AA in the 21st Century

AA in the 21st CenturyAlcoholics Anonymous has changed through the years, but AA might be facing bigger challenges in the 21st century than it did in the latter part of the 20 century. AA in the 21st century faces secularism and a general trend of suspicion of all institutions that appear traditional. AA has become an American institution and tradition is important to AA. Through the years AA has been attacked for being too religious, too much like a cult, too unwilling to change with the times, too insistent on the need for total abstinent from all drugs, even prescribed drugs, etc.

AA in the 21st century, in many ways, looks like AA in the 1930s when it was created. AA is still based on a set of principles, traditions and concepts that have not changed. The make up of AA has changed, though, and how members talk about alcoholism and recovery has changed. In most cities with any size, AA members are usually poly0drug users, with alcohol as only one of the drugs with which they had a problem. Most groups don’t talk much, if any, about the Christian concept of God, but rather a generalized “higher power”. There are even meetings that cater to free thinkers, agnostics and atheists.

AA groups have changed in many ways — there are gay groups, women’s groups, Hispanic groups, etc. There has been controversy about specialized groups, because many AA members believe that alcoholics of any race, gender, religion, etc., have a common bond in recovery. If specialty groups help individuals find sobriety and recovery, though, most AA members take a live and let live attitude.

AA in general doesn’t react in a knee-jerk style to criticisms, public controversy or demands to change. The AA central office basically stays clear of public controversy, avoiding politics or public displays of defense. AA simply says, this is what we do, and alcoholics are free to try it if they think it will help. There’s actually a libertarian streak in AA that’s attractive to most people. AA sticks with certain principles that are considered timeless and certain traditions that have worked to keep groups together, but AA leaves it up each group to be autonomous in its own affairs unless it harms AA as a whole — even, then, a renegade group that violates all traditions will simply not be recognized by the central office as an AA group — AA has no power to force the groups to conform. There’s enough latitude and flexibility in AA groups for AA to be wide enough and deep enough for any individual seeking help. If an individual doesn’t like one group, they can find another, or start one. I think AA in the 21st century will do just fine.

Motivation in Addiction Treatment

Motivation in addiction recoveryThere are basically three types of motivation in addiction treatment. One is to avoid unpleasant consequences through compliance. These clients are usually pushed hard to get into treatment, and they’re the most likely to return to their drug of choice. Another form of motivation is calculation — a person has calculated the costs and benefits of drinking and using drugs and has concluded that stopping will be a better choice. The third form of motivation is existential — the person has committed to addiction treatment because life in addiction has become miserable, hopeless and precarious. These last two forms of motivation are stronger than the first with the last being the strongest.

Although addicts who’re forced into treatment by the courts, family, spouse, etc., can and do recover, they usually have to go through more trouble before the desire to change is deep and meaningful. I’ve seen clients who’re forced kicking and screaming into treatment turn around and realize they have a problem. Most of us working in the field for a lengthy period of time have come to realize that it’s almost impossible to tell who’ll recover and who won’t, but the odds are not favorable for the person who’s in treatment just because someone holds leverage over the person. You’ll often hear people say about addiction treatment and recovery that the person has to want to stop drinking or using some other drug in order to recover. A desire to stop is not necessary in the beginning. I’ve seen people forced into treatment with no intentions of stopping have an epiphany and recover long term, and I’ve seen people who desperately wanted to recover never stop for any long length of time and eventually die from their addiction. Nothing has hurt the addict more than for people to tell him/her that they aren’t trying hard enough, and that if they just put their mind to it, they could stop drinking alcohol or using cocaine or shooting up heroin.

The person who rationally looks at their addiction and decides the costs of using drugs outweigh any benefits are at least motivated, but if addiction recovery were as simple as calculation, most people would stop long before the late stages of addiction. Calculation can be strong enough to get a person into recovery, but there usually has to be something stronger keeping a person in recovery or they go back to the drug of choice after the bad memories fade and the calculation changes. Perhaps the person has bad fortune in recovery and loses their job in a bad economy — the person who’s only calculating the costs and benefits might say that recovery is not “paying off”.

