I hear from counselors about patients often, and most often when the patients aren’t doing as well as the counselors think they should. One class of problematic patients are those that, haven’t “yet made a decision to remain abstinent.” I put the quotes around that phrase because that’s what I heard from a colleague about a patient of his recently. It’s also a phrase I hear from recovering people a good bit. It got me thinking. Do we really make a decision to remain abstinent? Can we make a decision to remain abstinent? I think not.

Addiction is a disease of the midbrain, an area of the brain far below the cortex, which is where we “think.” We don’t think with our midbrain, and our thinking cortex doesn’t have the power to overcome our midbrain. In fact, when our midbrain isn’t functioning well and isn’t feeding our cortex, we can’t think well. When our midbrain is functioning well, we have the chance to think well. I can understand how newly recovering people who can suddenly feel themselves think straight get the impression that their thinking has something to do with their new found sobriety. The sign on the wall at the AA meeting that says, “Think, think, think…” might have something to do with it too.

But that idea leads to a paradox. How can an illness beyond our control be controlled by our own thinking? How can we decide to be sober? If on the one hand we can decide to remain abstinent, then the question is, “Why didn’t we do that a year ago?” And if we can’t decide, the question is, “What the hell just happened that I don’t have to use any more?” To be quite honest, humans don’t like not being in control. We’d rather face the self-condemnation that follows the first question than the feeling that we’re not in control that follows the second. But recovery is about acceptance, so...tough. We'll just have to accept it.

Even with the acceptance that there’s something beyond our control though, there are too many people that have a feeling they had some part in their own recovery. In fact everyone does, and should. So if it isn’t deciding to be abstinent, just what is our role? I think it’s something that goes along with acceptance, surrender.

Surrendering is a decision, but it’s not a decision not to use. Surrender is a decision to stop running the show; it’s a decision to do what others suggest; it’s a decision to engage in a process that increase the likelihood of our staying abstinent even if that process doesn't make much sense to us at the time. That’s a decision we can make. So what, Howard? We’re back to your semantic nonsense.

Nope, we’re not. If we think we’ve made a decision to stop using, then all those things that are part of that process lose their importance, because, after all, we decided. But if we recognize that we can’t decide to not use, but can decide to do certain things that vastly decrease the chances of our using, then those things remain important. We can use our decision making powers in our best interests. So while it may seem to be just pickiness with words, it’s actually quite important for us to recognize that people don’t decide to remain abstinent, they decide to surrender to a process where they do things that bring about abstinence. The difference may seem subtle, but in the long run, it’s the difference between life and death.