Irving family’s fortunate son explains how he fell into a dark depression, and rose again

Originally published in the Globe & Mail
Written By Erin Anderssen

He was the scion of New Brunswick’s wealthiest family, a seemingly successful executive working with his father to oversee their dynasty. Below the surface, things were different. Erin Anderssen talks to Kenneth Irving about his descent into darkness, and what he lost and gained along the way

A few hours before dawn on April 17, 2010, Kenneth Irving, a favoured son in Canada’s third-wealthiest family, and the CEO of a multibillion-dollar energy empire, sat at the kitchen table in his forest-framed mansion outside Saint John. His wife and two youngest daughters were sleeping upstairs. From the windows of his house, he could see the grand sweep of the Kennebecasis River and the pine trees that he liked to plant in the mornings before heading off to Irving Oil, to take his place in the onetime office of his storied grandfather, K.C. Irving. By every standard, Kenneth knew he was a lucky man. And yet, alone in the dark, all he felt was anger and despair.

He doesn’t clearly remember raising his fist. He does remember that the pain was intoxicating. Later, he would tell one of his daughters that he took out his rage on the one person he blamed for his problems. He swung hard, over and over. He punched himself in the eyes until his sockets were a deep purple, until blood vessels had burst and his knuckles were raw.

His wife, Tasha, woke at 5 a.m. to an empty space beside her in bed, and raced downstairs. She found Kenneth, slouched over the kitchen table, his hands holding his head. He lifted his face to look at her. “Did you fall?” she asked, though she knew he hadn’t. He shook his head. She got on the phone to call for help.

That was the last night Kenneth Irving would spend in the house he had built beside the river he loved. He would never sit again behind the desk that had been handed down from K.C. to his second son, Arthur, and then to Kenneth. He has returned only twice to Saint John, the royal seat of the Irving empire, and then only to pack up his house and finalize the donation of the 50-acre estate to an environmental non-profit.

Kenneth Irving’s $2-million home in New Brunswick was donated to serve as a national centre to protect Canadian waterways. Read Paul Waldie’s 2013 story about that donation here.

Later, that life-altering day, after Tasha did her best over breakfast to distract their daughters from their father’s bruises with a well-meaning fiction about bumps in the night, after Kenneth’s psychiatrist arrived from out of town and insisted his patient be hospitalized for his own safety, Kenneth was driven to the airport. Along the way, he insisted on a detour – one last visit to his family’s refinery, just up from the harbour on the city’s east side.

As CEO, he had liked to go to its central control room sometimes, late at night, to watch the computer screens, listen to the two-way radio chatter, and discuss conversion rates and temperatures with the plant operators. He shouldn’t have gone this time – “What the hell was I thinking?” he says now – not looking the way he did. He says he wanted his doctor to understand this part of his life. Perhaps he also wanted to be with the engineers and technicians he so admired before the chance slipped away for good. He gave his doctor a quick tour, and feebly joked about an errant walk into a door, which fooled no one. Then, he left for Boston, because an Irving could not be locked up in a psychiatric hospital in New Brunswick. “That was it,” he recalls. “My last day on deck.”

Some of this story is known. It’s been the subject of newspaper columns and book chapters. But in a sturdy, tight-knit province where the Irvings keep the lights on but store their secrets safely in the shadows, most of what happened that day, and the echoes that followed it, is the stuff more of rumour than fact. With a private fortune estimated at $8-billion, the family owns New Brunswick’s three major daily newspapers, radio stations and a chain of weeklies. The Irving empire includes everything from shipyards and refineries, to pulp mills, railway lines and convenience stores – the family’s name stamped, in tall navy letters, on what seems like nearly every money-making enterprise in one of Canada’s poorest provinces.”The Irvings are a fact of life,” says Hugh (Ted) Flemming, the MLA for Rothesay, the riding next door to Saint John. “Like the Bay of Fundy, they are big and deep and they aren’t going anywhere.” A Senate report once estimated that Irving companies employ one in 12 people in New Brunswick. But you don’t have to work for the family to be tied to its fortunes – or to have an incentive not to speak too freely about the sudden, shocking disappearance of an Irving son.

