vain attempt to satiate it. These people feel empty and desperate. They use alcohol and or drugs hoping for any brief respite from their torment. Of course they are only feeding their addiction, not themselves, and so they are doomed.

Denial evaporates at this stage of addiction. The trouble is now it is too late to quit! The addict can no longer face life without her drug, even though she knows her drug is destroying her life. Way back during the Arrogant Highs or even during the Performance Highs the addict told himself he would quit if it ever got this bad. The trouble is, once it gets this bad, he can no longer quit! The addict at this stage is reduced to utter hopelessness. He is a candidate for suicide. She may just give up and drink herself to death.

How long does it take to descend from the top of the Lowarchy of Highs to the bottom? To go from the euphoria of the Arrogant Highs to the desperation of the Anesthetic Highs? The answer is, it depends. It depends on the person's vulnerability to addiction. It depends on the drug or drugs he is using. It depends on the age she started using. To some extent it depends on gender.

Some  people are more vulnerable to addiction than others. They may become addicted very rapidly. Some drugs are more addictive than others. People using narcotics get addicted really fast. Children and adolescents get addicted much faster than adults. And unfortunately for women they get addicted quicker than men. So a young girl using heroin would become addicted faster than anyone I guess. The truth is the process of addiction is subtle but fast. People become hopelessly addicted before they know it. It may take years or, could only take months, either way it happens to them in a subtle sneaky way they fail to fully comprehend until it is too late.

Fortunately there is a way out, it is not easy though. More about this later.





Russell P. Mai, LCDC, AAC

The Protective Highs

Last time I ended the post on the Acceptance Highs, (after quoting my two examples who both said, "I'll quit if it gets worse,") with the negative assurance that it gets worse. Which brings us to this posting on what I call the "Protective Highs." Before talking about them it might be good to look back at Maslow's Pyramid. The highs we have been looking at so far (Arrogant Highs, Performance Highs and Acceptance Highs) correspond to the three upper levels of Maslow's Pyramid (Belonging, Esteem and Self Actualization Needs). So far we have looked at how drug or alcohol induced highs replace these needs. The addict is no longer meeting his Self Actualization, Esteem or Belonging Needs. This is bad but, the next two levels of needs on Maslow's Pyramid are survival needs. The highs we are going to look at now displace survival needs. When the addict uses to get these highs she begins to ignore her survival needs in favor of getting high. This does not mean that the person using for an Arrogant High cannot accidentally overdose himself or crash his car into tree. That kind of stuff happens a lot. What it does mean is that now the addict's use routinely interferes with her ability to meet her survival needs.

The Protective Highs correspond to the Safety and Shelter Needs on Maslow's Pyramid. The addict pursues these highs at the expense of meeting his Safety and Shelter Needs. The Protective High gives a feeling of safety while in reality placing the addict in greater danger. Is it safer to be drunk or to be sober? Is it safer to be high or to not be high? The alcoholic feels safer when she's drunk but she's really at more risk. I once worked with a guy who used to say that when he got home from work he was going to open a bottle of Scotch and "turn into another lump in the sofa." When a person drinks to get that drunk they are using to reach a state of oblivion. When I taught the repeat offenders class to people with multiple DWI's every single one of them had thought everything was going to be okay when they again drove drunk, they were oblivious to the danger. Oblivion is a Protective High. It is the type of Protective High that comes from using sedative drugs like alcohol, tranquilizers, narcotics or even marijuana. There is whole other type of Protective High which comes from using stimulants like crack, cocaine or methamphetamine.

The Protective High in stimulants has to do with sustaining the high. Once the crack addict is high she is afraid of coming down and she keeps on using to Protect herself from coming down. She starts out by going to her ATM withdrawing enough money to buy a "rock" of cocaine. Then she drives to meet her crack dealer and buys a rock. Then she goes back to her apartment and smokes it. She decides that rock wan't enough. She goes back to the ATM, back to the crack man, back to her apartment, smokes it, back to her ATM, back to the crack man, back home, smokes it, back to the ATM.... On and on it goes all night long on an eighth of a tank of gas until her bank account is empty! Why? Because she is afraid of coming down!