The point is that a desire to stop is a good motivator, but not necessary to start the treatment process. Having a desire to stop, though, doesn’t guarantee recovery, especially if the person is quitting with the expectations that life will be trouble free without addiction. Addicts forced into treatment can and do recover, and addicts who initially decide to deal with addiction and recover can and do die from their addiction. What usually determines if a person recovers or not is their level of ongoing commitment to the long term process of recovery. The main form of motivation in addiction treatment that enhances long term recovery is internal commitment. When a person has truthfully admitted that addiction is a life-threatening problem and has committed to taking steps to achieve and maintain recovery, regardless of external circumstances or obstacles, then the motivation is real enough to sustain long term change and growth.

Addiction Recovery: Why Change Is Hard

Addiction recovery

The road to recovery

When chemically dependent individuals go through treatment and begin addiction recovery, then they return to alcohol or whatever drug of dependence they preferred, the “failures” are always noticed because of the consequences that usually follow. Those who go to treatment and remain abstinent simply go about their lives — their family and friends appreciate the new way of life in addiction recovery, but it doesn’t draw attention. Addiction is called a disease of relapse because when the brain is rewired during addiction it takes a long time to readjust in recovery. The cravings and the triggers to use or drink again are powerful. It’s not uncommon for a person to relapse during the first six months of recovery. Some relapse after years of abstinence.

A few examples will help understand. A cocaine addict goes through treatment, then, once out of treatment, goes through a period where life is dull and colorless. This perception of greyness and dullness is the brain adjusting from the slow regeneration of brain chemicals and a sometimes long adjustment period. The brain chemicals that make a person feel good naturally have not regenerated. If in treatment the person was educated on this process of brain chemical readjustment, the recovering cocaine addict might make it through this period, but it can become so overwhelming the person might decide to drink alcohol as a substitute just to feel better, even if her treatment counselor warned against drug substitution. Once the alcohol has clouded her judgment, she might feel better but begin craving cocaine to feel even better. Let’s say she goes to a bar to drink, then she sees a old friend, and the old friend has cocaine, and then you can finish the rest of the story.

Another scenario is a recovering alcoholic in the first six months who is an executive. The executive is invited to a party with his boss and several important business associates. There’s a good possibility that if the executive makes a good impression on the boss and the important associates he might get a promotion he’s been working on. The executive has never felt comfortable at social events without alcohol. The executive knows he can’t drink, and he’s been doing good in AA, but he dreads going to this event sober and awkward. The executive gives in to the urge to ease his tension and decides he’ll only have two drinks, just to relax, then he’ll continue his recovery the next day. It’s hard to remain abstinent when there are so many environmental triggers and so much adjustment to go through to feel comfortable without the drug of choice.

Relapse is not the end of the world. Relapse can be avoided but it takes great and persistent effort. There comes a time in addiction recovery when the adjustment period is pretty much over and the desire to drink or use drugs is gone, and the temptations are easy to manage, but getting to that point is the struggle. If a person relapses, they can get back on track — the danger of relapse, though, is that many people don’t make it back. It’s always better to stay abstinent and to not relapse — then the risk is removed. Easier said than done, I know.

The Suboxone controversy continues

Suboxone saves livesAlthough, I’m not sure why, at least from the standpoint of addiction treatment. Here are a few reasons that treatment facilities don’t use Suboxone, taken from a Rehabs.com article:

 

“Short answer, no. Suboxone is a temporary solution for a permanent problem.

“You can get strung out on Suboxone as badly as on heroin.”

“Oh no, absolutely not. We do not discharge them on Suboxone.” When I mentioned that the scientific literature reports that people do better on maintenance Suboxone than not, Iwas told, “The scientific literature is false. I’ve been doing this for 20 years.”

“We’re abstinence-based. Our success is getting to the underlying issues and we can’t get to those when they’re under the influence of a narcotic or other medications.”

Treatment for opioid/opiate addiction has historically produced poor results, so, I can’t understand why healthcare professionals would dismiss Suboxone when the use of Suboxone has proved to be effective. Suboxone is not a magic pill, but it does make withdrawal more comfortable, and, when used for the first few months of recovery, it allows the addict to get into treatment and begin utilizing a support group like AA or NA.