Kenneth was well-respected, seen as a modernizing, innovative force within the family’s third generation, an Irving with a worldly gaze and big plans to expand and diversify the energy business. But in the wake of his leaving Saint John, there were also whispers that challenged that narrative. Whispers that Arthur Irving, reluctant to fully cede power, had been unhappy with the business direction that Kenneth was taking, and fired his son. That there had been a fight over money. That the stress of the job – and all that went with it – had caused Kenneth to suffer a mental breakdown. But those are pieces of the tale, patched together from fragments of truth to quilt a tidy narrative.

There is a much darker version of these events, one Kenneth Irving has never told before. He is offering it now, in part, as a cautionary tale about waiting too long to seek help for a mental illness. You may wonder about that: What can a man as rich as Kenneth Irving say to those who have to wait in line for care, who can’t afford a full-time psychologist, who have lost their jobs because they were too sick to keep them, and don’t have a trust fund? To his credit, he is quick to acknowledge this: He’s not, he says, looking for pity.

What he seeks is understanding. He hopes that someone will see past the shiny objects that come with being born into the one per cent of the one per cent – the boarding school education, the private jet, the sprawling estate – and find a lesson in his story.

“I was born into this incredible situation. That is what is so strange about it. That is what is so hard to accept. That you are going through this when you know you are so fortunate in every way.”

Kenneth Irving with his grandfather, K.C. Irving, at a refinery circa 1990.

Even as a little boy, the eldest son among four siblings, Kenneth understood the path before him – the responsibility and obligations of being an Irving. When he was 6, he remembers, his grandfather taught him how to shake hands, and how to use the radio in the truck to call into one of the family’s myriad businesses. “Paper mills and shipyards and oil refineries on the weekend with my grandfather,” he says. “That was my life, and I loved it.”

K.C. Irving was well known for being frugal and a teetotaler, characteristics that he impressed upon his three sons, J.K., Arthur and Jack, who would each focus on their own fiefdoms in the empire. It was a formal family, one in which emotional indifference was viewed as a strength, handshakes stood in for hugs, and deference to elders was expected. Problems, business and personal, if they were discussed at all, stayed inside the Irving fold. The family name brought privilege and respect, but also obligation and adherence.

Maritime industrialist K.C. Irving, shown in October, 1959.THE CANADIAN PRESS

At 17, Kenneth was called by his grandfather to a private meeting, where it was proposed that he take K.C.’s own middle name, Colin. He added it legally in 1983, and uses it today in his e-mail address. “It was one of the proudest days of my life,” he says, a sign of approval: that preserving the meaning of those initials now fell to him.

If K.C. was a lodestar in Kenneth’s life, the situation was less stable at home, where, by the time Kenneth was a young teenager, his parents were beginning the path to a hostile divorce. From Grade 9 to graduation, Kenneth attended Lakefield College School, a private boarding institution in Ontario. His younger brother, Arthur Jr. later joined him at the school. His older sister, Jennifer, went to boarding school in Switzerland. Emily, the youngest of the four, would move with their mom, Joan Carlisle Irving, to the West Coast when the parents made their split official in 1980. When discussing his life before he became sick, Kenneth rarely mentions his mother. She remarried in British Columbia, and the bitterness between her and his father meant he had little contact with her.

Starting in high school, Kenneth spent only short stints in Saint John. He worked most summers away, taking jobs as a labourer, such as baling hay and cleaning turkey barns. Later, he attended Bishop’s University in Quebec, studying social science, and acting in plays. On school breaks, he worked entry-level jobs for Irving Oil – his resumé includes such titles as underground petroleum-tank operator and lubricant-packaging-and-production-line worker. In his last year of university, he begged off an economics final to get a gig as a roughneck on an offshore drilling rig headed for the cold waters of the Gulf of St. Lawrence.

Kenneth Irving’s company name tag.

A few years later, he moved to Alberta, to work with Chevron, a company then partnered with Irving Oil, for a management-training program designed to give him front-line experience. He spent time as an assistant to the geologists in Calgary, and was later sent up north, to places such as Slave Lake and Aklavik, to the drilling rigs. “It wasn’t glamorous work,” he says, although his voice lifts when he talks about those experiences. “There wasn’t really a game plan for me. I had to make my own way.” But it was expected that he would soon take his place at Irving Oil headquarters – what locals call the Golden Ball.