I once worked with a homeless man who had been expelled from the only shelter available to him on Galveston Island. He told me that if he had to spend the night on the streets of downtown Galveston he was going to get drunk. I asked him if he was more likely to get rolled (robbed while passed out) drunk or sober? He replied, "drunk." I asked him if he was more likely to be severely beaten by one of youth gangs looking for victims if drunk or if sober? He replied, "drunk." I asked him if did not make more sense to stay sober than it did to get drunk? He replied, "I can't face it out there sober!" adding "If I got to spend the night on the street I am getting drunk." In other words he would prefer the illusion of safety provided by a Protective High to actual safety!

During the Protective Highs stage of addiction the Safety and Shelter Needs are neglected. They fall by the wayside. The addict smokes up his rent money. The alcoholic drinks up her insurance payment. Taking care of Safety and Shelter Needs is ignored in favor of the desperate search for a Protective High. Family and friends often enable the addict by lending him money to pay bills or rent. The addict gets high instead. The addict's parents let her move back home, now she does not have to even consider her Safety and Shelter Needs and can spend all of her and all of their money on getting loaded!

Ask the person using for Protective High about their drug or alcohol use and he might blow his stack! She might cuss you out! The alcoholic does this because he feels threatened by the query. She knows that sooner or later something terrible is bound to happen if she does not stop! On the other hand the very thought of stopping scares him to death! He needs to quit before it's too late but he can't face life without it. The addict is a scared, angry and confused mess at this point in her addiction. More and more he alienates all those around him. She resents people butting into her affairs but is desperately lonely and afraid.

Still this is the next to last stage of addiction not the last, when it comes to addiction things can always get worse. We will see how much worse next time.








Russell P. Mai, LCDC, AAC

The Acceptance Highs

Once the Performance Highs are gone (like the Arrogant Highs which preceded them) they are replaced by another set of highs. Recall that the Arrogant Highs displaced Self Actualization Needs, needs the user may not have actually experienced yet, and the Performance Highs displaced Esteem Needs. This means getting high replaced these needs. Getting high to meet needs ultimately fails. After some period of time the person using for a Performance High loses the esteem of others, eventually they lose their self-esteem.

The next level on the progression downward in the Lowarchy of Highs (Figure 2. above) is the Acceptance Highs. These highs displace the Belonging Needs on Maslow's Pyramid. They are called the Acceptance Highs because the person using for an Acceptance High feels more acceptable to others when they are high or talking about getting high than when they are not. Their actual ability to maintain healthy relationships with others actually goes away during this stage of the addiction process. Some examples may help in making the point.

At one time in my career I frequently dealt with people who were walk-in clients of a large private nonprofit agency. I described one of those sessions previously in the post on Arrogant Highs. Well that was not the only mother and son duo I have dealt with. Some years later a mom and her 15-year-old son had a session with me. The son had been using marijuana regularly since he was age 11. His mother confessed she had actually introduced her son this drug but, she had quit using about one year previous to our session. She felt guilty for leading her son into marijuana use and, she hoped that because he had followed her bad example, he might just follow her good one and quit too. He did not.

They told me that when the boy was 11 years old and first started smoking weed, he was a straight "A" student, a pitcher on his little league team and a member of the school band. When I met them he was age  15, smoked weed daily, was a "C" student, played no sports (in fact he skipped P.E. most days and smoked weed with his friends), and was not engaged in any extracurricular activities. His mother left the session so the boy and I could talk in private.

I asked the boy, "Do you think marijuana could be holding you back?" He responded, "I am sure that it is." (This response surprised me!) I next queried, "Why don't you stop" (using marijuana). He said, "Because I feel like I would be a nerd." "Oh," I said, "you feel like your friends would put you down if you quit?" He replied, "No I think my friends would be proud of me if I quit." (I was confused!) Again I asked, "So why don't you quit?" And again he replied, "Because I feel like I would be nerd." (I paused and pondered his words.) Then I said, "Oh I get it! You feel like you would be a nerd, if you quit smoking weed!" He said, "Yeah I feel like I would be a nerd." I asked him if he thought he was addicted to smoking marijuana and he responded, "I don't know, maybe."