For most opiate addiction problems outpatient treatment is sufficient. If I had to identify a problem with Suboxone, I’d say the main problem is that it works too good in the beginning and the person thinks that all is now well. It’s vital when starting an opiate addict on Suboxone to explain the process. Just because the person feels much better after taking the Suboxone doesn’t mean that treatment isn’t necessary. Much emotional and mental damage is done during addiction, and if this damage is not dealt with it comes back to haunt a person after the smoke of the “revival” has cleared. When an addict decides to do something about their problem, there can be a period of emotional exuberance, especially if Suboxone has eased the withdrawals, but this phase of recovery can fade quickly, then the ghosts and demons return.

Most studies done on the effectiveness of different methods of treating opiate addiction are usually studies which take data from the first few months, if that long. Follow up studies are suspect because they’re based on self-reporting, and that self-reporting is not really accurate. I’ve observed opiate addicts over a period of years from beginning to treatment to aftercare to AA or NA to long term recovery management. After a while it becomes obvious that some things are conducive to long term recovery and some things aren’t.

Treatment programs that don’t use Suboxone or some other maintenance medication usually have a low retention rate when it comes to opiate addiction (I use opioid and opiate interchangeably, because opioids are simply synthetic opiates). When an opiate addict goes straight to a physician for Suboxone and sees only the physician once a month for short term “counseling” the person usually goes in and out, returning to heroin or whatever opiate they were using before, or some other drug as a substitute, then goes back on Suboxone, or Subutex which doesn’t contain Naloxone (that’s another story for another post) and is more conducive to this back and forth usage.

Most doctors trained in addiction medicine recommend that the opiate addict who wants to use Suboxone get an assessment at an addiction treatment facility. The best success I’ve witnessed is when the opiate addict takes Suboxone for three to four months, goes through an intensive outpatient program, and after discharge manages recovery long term through medical care, nutrition, attendance at AA or NA,  a sponsor in AA or NA, exercise and continuous spiritual/personal growth. There are factors involved all along the way that either enhance recovery or hurt recovery. Low quality treatment or lack of treatment is a problem in many areas, as is a lack of doctors who truly understand addiction. In many areas there are AA or NA groups who are critical of Suboxone, even though AA has had a pamphlet out for decades that says AA members aren’t doctors and shouldn’t interfere with medical treatment.

The main problem dealing with opiate addiction is the same old problem of funding. If people can’t access addiction treatment or pay for medication, then all the other solutions are not attainable. Once this country gets its insurance problem worked out, perhaps the idea will win out that treating the addiction problem now with the most effective methods will save lives and billions/trillions of dollars in the future. The bottom line is Suboxone helps to saves lives.

 

 

From Heroin to Fentanyl

Fentanyl and heroin

Opioid Addiction

You might get confused over terms as you read about opium, opiates and opioids. Heroin, morphine, opium and codeine are opiates produced from the opium poppy plant. The other painkillers you read or hear about or ones prescribed usually by a doctor, such as Percocet, Demerol, Oxycodone, etc., are likely opioid pain killers – opioids are synthetic drugs. So, opium has to do with the poppy plant, opiates are produced from opium and opioids are synthetic, opiate-like drugs. As bad as opiates are for those who become addicted, opioids like Fentanyl are becoming worse.

The drug Fentanyl is an opioid, a synthetic, opiate-like drug that is 50 times more potent than heroin and 100 times more potent than morphine. In some areas of the US, Fentanyl is now a larger problem than heroin. According to this NY Times article, in certain New England areas, illicit Fentanyl is coming from Mexico. Although Fentanyl is great for pain relief if applied properly by medical professionals, it’s high risk to buy it off the street because it’s so potent.

The strange part is that when addicts hear about someone overdosing from a strong drug like Fentanyl, they’ll seek it out, thinking they won’t use so much as to kill them, but knowing they’ll get what they consider good product. Addiction and thrill seeking override good judgement. This is from the article:

“It’s just everywhere,” Heather Sartori, 38, a former nurse who is on methadone after years of shooting up heroin, said as she sat at a busy McDonald’s here. “It would be really hard to navigate through this city without being touched by it.”

She said she had lost several friends to fentanyl and called Lawrence’s drug-infested landscape “the treacherous terrain where the ghosts of the fallen linger.”

“It’s cheaper, and the high is better, so more addicts will go to a dealer to get that quality and grade,” she said, even if it means they could die.

“That is the phenomenon of the addicted mind,” she said. “It’s beyond the scope of a rational thinker to understand.”