By 1988, he had his own cubicle at Irving Oil, and was living in an apartment in the south end of Saint John. He became close with his father. They shared hotel rooms when they travelled for work – “to save a buck,” Kenneth says, laughing. In June, 1993, Arthur stood beside his son as best man when Tasha, a teacher and pianist from Vermont, walked up the aisle in a ceremony at her family’s home in Bennington.

They spent time duck hunting on Arthur’s secluded, lakeside property in Hampstead, N.B., and later worked together to design a beach house for Arthur on the Bay of Fundy. Kenneth and his family would regularly attend parties hosted by Arthur and his second wife, Sandra. Kenneth’s friends would make the invite list for the annual summer BBQs. True to Irving practice, alcohol was not served at those events – a rule Kenneth respected in his father’s presence, although he enjoys a beer with friends. According to Andrew Rouse, a Fredericton lawyer and long-time friend to Kenneth, Arthur was a generous, if reserved, host. “He is not a guy who will sit down and talk your ear off,” Mr. Rouse says.

In 2009, Kenneth named the holding company for Irving Oil after Fort Reliance, the national historic site in the Northwest Territories where he and his dad had gone canoeing. “Those are good memories,” he says, of his erstwhile relationship with his father. “I don’t want that part of my history to be rewritten.”


Kenneth Irving on his erstwhile relationship with his father, Arthur: ‘I don’t want that part of my history rewritten.’

Families are complicated enough when the members make their own way in life; they often become immeasurably so when business binds fortunes and futures. (Ken’s eldest daughter, Starling, introduced her dad to Arrested Development, the TV show about a beleaguered son trying to run a family business. It was, he says jokingly, “very inspirational.”)

When K.C. Irving died in 1992, leaving his sons to manage the dynasty that he had built from a single sawmill and a car dealership, and to navigate its complex, overlapping operating structure, controlled by a trust in Bermuda. Over the years, the brothers had assumed distinct roles in the empire – Arthur took over the energy side; J.K., forestry and shipbuilding; Jack handled real estate and construction.

The brothers had their differences, and as each of the third generation settled into its management roles within the company, the clash of business interests and personalities only sharpened. In November, 2007, in an exclusive interview with The Globe and Mail, J.K. Irving confirmed that the three brothers were working on breaking up the family conglomerate. It would mean that the cousins, particularly the two heading the biggest pieces – Kenneth, at Irving Oil; and Jim Irving, J.K.’s eldest son, who was running the forestry enterprises – could manage their interests independently. Dissolving the K.C. Irving trust, according to a court document, cost “in the region of $100-million” in legal fees alone. Ensuring that each brother received what could be deemed a fair share required a team of lawyers, hashing it out offshore.

The fate of the company as it passed to the third generation weighed heavily on Kenneth’s mind. Mike Crosby, an American executive recruited to Irving Oil by Kenneth in 1999, recalls how he often talked about the so-called founder’s trap, in which companies created by a powerful patriarch crumble by the time the grandchildren take over. Kenneth, says Mr. Crosby, “had this huge legacy business that’s got his name on it, and he didn’t want to lose it as the third guy on the watch.”


Are the secretive Irvings ready for their close-up?

The Irvings run New Brunswick like a hermit kingdom. Bruce Livesey looks at how the Energy East pipeline threatens to catapults the family onto a national stage. (for subscribers)

As CEO, Kenneth began recruiting outside managers, and shifting the culture at Irving Oil. The company replaced rusted tanks and old trucks, made improvements to its convenience stores, and embarked on a major retrofit of the refinery itself. (Canada’s largest, the refinery produced 320,000 barrels a day.) Time and money went into leadership training and employee engagement – including raising salaries to industry standards – and much-needed repairs, such as the addition of air-conditioning to the aging headquarters, which had been built by K.C. in the 1930s mainly to serve as a parking garage for his Ford dealership, and was remodelled into offices two decades later. As Mr. Crosby puts it, “It was like we were in the middle of his dad’s house, and while his dad is still living in the house, we were tearing down the walls, adding additions, repainting everything in the rooms. We were transitioning the company to the next stage.”