Around that same time I was also an instructor of the Texas DWI Intervention Course (repeat offenders program). One of my students was a gentleman in his 70's. This fellow had collected a bunch of DWI's from various states including one in Texas. Once Texas discovered all his previous DWI convictions the state ordered him into the repeat offender program. This course is cleverly designed to gradually convince students they have a serious alcohol problem (they all met criteria of alcohol dependence). Right on schedule this elderly gentleman confided to me, "I think I might have  a drinking problem." (He did have one.) I replied, "What do you want to do about it?" He explained that every day he played cards with some buddies of his, that as they played they drank beer. He then asked me, "What are they going to think of me if I won't have a beer with them?" I remembered what the 15-year-old had said a couple of days before and said, "Maybe your friends will be glad for you, maybe they'll be proud of you for not drinking!" The old man replied, "Yeah maybe but, it just wouldn't feel right if wasn't drinking with them."

During the Acceptance Highs stage of addiction the alcoholic's or drug addict's behavior actually becomes increasingly less acceptable to others. The alcoholic may make long rambling emotional phone calls in the middle of the night which she is unable to recall later (this tends to alienate people). The drug addict may be unreasonably jealous or completely untrustworthy (often both). Acquaintances drift away, but close friends and family offer constant reassurance of their loyalty. They don't want the addict to feel insecure. These wrong headed efforts ultimately fail.

The elderly man and the adolescent boy, described above, were using for an Acceptance High. The boy did not want to "feel like a nerd" (unacceptable) and the older man said that not drinking with his buddies "just wouldn't feel right" (unacceptable). Both were concerned they may have a substance disorder, the boy answered, "maybe" when asked if he was addicted and the old guy thought he "might have a drinking problem." I asked the older man and the teenage boy the same question, "What are you willing to do about it?" Even though these were separate conversations, they both gave the exact same answer, "I'll quit if it gets worse."  We know what happens, it does get worse. More about this in the next post.










Russell P. Mai, LCDC, AAC

The Performance Highs

The Arrogant Highs fade away and are replaced by the slightly less euphoric Performance Highs. The Performance Highs are so named because these highs do seem to enhance performance. They are not to be confused with physiological effects of certain performance enhancing drugs such as steroids, human growth hormone or erectile dysfunction medications. These Performance Highs come from psychotropic drugs.

We all know of musicians who have used drugs to enhance their performance or creativity. We have heard of athletes using cocaine, writers using alcohol, artists using various substances believing that their talent and skill were enhanced through using. Perhaps for a time this was true. Eventually the musicians lost their creativity. The athletes lost their ability. The writers and artists no longer produced. Too many talented people eventually lost their lives.

You do not have to be an artist, musician or athlete to use for a performance high. Anyone is who needs a few drinks before they are willing to dance is using for a performance high. The same is true for those who need something (psychoactive) in their system in order to chat up a member of the opposite sex. If need to smoke weed in order to enjoy a concert this is also a sort of performance high. Obviously students abusing stimulants in order to prepare for a test are using for a performance high. So are workers who use drugs on the job in order to get through the day.

During the Performance High stage of the addiction process a person's actual performance gradually declines. This is because as they come to rely (remember that word from the 1/12/13 post?) more and more on the drug(s) for their performance they put less and less effort into the kinds of things that help real performance. In other words the musician ignores practice, so does the athlete, the lover depends on a drug and loses his charm, the student ignores her studies, the worker  becomes less reliable as he relies on drugs more.

