Analysis of an Aa Recovery Story: It Might Have Been Worse Sample

Social Influence: High parental expectations were placed on him, and he was instilled with the aspiration to win. He idealized his family and followed their guidance, working diligently from an early age, both after school and during holidays, as he adhered to his parents’ slogan: “Keep busy; always have something constructive to do.”

This continued into adulthood, as he remained busy and strove to move up the ladder of professional success. Through hard work, he eventually became the manager of a large bank. As his family was quite community-oriented, he also became the manager of several civic organizations.

Social Conformity: As his work led him into more and more social activities, he observed his friends drinking without harmful effects. With his sense of belonging, he desired to be similar to his friends. An important trait of his personality was that he “disliked being different.” At first, he had friends in his group membership for leisure activities, but later on, he had drinking friends for whose company he neglected his children.

Progression of Addictive Behavior: Measures and Frequency: He started by drinking occasionally while enjoying golf, cocktail hour, good news, or after hard days, concerns, or pressures. Then, drinking became a utility for other pleasures and became excessive. His social and leisure activities, such as golf, hunting, and fishing, took second place to drinking.

He eventually began drinking in the morning, “at first just two, then gradually more.” Drinking became prevalent, and drink planning became more important than any other plans. Alcohol became the priority in his life. Plagued with tension, feelings of humiliation, guilt, regret, anxiety, depression, and weakness, he was desperate with emotional anguish. “Hangovers were always with me…cold sweat suits, edgy nerves, lack of sleep.”

Out-of-Control Behavior: He became careless, sometimes returning to work when he shouldn’t have, which showed how confused he was. He worried his business associates, humiliated his children (who stopped bringing friends home), and his wife (who threatened to leave him).

Invitations to socialize with friends became fewer, and he hurt his family, work colleagues, and friends in order to drink as much as possible. Sometimes, he would wake up after blackouts, not knowing how he’d gotten back home, realizing he had driven his car. “I was living in constant fear that I would get caught while driving…Blackouts were a constant concern.”

He made many failed attempts to quit and broke promises. He attempted to hide his drinking by going to places where he would be anonymous (or believed he would be, as later on, he realized people knew about his alcohol addiction), sneaking drinks, making excuses to go out, and so on. “The next steps were bottle concealment and excuses for trips to drink without restraint.”

Recovery: Change: Rock’s underside followed a household crisis and an ultimatum issued by his girl. “It’s AA – or else!” In the AA plan, his emotions changed to trust and alleviation, and his behavior changed to ‘getting active’ by assisting, which he reckons suited him well. He started taking back his pre-drink community duties.

Spiritualty: He went for the AA plan without reservations, doing all he was told. There, his conformity served him well. He made the observation that declining the religious plan would be the effect of bias: “The fact that AA is a religious plan didn’t raise any bias in my head. I couldn’t afford the luxury of bias.”

APPLICATION OF THEORIES

Social Learning Theory

Social Influence. As in the procedure noted by A. Bandura (1977), this man learned by observing and copying his parents, paying attention to them as models. Retaining information, he was capable of copying early in life, acquiring “work of all sorts after school and during vacations.”

While working, he tried to find what would appeal to him as a life’s work, demonstrating he had the internal motivation to do those jobs. Conditioned early to work hard, he became the manager of a large bank and a director in “many important establishments having to do with civic life.”

Once his aspirations were achieved, he started observing his friends, learning through modeling, seeing them drinking without apparent bad effects. He joined in the drinking on occasion, then daily, with the combined enjoyment of company and alcohol having a positive reinforcing effect. “Positive reinforcing effects are critical for establishing self-administration behavior, which leads to the hypothesis that positive support is the key to drug dependence” (Wise, 1988).

Progression of addictive behavior: Drinking became associated with the positive reinforcing consequence of the social rewards and pleasure of playing golf with friends and sharing cocktail hour. Drinking, first conditioned by those associations, became the main component of the reward, and the social activities became excuses for drinking.