Hopefully, as the opiate/opioid problem spreads, more resources will arise to intervene, educate and provide treatment. This is not a new problem – opium, opiates and opiate-like drugs have been a problem since opium poppy plants were first discovered thousands of years ago. Today, though, in the 21st century, there are answers to the problem. Also, opiate/opioid addiction should always be considered in the context of addiction in general — still, alcoholism does far more damage to society than opiate/opioid addiction. We’ve come a long way treating addiction, but there’s still a lot that needs to be done.

 

Addiction and Recovery Management

Recovery management and addictionThe major difficulty with recovery from addiction is that addicts have created a slew of faulty conclusions that aren’t based in facts and reality. Recovery Management is, in large part, reexamining these conclusions and slowly accepting facts and reality. Addicts aren’t the only ones working off faulty premises or avoiding facts and reality, but for the addict this lack of clarity and truth can be deadly.

Those looking at the behavior of an active addict will likely see the destruction with no problem. The observer might say that the addict is insane because they keep doing the same things over and over and apparently not learning that the actions lead to the same consequences. In the book Alcoholics Anonymous, Bill Wilson likens this “insanity” to a jaywalker who continues to jaywalk and get tickets until he’s ruined his life. That would surely meet the definition of insane.

In the addict’s mind, though, the drug, be it alcohol, opioids, cocaine, Xanax, etc., is holding them together. In the addict’s mind life is out of control, painful and confusing without the drug. This is why most people who don’t understand addiction become frustrated with addicts — when it comes to their drug of choice, the addict is not dealing with facts and reality. The addict might be reasonable and reality based in other areas, like business or daily decision making on other issues, but when it comes to the drug on which they’re dependent, they are completely out of touch with reality, except for the private reality they’ve created in their addiction, which, to them, seems very real.

Long term recovery management entails complete re-evaluation of the addict’s relationship to the drug. This is where support groups come in — from my perspective the most powerful agent of recovery for the addict is the support they find from other recovering addicts. The understanding and the bond between recovering addicts is powerful and life changing, much like the bond developed among all people who share a survival experience from certain tragedies.

It’s not that friends and family members can’t provide powerful support, they can, but there are some things about addiction, the “insanity” of addiction and recovery from addiction that only another recovering addict will understand. All forms of support are vital, and recovery management is holistic — nutrition, intellectual pursuits, exercise, relationships, spiritual and so forth. Support in all these areas will enhance recovery, but paying attention to the ongoing, deep, re-evaluation of the relationship to the drug is primary.

Progression of Drug Addiction

The Progression of Drug Addiction

The science of addiction

I tell clients all the time that no one is born a skid row drug addict. There’s a long, painful road to the bottom for alcoholics and all others dependent on a drug. Furthermore, not all those who become addicts wind up on skid row. Drug addiction can happen to those who have plenty of financial support. Some addicts almost immediately experience dependence and obsession with a drug when they first try it — especially meth and cocaine addicts. Usually, though, it takes years for someone to become severely dependent to the point that they place at risk all that’s important to them just so they can continue to use their drug. This doesn’t mean, though, that anyone who uses a drug for a long time and often will become an addict. There’s a combination of factors – genetics, dysregulation of brain chemicals, psychological and environmental factors – that create addiction which progressively gets worse. Many people will not become, say, an alcoholic just because they drink on a regular basis for years. A person interested in understanding how addiction works in the brain can read The Science of Addiction.

For the purpose of this post, I simply want to clarify misconceptions about addiction and drug misuse, and how sometimes it doesn’t really matter if a person is dependent or simply misuses a certain drug — it only matters what the person does about their problem. I’ve written about this topic several times, but it’s a complex subject that requires a lot of discussion, and it’s a subject that science is still researching. Scientists have pretty much isolated the part of the brain, the mesolimbic dopamine system, that pertains to chemical dependence (addiction). But when dealing with someone who has a drug problem, all the charts and scientific explanations don’t fully help us understand drug-related behavior. As I wrote above, it’s complex. Everyone has their own version of an addict in their heads, until they come across an addict that doesn’t fit their version.

I’ve dealt with young addicts who within a year were dependent on their drug of choice and totally out of control. I’ve deal with housewives whom no one suspected of having an addiction, who quietly suffered at home, mostly alone,  from a dependence on pills. I’ve deal with respectable business people who certainly never intended to lose control of their drinking, but wound up after 10 years  of drinking in a treatment center totally bewildered that they were drinking daily to keep from falling apart. I’ve dealt with Priests, plumbers, school teachers, homeless men and women, stock brokers, atheletes, high school kids, Psychologists, Biologists, carpenters, accountants and politicians.