Friends and family are not much help. Because they care about the drug user they are loathe to hurt his feelings. Instead they try to bolster her pride (to meet her Esteem Needs for her) by telling her she is doing a good job. Family tells the drinker he is a great dad despite his declining ability to fulfill the role of a good father. His wife makes excuses. Her coworkers take up her slack. They do this because they don't want to be jerks. Friends, family, coworkers make excuses, take up slack, and offer encouraging words up to a point. This the point when they can no longer make excuses, are unable to take up any more slack. Some reach that point sooner than others, some take a long, long time. Eventually the Performance Highs fade.

Before they fade the people using for a performance high will demonstrate denial concerning their substance disorder. Denial at this stage in the Lowarchy of Highs is slightly different than at the previous stage. In the Arrogant High stage of addiction denial was absolute. Now denial takes the form of rationalization. People using for a performance high rationalize about their substance use. They believe it is an asset. The will explain how their use of drugs or alcohol enhances their life in some important way. They rationalize a deficit into an asset, it's a kind of like they are cooking the books and embezzling from their esteem account (the esteem of others and their own self-esteem).

The Performance Highs like the Arrogant Highs which preceded them are also replaced by another set of highs. These next highs are not as rewarding but, they correspond to more basic needs on Maslow's Pyramid so, they are much harder to do without. They are more addictive.







Russell P. Mai, LCDC, AAC

The Arrogant Highs

Last time I wrote about Maslow's Pyramid. What follows is based on that conceptual framework. So if you have not already read the last posting you may want to. Maslow called his model of human development and behavior the Hierarchy of Needs. I call my model of the addiction process, based in his ideas, the "Lowarchy of Highs." Lowarchy is a neologism and you will not find it in the dictionary. I use this made up term to emphasize the negative (downward) progression of addiction. The Hierarchy builds from the bottom up. The Lowarchy destroys from the top down.

The first highs are the best highs. These are at the summit of the Lowarchy. These highs correspond to the Self Actualization Needs on Maslow's Pyramid. Achieving the Actualization Needs involves a life of effort and self-exam. All you have to do to achieve these initial highs is, get high, take the drug, smoke it, drink it, snort it or inject it and this is as good as it will ever get! These initial highs I call the Arrogant Highs.

They are not called the Arrogant Highs because people who get high are arrogant. Some perfectly humble people just might decide to get high. The high they experience will not be so humble. It may give them an on top of the world feeling, euphoria. But these people are not on top of the world they're just high. And that's why these highs are called the Arrogant Highs. Some examples may help to explain the Arrogant Highs.

If you wanted to meet a room full of experts on any subject where would you go? If you wanted to hear from experts on economics, geopolitics, marriage, national defense and auto-mechanics where could you go to find experts on all these and many other subjects? A university? A library? A church? No! None of those places have all the expertise readily available. However you can walk into almost any bar in any town, anywhere and find a room full of experts on these and many more subjects as well. These experts will gladly and endlessly share the vast knowledge with you! But, are they really experts, or are they just drunk?

You might be a shy, reticent and self effacing individual the essence of humility. But snort a line of cocaine and SHAZAM! You are the coolest, smartest, sexiest person around! The life of the party.

A number of years ago a lady brought her son to see me. She was concerned because he regularly smoked marijuana seemed to be developmentally stuck and was going nowhere fast. He was 20 years old, a high school dropout, unemployed, and lived with his mother. I met with him in private. With his mother away this young man confided in me that besides his routine use of marijuana he had recently begun experimenting with LSD.

This young man told me that on his most recent acid trip he had gotten "the answer." I asked, "The answer to what?" He responded, "No it's not like that man." I queried, "Do you mean like, the answer to God the universe and everything?" He said, "Yeah like that, the BIG answer!" I asked, "What is it?" He replied, "I could tell you, but you wouldn't get it." He continued, "So I am going to write a book and as you read the book the answer will gradually occur to you," adding, "and I'm not even going to charge any royalties for this book, because I just wouldn't feel right about it!"