It is likely that his high position and demanding work involved stress. “If these stressful occasions of use become frequent enough, it is likely that an alcohol use disorder will develop” (Maisto, Carey, and Bradizza, 1999). He drank as a response to emotional disturbances, to stressful situations (hard day at work, concerns, etc.), and was negatively reinforced by them.

He describes the vicious cycle of withdrawals bringing fear and tension, causing him to use for immediate relief, negatively reinforcing his drinking. “While initial drug use may be motivated by the positive affective state produced by the drug, continued use leads to neuroadaptation to the presence of the drug and to another source of reinforcement, the negative reinforcement associated with alleviating negative affective effects of drug withdrawal” (Russell, 1976). More stress came with fears that blackouts caused.

Out of control behavior: He learned to hide his imbibing from negative support to avoid his friends’ and wife’s reactions. His habit-forming behaviors were likely reinforced by his wife’s empty menaces to leave.

Recovery: When he did acquire into AA recovery, he learned by observing and copying, doing everything he was told. From his first meeting with an AA member, he learned by patterning, vicarious experience, and cognitive learning.

Self-Efficacy and Social Influence: It is likely that this man’s early experiences of work and the observation of his family’s aspirations contributed to his self-efficacy in his “ambition to succeed,” resulting in great success in his work life.

Progression of habit-forming behavior: “Frequently, habit-forming behaviors are exhibited under conditions perceived as nerve-racking.” His self-efficacy level was probably lowered with his failed efforts at stopping. They could have brought on an Abstinence Violation Effect (AVE) as described in Marlatt and Gordon’s (1980, 1985).

Out-of-control behavior: “People fear and avoid endangering situations they believe exceed their coping abilities.” That man developed his concealment behavior as a result of situations he expected not to be able to cope with.

Recovery: “Situational factors affect substance use” (Maisto, Carey, and Bradizza, 1999, p. 118): the situation of a ruined birthday party and his daughter’s ultimatum caused the rock bottom and the final decision to stop drinking. Goldman, Del Boca, and Darkes (1999) argue that “expectancies have a causal (mediational or process) influence on drinking”. That man’s expectancies changed following the AA program. “It was a great relief to know I didn’t have to drink anymore.” He stopped expecting he would have to as he had before.

Self-Control Theories:

Self-Regulation and Social Conformity: Gailliot et al. (2007), cited in A.C. Moss and K.R. Dyer, gave support to that theory, showing that “our ability to exert self-denial may be linked to blood glucose levels”. That man’s energy was depleted at the end of the day, and following Sokoloff’s impression (1973), his brain most likely lacked energy at cocktail hour and socializing hour.

Progression of habit-forming behavior: Baumeister (2003) states that “self-regulation operates as a limited resource, akin to strength or energy, particularly insofar as it becomes depleted after use–leaving the depleted self later vulnerable to impulsive and under-controlled behaviors (including increased ingestion of alcohol)”.

This fits well with the description of the development of the habit-forming behavior of that man. As the manager of a large bank and several civic institutions, it can be assumed that he was in a high-pressure job.

“People in high-pressure occupations can become ‘functioning alcoholics’. So he was, at least for a sustained period of his dependence, able to regulate his behavior during the day while he worked. Then, as described in Baumeister’s theory, his energy resources became depleted at the end of the day.

After work, he became unable to continue to regulate his behavior, and his drinking developed more and more as he wasn’t able to control his consumption. The development of that man’s alcohol addiction fits in with Baumeister’s theory that “the development of addictive behavior may involve a gradual decrease in one’s ability to exert control.”

Out-of-control behavior: As self-regulation is an ability to suppress inappropriate responses and to activate appropriate responses, it does show in this man’s careless behavior at work, with family duties, and in blackouts. His behavior became out of character as he’d been so responsible up to the time addiction took over his life.

Inhibitory Dysregulation: According to that theory, chronic use of drugs or alcohol results in neurological damage in the orbito-frontal cortex and the anterior cingulate cortex. Those parts of the brain are in the reward system; they reduce the ability to suppress rewarding behaviors.