I once was very concerned that those who came into treatment at what seemed an early stage in which the person still had control of the alcohol/drugs, but made bad decisions often when drinking or using some other drug, were being treated for addiction but might not be “real” addicts. I later understood that misuse of alcohol and drugs is dangerous and detrimental to mental and emotional health. Perhaps some of the people in treatment don’t meet all the criteria for full blown drug addiction, but they might be in the early stage or they might simply be the type that misuses drugs to deal with life or escape life. Maybe they can quit easier than the person who has a brain disease that creates physical dependency and insane craving. Treatment can help both. I’ve seen many people come through treatment who I suspected were not true addicts, but they needed help learning coping skills and developing an understanding of what they really wanted in life — they decided that drugs were not needed and that they’d be much better off without alcohol or some other drug. Drugs can create problems in lots of ways, and most times the problems don’t get better unless the person receives some kind of help — the problems usually get progressively worse. This doesn’t mean that everyone who has any kind of problem with alcohol or some other drug must go into a formalized drug addiction treatment program, but they usually do need to take actions to deal with the problem, whether it’s AA, talking with a physician, getting support from a friend or family, something to change the self-defeating behavior.

Chemical Dependency: Cause and Effect

chemical dependency: cause and effect

When discussing addiction, or chemical dependency, not many people really understand the subject. Don’t feel bad, because many health professionals don’t understand chemical dependency. The most common idea I run across is that addiction is caused by underlying psychological problems. In other words, most people don’t understand chemical dependency as a primary disease. I’ll use CD to refer to chemical dependency or addiction, both terms are used – however, chemical dependency is the clinically preferred term. The term addiction has lost a lot of its meaning through popular use — I’m addicted to ice cream, I’m addicted to a person, I’m addicted to golf, and so forth.

CD refers to dependence on a chemical, a drug. Substance abuse is also used quite often when the person using the term is really referring to CD. Abuse, or misuse, of a drug is not the same as CD. A 22 year old college student might misuse alcohol to fit in or to feel comfortable in social situations, or to impress friends, but that doesn’t mean that CD exists, even if the young person gets in trouble and gets a DUI. Mostly this confusion over terms is based in lack of understanding of CD. Although lack of understanding is the main reason for confusion, there are other reasons people refuse to refer to CD as a chronic brain disease.

Way too many people resist acknowledging CD is a chronic brain disease because they believe it excuses the person from responsibility. In order to accept CD as a disease, they think they have to change their ideas about free will, choice, responsibility, accountability for actions, etc. We’ve all heard such stories as the young kid who killed someone while drinking and driving and was not imprisoned because he was brought up as a privileged kid and wasn’t taught responsibility. This type of situation mixes social, moral and legal issues with biological issues.

Determining why someone starts to drink, or if they should drink at all, does not tell us why the person develops a dependence on alcohol. A moralist might say the person should never have started drinking in the first place, that the act of drinking is a choice and the chooser is accountable for the outcome. True, true, but this doesn’t tell us why one person develops a physical dependence on alcohol while another who drinks doesn’t become dependent. The moralist might say that the person who drinks alcoholically simply didn’t control his/her drinking and thus became dependent. But what about the heavy drinker who never becomes physically dependent on alcohol? The moralist doesn’t have an answer. Science doesn’t have all the answers, but science has learned quite a lot about CD and drinking in general — the moralist can learn if he/she wants to truly understand chemical dependency. The moralist might still say that the person is responsible for his/her condition, and most everyone will agree — this is what recovery is about. Recovery from CD is about taking responsibility for this chronic brain disease and taking actions to remain abstinent. There’s common ground, but first let’s all accept the facts. We’ve learned in the addiction treatment field that blaming or shaming people for their condition, a condition they didn’t choose, is not helpful, but showing someone how to deal with the condition and how to change is helpful.