Now my friends, the above is a great example of an Arrogant High! Here was a young man, 20 years old, unemployed, a high school dropout, who smokes pot every day and lives with his mother and he has the answer to everything! If I have any questions, any at all, about anything, I am not going to consult this young man, what can he tell me, fire up a fat boy and chill? Yet despite all the evidence to the contrary his Arrogant High has him believing he knows the inside dope about everything.

The Arrogant Highs are really good highs. If you question someone using for an Arrogant High about their drug use they will actually feel sorry for you. They will find you pitiful. After all you just don't get it you are a square an object of scorn.

A person using drugs for an Arrogant High will not work to meet their Self Actualization Needs. Why should they? using a drug puts them on top of the world without any real effort on their part.

Sooner or later the Arrogant Highs fade. They are replaced by another set of highs. Highs not quite as good as the Arrogant Highs but, still pretty good highs. These next highs correspond to slightly more basic needs. They displace these needs, just as the Arrogant Highs displaced the Self Actualization Needs. More about them next time.





Russell P. Mai, LCDC, AAC

Maslow's Pyramid

I had been working for a number of years with teenagers under the supervision of the juvenile justice system when I had the opportunity to give presentations at a high school. One of the classrooms to which I talked was an advanced placement class. These students were so much more mature and attentive than the teens I generally dealt with that I suddenly realized how little I knew about healthy adolescents.

I have a strong feeling that mental health professionals in general have a rather jaded view of humanity which is product of their overexposure to dysfunctional individuals and groups. The increasing integration of addiction professionals into the mental health community has corresponded with an increase in the diagnosis of mental health disorders in substance disordered individuals. Coincidence? Perhaps. Still even the most objective professionals tend to identify the disorders they have been trained to find.

One of my heroes is the late American psychologist, Abraham Maslow. Maslow was the first psychologist to study healthy people. I believe that understanding Maslow's ideas is important. In my view understanding Maslow is a prerequisite to understanding the addiction process. Like many prerequisites it's full importance to what comes later is not self evident so please bear with me and have faith that what follows will help later with your comprehension of addiction.

Maslow's called his model of human psychology "The Hierarchy of Needs." Most people call his model "Maslow's Pyramid" (for obvious reasons). Maslow put forward the idea that people do the things they do in order to get their needs met. He said these needs are hierarchical in nature. Meeting the most basic needs takes precedence over meeting less basic needs. Meeting the needs approaching the summit of the hierarchy is rewarding in ways vastly different than the rewards of meeting the needs at the base of the hierarchy. The model graphically depicts the necessity of meeting the more basic needs (those near the base) before the higher level needs can be met. After all you cannot build on nothing. Only after all the lower level needs have been met can the uppermost level of needs be addressed. This is why hardly anybody ever gets these needs met!

At the base of Maslow's Pyramid are the Physical Needs. These most basic needs are concerned with immediate survival. They include, food, water, and respiration. Most of the time we take these for granted. We just assume these needs will be met. Therefore most of us are not motivated on a day to day basis by these most basic needs. Natural disasters can alter our motivations. Following natural disasters people who had taken these most basic needs for granted may suddenly be motivated by hunger or thirst. In the case of fire they may be motivated by the need to respire.

The next level on the Hierarchy is the level of Safety and Shelter Needs. People sometimes have difficulty understanding why food and shelter are on different levels of the Pyramid. The reason is, starving people (or animals) will risk their safety and shelter in order to eat. For instance during the initial U.S. assault on Afghanistan our forces dropped both bombs and rations. Cluster bombs were dispersed widely as were packages of food. Sometimes the cluster bombs did not explode immediately on impact. Both the bombs and the food aid were contained in yellow packages. Starving Afghans would risk being blown to smithereens in order to get something to eat. This dire example clearly illustrates why these two needs are on different levels of Maslow's Pyramid.  http://articles.cnn.com/2001-11-01/us/ret.afghan.fooddrops_1_cluster-bombs-unexploded-cluster-bomblets?_s=PM:US

The two levels of needs described above are collectively known as the Survival Needs. This is because we will not survive if these two levels of needs go unmet. Meeting the Physical Needs is an immanent requirement for survival whereas meeting Safety and Shelter Needs is a long-term survival requirement.