This does not account for the social influence subject in this man’s life, but it does account for the progression of his addiction, as he became less and less able to suppress the drinking behavior while he got the reward of pleasure or the reduction of his stress. That part of the brain is also affected in some other disorders of compulsive behaviors, such as OCD patients (Modell et al., 1992).

When they are affected, there is difficulty suppressing certain thoughts and inappropriate behaviors. Lubman, Yucel, and Pantelis (2004) explain that “some addicted persons are unable to control their drug use when faced with potentially adverse consequences.”

That would account for out-of-control behaviors such as going back to drinking even though his physical and mental health were deteriorating, he was threatened to lose his wife and family life, etc. However, if, as the theory posits, decision-making is impaired as impulsive responses cannot be easily controlled, the recovery phase is not accounted for unless there could be spontaneous instant healing. In this case, the man made a very good decision after having those centers impaired.

Comparing and contrasting theories

The Social Learning Theory is the one that can account for most of that man’s narrative. The subject of hard work learned from the parents by observation and imitation is consistent with it. Self-Efficacy goes with it: built in childhood with experiences of diverse occupations, the anticipation of success went along with his aspiration.

The four SLT defined by Bandura (1969) are present in that man’s narrative (cited in Psychological Theories of Drinking and Alcoholism, p. 113):

1. differential support: the stimulation status being the scene of pleasant fortunes as golf, fishing, etc.;
2. vicarious acquisition: by observation of others.Modelling is a “major beginning of acquisition of imbibing patterns”. The observation of his friends imbibing without evident injury was enough to overrule his old sentiment against imbibing.
3. cognitive procedures: anticipations of behavioral results of pleasance with friends and activities.
4. mutual determinism: “As the single alterations his behavior, the environment alterations in response which in bend affects the individual’s future behavior.” It is seen in his concealment behavior and going to stumble, etc., as a reaction to having been caught imbibing by his married woman; he would be after stumble just to be able to imbibe freely.

His bantering gag about his married woman acquiring “more narrow-minded” was likely how he perceived her when he was in active dependence. And in fact, she also likely became more tense and fearful too. This, in turn, would have caused him to react by drinking even more.

Bandura (1969) “emphasizes stress decrease as a major pharmacological action of intoxicant and, therefore, as a major agent of negative support.” However, the SLT does not wholly apply to the sudden AA recovery. Arguably there could have been some (concealed?) learning happening during the active dependence, through the negative effects, which eventually led to the decision to give up, but it doesn’t account for the sudden absence of withdrawals and the “knowing” that he wouldn’t need to drink anymore.

However, the duration of recovery is consistent with Marlatt and Gordon’s idea (1985) that “The acquisition of cognitive schemes in a self-management plan can result in changes in habit-forming behavior to new, more adaptive behavior coming under the control of cognitive procedures of consciousness and determination making.” That was this man’s case in AA. Self-Efficacy was defined by DiClemente, Prochaska, and Gibertini (1985) as “the degree to which one feels competent or capable of performing an action”.

As a cognitive process, it is likely to be a conscious process. That man’s self-efficacy might have been high regarding his work life, but as his drinking progressed, it became low regarding his ability to cope with stressful situations, so he drank on them.

“Bandura hypothesized that alcohol problems resulted at least partially from shortages in skills to manage or cope with stressful events without the use of alcohol.” Then alcohol becomes a stressor itself. The memory of the stress seems to be taken off at first, but the effects of drinking become stressful in themselves, hence the ‘reciprocal determinism’.

The stress reduction effect does not last with the effects of alcohol. It is like a mirage that grows as stresses grow with alcohol use. Expecting he was not going to be able to cope with situations (such as facing his family) resulted in maladaptive coping behaviors (such as planning trips to drink).

Self-efficacy does not account for the sudden halt in drinking as recovery happened when it was likely at its lowest point. When an individual decides to take on the AA plan or any plan of recovery, he/she can often be at their lowest level of self-efficacy.

The self-regulation theory involves processes that are not conscious like self-efficacy does. The failure to inhibit inappropriate responses can happen entirely out of the consciousness of the individual. What an individual does during blackouts is a good example of that. It means the individual won’t be able to elicit appropriate responses.