Alcoholics and Meditation

alcoholics and meditation

Peace, quiet and mindfulness

Writing about alcoholics and meditation might appear weird without context and an understanding of recovery from alcoholism. Also, having a little knowledge of Alcoholics Anonymous’s 12 Steps will help, especially Step 11:

Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

The world is much more secular in 2016 than in the 1930s when the Steps were written, but even then there was controversy over the use of “God”, prayer, “His will”, etc. The compromise was God as each individual understands, or perhaps doesn’t understand,  God/god. The “we” in the step meant the founders as each understood “God” at the time AA was started. There’s no official understanding of God or god. There are even Free Thinkers, Agnostics, Atheists AA meetings in many cities. Most AA meetings in larger cities don’t have a religious tone, but in the Bible Belt and Midwest you’ll find meetings that have a religious flavor. AA is wide enough and deep enough to accommodate the belief or lack of belief of any alcoholic. The point is the principles embedded in each Step, and for the purpose of this post, meditation is the point.

Many people think of meditation as a clearing of the mind, but the original meaning of the word had more to do with deep, serious mindfulness. In recovery from addiction, it helps to take time from each day to listen to thoughts/emotions, to consider life/purpose/spirituality/understanding more deeply. Sometimes it’s good just to clear the mind so that deeper thoughts and emotions can arise out of all the hubbub. Meditation is an individual thing — some people prefer more formalized methods, and some prefer to just let what happens happen. It’s up to the individual, but most people who try it say that it helps tremendously.

When the recovering alcoholic makes contact with a deeper part of the self, that deeper self usually doesn’t want to go toward destruction but rather toward healing and personal growth. This is an excerpt from alcoholrehab.com:

Using Mindfulness in Recovery from Addiction

When people are in the early months of recovery, they often experience a kind of mental fuzziness. They may struggle to think clearly as their mind adjusts to life without substance abuse. This is also a time when their emotions are erratic. Those who fail to cope with these challenges in early recovery are more likely to relapse. Mindfulness meditation can be a great tool at all stages of sobriety. It gives people more control over their emotions and increases mental clarity.

Mindfulness Meditation Defined

Mindfulness involves purposely paying attention to the present moment. It also involves being aware of thoughts, feelings, and emotions as they occur without being carried away by them. Mindfulness is a non-judgmental form of observation.

Apart from alcoholics and meditation, I think anyone can benefit from meditation — it’s a great break from all the noise, if nothing else.

Honesty in Addiction Recovery

Honesty in addiction recovery

Honesty

During their active addiction, before addiction recovery, addicts live in a world of pretension, half-truths, exaggerations, rationalizations, justifications, and flat out lies. These are mostly defense mechanisms to protect what the addicts thinks is holding it all together, the drug of their choice. From the outside it appears insane when an alcoholic’s dishonest about something that’s destroying him/her. When a heroin addict lies, cheats and steals to get a little more heroin, to the non-addict it seems to make no sense at all that a drug could be that important. Is the alcoholic or heroin addict having so much fun that they’ll violate all trust to get what they want? I doubt the addict is having any fun at all at this point. In the addicts’ mind they need the drug to keep going, to keep from losing their mind, to keep from suffering mentally and emotionally, to function.

In the later stages of alcoholism, withdrawal from alcohol can be fatal, and for the heroin addict withdrawal feels like dying. Addiction recovery seems impossible. Withdrawal can be so painful that it cancels out reason and judgement. The craving feels like a matter of survival, so, yes, the addict will lie to keep from getting in this condition. In early stages, though, the lies are merely a defense against the judgement of others. No one wants to see themselves, or have others see them, as someone who can’t handle alcohol or is a junkie or something like that. Out of pride most addicts in the early stages will make excuses for their excesses and periodically strange behavior. At this point the person still has some control over the drug, so they can straighten up for a while to prove they don’t have a problem.

The addict might be totally honest in business and in general, but when it comes to the addict’s drug of choice there’s growing dishonesty. In treatment and addiction recovery we stress rigorous honesty and try to break down the denial the addict has built to protect their drug of choice. It’s critical that the addict in recovery looks at the addiction with rigorous honesty. This takes a while. At first, it’s a simple decision to admit there’s a problem, then it’s a process of becoming more and more honest as treatment/recovery feels more comfortable, and as they witness others in the group become more honest. It’s not surprising when someone in early recovery still minimizes the problem — it’s not necessarily a sign that the person will relapse — it just takes time to become rigorously honest. As long as the person is still taking recovery type actions, there’s hope.