The next level on the Hierarchy of Needs is the Belonging Needs. Meeting these needs is not required for survival. Survival without a sense of belonging would however be a fairly bleak prospect. Most of us have known the misery of loneliness at some time or another. We have a strong desire for love and companionship. Life does not seem worthwhile without these needs being met. Ideally our need to belong will be met through having a happy and healthy family, wholesome love relationships and high quality friendships. The Belonging Needs are so strong that people frequently settle for less than ideal friendships, less than ideal relationships and less than ideal families. Some people even settle for downright unhealthy situations just in order to fit in, belong or experience a twisted sort of affection.

Once we experience belonging another set of needs arise. These are the Esteem Needs. Esteem Needs are the desire for both self-respect and the respect or admiration of others. If you are a parent you probably want your children's respect. If you have parents you probably would like them to be proud of you. If you are in a relationship you most likely want your other half to appreciate you and are displeased if they take you for granted. Likewise as an employee you want your employer to appreciate your hard work. If you supervise others you also want their respect. Maslow said most of us spend our time trying to get these needs met. Personally I think he may have been a little optimistic, it seems to me that lots of people are just trying to survive (Maslow was an American living at a time when our economy was booming).

This is an appropriate point to reinforce the point that meeting higher level needs depends upon having all the lower level needs met. If a person is starving to death they will be desperate for food, any food. They would even be willing to eat from a dumpster if that was the only place they could find something to eat. If another person came across them eating from a dumpster and dared to question how they could behave in such a demeaning manner, their understandable response might be, "What are you talking about? I'm starving to death!" If you are starving your life is based on meeting your Physical Needs and someone suggesting your choice of cuisine is demeaning (Esteem Needs) would make no sense at all! If you are living at the level of Physical Needs you do not experience Esteem Needs. On the other hand offering shelter to a starving person might pique their curiosity and they will probably be interested once they have eaten their fill. This will be important later when looking at addiction.

Just as in the Belonging Needs it would be nice if people always achieved their Esteem Needs in healthy ways. This is unfortunately not always the case. If a child cannot impress his parents through high achievement he may start impressing them through low achievement. If a person cannot earn respect in healthy ways they may earn it in unhealthy ways such as bullying others. Healthy means of meeting the Esteem Needs are likely more sustainable than unhealthy means. Still advertisers have learned to sell us all kinds of unnecessarily expensive products based on our desire to impress ourselves and others. Achievement is the true route to meeting our Esteem Needs, and the only sustainable method in the long-run.

The highest level on Maslow's Pyramid is the Self-Actualization Needs. Abraham Maslow estimated that less than 1% of people ever meet their Self-Actualization Needs. Most will never even be aware of these needs. The lucky Self-Actualized few have a wonderful feeling of connection. They know they are fulfilling their special purpose. They believe they are living the life they were born to live. They are becoming the people whom their creator (if they believe in one) had in mind on the day they were born!

This is a cursory examination of Maslow's Hierarchy of Needs. Maslow was unique in studying healthy people and what motivates healthy individuals. His views are at once commonsense, idealistic and optimistic. Next we will use Maslow's concepts to help us understand the process of addiction.




Russell P. Mai, LCDC, AAC

The Advantages of Drugs and Alcohol

There are some people who seem to become immediately addicted once they try drugs or alcohol. For most it seems to take some time to become addicted. The length of time varies significantly. There is a period between first use and addiction during which substance reliance develops. Before we become dependent substances we first become reliant on them. I became aware of this important aspect of addiction over a period of time.

I used to be involved with a drug prevention program aimed at kids. The premise behind our efforts was kids use drugs because they are lacking in self-esteem. I doubted this as I recalled having fairly healthy self-esteem when I started using alcohol then marijuana and later LSD. Some of adolescents I encountered in prevention classes seemed extremely self assured despite their positive attitude about drug use!

