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In the following excerpt, Marya Hornbacher considers her early encounters with Alcoholics Anonymous and the Twelve Steps.

I remember the first time I read the Twelve Steps at an Alcoholics Anonymous meeting. I sat down with my cup of coffee, avoiding everyone's eyes, and stared at the Steps on a poster on the wall. I made it through Step One all right-didn't make a lot of sense to me, but I got the general idea-and then I came to Step Two: Came to believe that a Power greater than ourselves could restore us to sanity.

I tripped over the word sanity, nearly laughed out loud, and then nearly cried.

"Sanity" was not something I was particularly familiar with. I have a mental illness, bipolar disorder, and that in itself had taken from me time and again the sanity I desperately wanted. Compounded by years of the insanity of alcoholism and addiction, I was, at that time, pretty well convinced that sanity was something I could never hope for. I sat there as that AA meeting was called to order, slumped in my chair, and wondered if I should just walk out. I thought there was no way I could ever have what the people around me seemed to have: laughter, companionship, stability-and sanity.

I was very wrong. The Twelve Steps have led me on a fascinating, often difficult, but eventually rewarding and powerful journey to a place of ever-increasing sanity and stability....

I remember my very first shot at getting sober. I'd been on and off my medication for some time and was drinking day in, day out. I knew I had to stop, but I just couldn't make it happen on my own. In desperation, I called Alcoholics Anonymous and was directed to the closest meeting. I sat shaking in my folding chair while all around me people were inexplicably jolly and laughing. The meeting began, but I was hardly aware of it-it had been a long time since I'd had a clear thought. Instead, I was staring at the Steps and Traditions on the wall. And my "clear" thought was this: "What on earth does that mean?" I read the Steps over and over, trying to make sense of them. The only thing I could finally sort out was this: they were talking about God, and I wanted no part of it. I left the meeting more discouraged than when I'd walked in.

I had nothing personal against God or a Higher Power. Hadn't I prayed? And prayed and prayed, for help, for sobriety, for sanity? Hadn't I prayed every day that this would be the day I'd put the bottle down, and the world would come into focus before my eyes, and I'd finally be able to manage my life and my wayward mind? Hadn't I prayed, too, that my mental illness would disappear? Hadn't I sat night after night with my drink and my foxhole prayers, trying to believe that I could drink myself sane-or at least drink myself into oblivion and out of the pain I was in?

Talk about doing things backward. Every day I did just what I needed to do to keep myself in misery: I drank. At night I tossed my meds back with a drink and wondered why on earth they weren't working. Who cared if every single doctor I'd ever seen told me not to drink on my meds? They were just saying that, I was sure. They didn't know what they were talking about. If they had my life, I thought, they'd drink too. If they had to live with a mental illness, they'd be drinking with the best of them.

That's probably the biggest fallacy about mental illness and addiction: that we use because the pain of our mental illness "makes" us use. The pain we're in (so the theory goes) "makes" us reach for the substances we abuse. We are (we've all heard it) "self-medicating."

Well, so are all the other addicts. They're in pain too. What sobriety helps us understand is that we don't really drink because we're in pain. We drink because we're addicts. And that in itself is pain enough.

I drank when my mental illness was painful, sure. And I drank when it wasn't. I drank when I was stable, unstable, happy, sad. I drank to celebrate, and I drank to wallow in my sorrows. I drank because it was Tuesday, because it was sunny, because it was raining, but most of all, I drank because I'm a drunk.

The element of truth to the idea that mental illness causes us to self-medicate is this: people who have mental illness are highly predisposed to also have the mental illness of addiction. This isn't a psychological correlation, it's a physical one. People who are born with a genetic predisposition to mental illness are also born with a good chance of becoming addicts. Nearly half of people with depression, more than half of people with bipolar disorder, and many people with schizophrenia and other mental disorders deal with substance abuse at some point in their lives. Those of us with mental illness in our family tree often also have alcoholism and other addictions inscribed on our genes. There seems to be a close genetic relationship between the mental illness of addiction and other mental illnesses.

This means that we're born with a double whammy waiting for us. And when we get hit, we get hit hard. Addicts with mental illness have lower rates of recovery than addicts without. But that doesn't mean we can't get sober. We absolutely can. As it says in the Big Book, "even people with grave emotional and mental disorders can recover if they have the capacity to be honest." We have that capacity. But like other addicts, we have to dig deep to find the honesty with ourselves that we need to find sobriety. That honesty is one of the elements of sanity that we'll recover as we move through the Steps and as we work Step Two.

So how do we define sanity? When I was in early recovery, I spent a lot of time trying to explain to my sponsor that I couldn't be restored to sanity if I'd never had it. And I believed I had not. I believed my mental illness had been the cause of all the insanity in my life. I didn't see yet how insane I'd been in my addiction. I even doubted, in some secret part of myself, if I really needed to get sober. Maybe, I thought, if I just get my mental illness under control, then I can keep drinking. Maybe if I just get on the right meds, get the right therapist and psychiatrist, do all the other things they're telling me I need to do-then can I drink?

And that is the insanity of addiction.

This is an excerpt from Sane: Mental Illness, Addiction, and the 12 Steps. For details, see sidebar.


Twelve Steps and Mental Illness

Sane: Mental Illness, Addiction, and the 12 StepsIn Sane: Mental Illness, Addiction, and the 12 Steps, Marya Hornbacher examines the Twelve Steps and sets out suggestions for how those with mental illness can work through them and apply them in their support groups and their life in recovery. Buy Now

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