It fails to explain the sudden recovery and change the subject had when he accepted the AA plan: he had just had his rock bottom, and according to that theory, he would have run out of mental energy and been unable to elicit the appropriate response he then had. It could be argued, though, that at that point, he could have become aware of his inability to regulate himself to the point that he gave up trying and let his family and, accordingly, his AA friends make the decisions for him.

The inhibitory dysregulation theory mainly applies at the developmental stage when the brain reward pathway is gradually changed, and the addiction “turbocharges” it. It also accounts for the progression on quantity and frequency and the out-of-control behavior, in particular, the compulsive side of it, with the difficulties inhibiting thoughts of drinking and planning to drink. The obsessive and compulsive side of alcoholism is very close to OCDs in which those same centers are affected. However, as for the three other theories examined here, it fails to account for the instant stopping and the AA recovery.

Mentions:

1. Bandura, A. (1977). Cited in T. Moss and K.R. Dyer, Psychology of Addictive Behavior. 2010, Palgrave Macmillan: Basingstoke, Ch. 3, p. 64.
2. Baumeister, R.F. (2003). Ego depletion and self-regulation failure: A resource model of self-control. Alcoholism: Clinical and Experimental Research, vol. 27, no. 2, February 2003, Cleveland, Ohio.
3. DiClemente, Prochaska, and Gibertini (1985). Self-Efficacy and the phases of self-change of smoke. Cognitive Therapy and Research, 9, 181-200 (in T. Moss and K.R. Dyer, Psychology of Addictive Behavior, Ch. 3, 2010, Palgrave Macmillan: Basingstoke).
4. Einstein, A. (viewed on 12 March 2012 at: http://thinkexist.com/quotation/nothing_truly_valuable_arises_from_ambition_or/145959.html).
5. Gailliot, et al. (2007). Cited in A.C. Moss and K.R. Dyer, Psychology of Addictive Behavior, 2010, Palgrave Macmillan: Basingstoke, Ch. 4, p. 71.
6. Goldman, M.S., Del Boca, F.K., and Darkes, J. (1999). Alcohol expectancy theory: The application of cognitive neuroscience. In K.E. Leonard and H.T. Blane, Psychological Theories of Drinking and Alcoholism, Guilford Press: USA, Chapter 6, p. 218.
7. Hilgard and Bower (1975), p. 599, in K.E. Leonard and H.T. Blane, Psychological Theories of Drinking and Alcoholism, 1999, Guilford Press: USA, Chapter 4, p. 107.
8. Lubman, D.I., Yucel, M., and Pantelis, C. Addiction: A condition of compulsive behavior? Neuroimaging and neuropsychological evidence of repressive dysregulation. University of Melbourne, Victoria, 2004.
9. Maisto, S.A., Carey, K.B., and Bradizza, C.M. (1999) in K.E. Leonard and H.T. Blane, Psychological Theories of Drinking and Alcoholism, Guilford Press: USA, Chapter 4, p. 113.
10. Marlatt and Gordon’s (1980, 1985) in S. Curry, G.A. Marlatt, and J.R. Gordon. Abstinence Violation Effect: Validation of an Attributional Concept with Smoking Cessation. Journal of Consulting and Clinical Psychology, 1987, vol. 55, no. 2, 145-149, University of Washington.
11. Modell, J.G., Glaser, F.B., Cyr, L., and Mountz, J.M. (1992). Obsessive and compulsive features of hungering for alcohol in alcohol abuse and dependence. Alcoholism: Clinical and Experimental Research, 16, 272-274.
12. Russell (1976), in George F. Koob. Drug Addiction: The Yin and Yang of Hedonic Homeostasis. Neuron, vol. 16, 893–896, May 1996, Cell Press, Scripps Research Institute, Department of Neuropharmacology, La Jolla, California.
13. Wise (1998), in George F. Koob. Drug Addiction: The Yin and Yang of Hedonic Homeostasis.