The Houston PBS station once televised a series on sex addiction presented by Patrick Carnes author of, Out Of The Shadows. He was of course focused on sex but I think his explanation of how intelligent, competent people, from good families, can become reliant on sex, also works for drugs and alcohol.

I will do my best to explain. At the simplest we could just say that people drink and use drugs because it is fun to do so. This is pretty accurate but it is too broad to be useful. The other extreme would be to say that every individual uses drugs and alcohol for individual reasons. Also accurate but way too narrow to be useful. Patrick Carnes listed four desires he said people choose to meet through sex. I liked his list, so I co-opted it!

The first of these desires is escape, the second is excitement, the third mystery, and the last fulfillment. There is absolutely nothing wrong with any of these desires! We all want to escape from time to time there is nothing neurotic about the desire to get away form it all upon occasion. Similarly we need some excitement, some of us need quite a lot, others just a bit. Everyone has a degree of curiosity, and that curiosity creates a desire for mystery. And who wouldn't want to feel fulfilled? No one that's who. How do we normally go about meeting these desires? Typically in lots of normal ways like the ones listed below.

Typical ways of escaping our routine might be, reading, watching TV or going to the movies, taking a trip, watching sports, shopping or going fishing. We might find it exciting to ride a motorcycle or practice martial arts. We might find online gaming exciting, or roller-blading, dancing, or going to concerts. Going on a blind date could be mysterious, so could dining on ethnic foods, reading a mystery or foreign travel. We all want fulfilling careers, or at least hobbies. We look for fulfillment from our family life, in friendships and in our religious or spiritual life.

Okay now it is time to get real. Escaping into a book requires an interesting read and the ability to focus, sometimes our problems may be too pressing. TV is often boring and movies take planning and then some fool keeps talking during the show! You go on a trip only if you can afford it and are allowed time off, then when you get there it looks just like any other place - fast food and tourist trinkets. You may not catch any fish, there is nothing to buy on your shopping trip or it all costs too much! Sometimes there is no escape. Excitement; Motorcycles are expensive and no fun in bad weather. Martial arts involves repetitive exercises  that are not all that exciting. Online gaming can get old fast, after a while all the games seem the same. Roller-blading requires skill and decent weather or you have to do it indoors going round and round in a circle. Concerts are expensive and the band you want to hear never plays locally more often than every few years. Mystery; Your blind date shows up and it's your ex! The ethnic food you order smells bad and tastes worse. You solve the mystery you're reading by chapter three. Fulfillment; Sometimes family life is more trying than fulfilling, friends sometimes take but don't give and listening to sermons gets boring!

I know I am painting a bleak picture, the point is all the above ways of escaping, finding excitement or mystery or achieving fulfillment involve luck or skill or money or can only happen occasionally or need others to cooperate. Sometimes, perhaps frequently they do not work out as well as we had hoped they would.

Using drugs and alcohol has advantages over the above methods of achieving our desires for escape, excitement, mystery and fulfillment. For one thing drugs and alcohol are relatively cheap. It's a lot cheaper to get drunk or high than it is to take a trip, buy a motorcycle or raise a family.

Using drugs and alcohol requires very little skill. Keeping crack crackling is something people master rapidly.  Playing golf requires skill, mastering martial arts takes discipline, taking a course in astrophysics is hard work and gaining fulfillment through spiritual practices requires devotion but getting loaded is easy.

A person can use drugs or alcohol anytime they want to. Fishing requires appropriate conditions, hang gliding also requires the correct conditions, gazing at the stars through a telescope requires a dark clear night away from city lights, engaging in a fulfilling career requires a confluence of many circumstances, using narcotics just requires Internet access or access to a pain clinic or two.

The cooperation of others is not required in order to get drunk or high, not so if you want to veg-out watching TV and your spouse wants to talk, or you are excited by the prospect of having sex but your partner isn't, you cannot go on a blind date by yourself, family life requires a family, all these require others cooperation but you can peak on LSD in complete isolation.

Finally when it comes to luck drugs and alcohol have it all over these other methods of reaching our desires. Catching fish requires some luck, so does watching sports for excitement, or solving a puzzle even having a good relationship requires a fair amount of luck. Not so with drugs and alcohol, you can depend on them, they are reliable.

The truth is drugs and alcohol have all kinds of advantages; they are relatively cheap, they are readily available anytime anywhere, they are easy to use - the drug does all the work, and they are reliable, they consistently work the way you expect them to work. None of those other means of reaching our desires have all these advantages. That is the problem! The problem is not that drugs don't work. The problem is that they do!

It is because of the easy access, relative cheapness, ease of use, no assistance needed and reliable efficacy of drugs and alcohol that intelligent, well mannered, self confident, people from good homes wind up relying on them. We need to admit the truth and understand that everybody, smart or stupid, crazy or sane, is vulnerable to the advantages of drugs. They work and that is the problem!

The advantages of drugs and alcohol lead people to rely on them. Too often reliance devolves into dependence. It is subtle process that happens before we realize it. More about that later.






Russell Mai, LCDC, AAC

Is The Big Book of AA Still Relevant?

A number of years ago I was concluding a counseling session with a client. He was in his 30's and wasn't happy about his alcohol dependency but grudgingly accepted it. I suggested he attend AA and read their book as a means of gaining acceptance of his alcoholism. He didn't much care for this suggestion.

This man described AA in rather condescending terms. He seemed to feel it was for stupid people. Perhaps he had attended a meeting and had heard someone say "you can be too smart for this program but you can't be too stupid." I wish people wouldn't say things like that as it might run some people off. I suggested he might try a different meeting and give the AA "Big Book" a read. He clearly was not ready for a solution because he rejected this suggestion. (When you go to someone for advice and then reject the advice that is clear evidence you do not want a solution.) He added that the Big Book was out of date having been written prior to WW II. He said he would like something newer, more up to date, something based on science unlike the Big Book.

Now here was a question which gave me some pause. Sure I liked the Big Book and believed it to be just about the most helpful book ever written, but how well does it align with current knowledge about addiction? Well actually it does remarkably well.

Approximately a decade and a half after the Big Book was written the American Medical Association [AMA] first recognized alcoholism as a disease. The AMA definition of addiction has been amended recently specifying that addiction is a brain disease. This not withstanding the older wording remains describing alcoholism as a "primary, progressive and chronic," illness with characteristics such as "obsession" with alcohol, a "compulsion" to continue drinking once drinking is initiated and ongoing drinking "despite negative consequences." The definition from the AMA includes "distortions in thinking, most notably denial."

The description of alcoholism contained in the Big Book of AA includes all of the above. The Big Book states that "over any considerable period we get worse never better." This is a clear statement about the progressive nature of addiction. Denial is described in the Big Book as "The idea that somehow, someday he will control and (emphasis is mine) enjoy his drinking is the great obsession..." Actually the entire AMA definition of alcoholism is really a summary of the first 164 pages of the Big Book.

What about these latest brain disease findings? http://www.drugabuse.gov/publications/science-addiction/drugs-brain A few years ago a friend and I happened to be attending a lecture on addiction and the brain at UTMB Galveston. The talk was based on ten years of recent research. The speaker described how for persons with a history of addiction certain neuropathways are bypassed and others are selected when the subject is presented with a visible stimulus related to the substance they are or were addicted to. Basically all the pathways involved with inhibition and judgement are bypassed and those involved with instinctive actions are selected. In other words the subject was found to be "powerless over alcohol" his or her decisions evidenced that "our lives had become unmanageable."

The truth is that the Big Book is not a science book as such. It is not based on decades of controlled experimentation. However the hypothesis put forward by the Big Book has been validated by years and years of experimental evidence. The ideas contained in the Big Book of AA represent a theory of alcoholism and actually a theory of addiction which appears incontrovertible. Unless future research entirely negates current knowledge your best bet for comprehending and overcoming addiction are contained in the pages of the book Alcoholics Anonymous.


Russell Mai, LCDC, AAC