Between 2000 and 2008, the value of the company, using a benchmark developed by Deloitte Consulting, doubled twice over, says Mr. Crosby, who left shortly after Kenneth’s illness, is now the executive vice president of Land America’s at World Fuel Services. “That’s the story that doesn’t always get told,” he says. The achievement, Mr. Crosby recalls, was celebrated at a management meeting during the summer of 2008, in Wolfville, N.S., at Acadia University, Arthur’s alma mater, in the building that bears K.C. Irving’s name.

That same year, Kenneth officially moved into the mahogany-panelled office once occupied by his grandfather, with the wall compartment that concealed a private washroom. He says he felt invigorated by the challenge of running what was considered the sweetest piece of the dynastic pie. He had ambitions to invest in new technology and grow an energy hub on the East Coast. “I had a really special job,” he says, “and I was able to do it well.” He is described by several former employees as inclusive and socially conscious, eschewing work titles for team-building and collaboration. As CEO, he favoured “360” performance reviews, in which the boss is also confidentially critiqued by those reporting to him. “I wasn’t,” he says, “a command-and-control type of personality.”

Still, he wasn’t above a tough negotiation. Under his watch, Irving Oil swung a large – and controversial – discount on the property taxes for a new natural-gas terminal, to loud objections from the public. (In December, the provincial government passed legislation to rescind the tax break.) Kenneth was also keen to expand Irving Oil’s reach. In 2009, he opened the company’s first Toronto office. And he was interested in alternative energy: The company began exploring the possibility of extracting power from the legendary tides in the Bay of Fundy.

“Kenneth understood the energy business at a very strategic level, and he networked a lot,” says Mike Ashar, who was recruited to become Irving Oil’s chief operating officer in 2008, after a 20-year career at Suncor. (Mr. Ashar would oversee the day-to-day operations at Irving Oil, while Kenneth became CEO of Fort Reliance; when Kenneth left the company, Mr. Ashar was formally appointed as CEO by Arthur.) Although Mr. Ashar would ultimately have his own legal conflict with the Irvings – and declined to speak to The Globe and Mail about any other member of the family, or the events of 2010 – he was more than willing to discuss his opinion of Kenneth: “I joined Irving Oil,” he says, “because of him.” He found Kenneth progressive, and easy to work with, not someone to toss around his Irving name.

“He had a vision,” says Mr. Ashar. “It is very hard not to like him as a person.”

For the most part, sources say, Kenneth sheltered his new management team from any simmering family tensions. But playing out behind the scenes was another narrative, one driven by an aging patriarch, strong personalities, and competing visions. Kenneth’s sisters did not have a business role with the company; his brother, Arthur Jr, worked on brand development and managed the real estate. One former employee recalls that sometimes, during management meetings with Arthur, Kenneth and Arthur Jr., members of the executive team would be asked to leave the room. They would sit outside, on at least one occasion for three hours, while the conversation clearly turned heated behind closed doors. “Ken would always be very apologetic,” afterward, the source observed. But the cracks were beginning to widen under his feet.

Even after Arthur handed the reins to his son, say sources connected to the company at the time, he made random appearances in the office, micromanaging even relatively small decisions such as, for example, those involving office renovations. “His father never got out of the way, didn’t really let Ken run the business, and that became a crisis in the end,” one source recalls.

Three sources, speaking on background to The Globe, describe how Arthur Irving was quick to show his frustration, raising his voice in meetings to openly contradict or berate Kenneth, exhibiting little regard for who was listening. “I have never seen anything like it [in a corporate setting],” recalled one source. “He didn’t hide his disdain for the path we were on.”

Expanding Irving Oil required resources – and risk. But by 2009, oil prices had collapsed, and the economy was in recession. Running a company whose main source of profits was its massive oil refinery and its gas stations became significantly more challenging, a problem not unique to the Irvings.

In a well-publicized partnership with British Petroleum, Irving Oil had announced that it was exploring plans to invest in a second refinery outside Saint John. The deal, worth $7-billion, was cancelled in 2009 as refineries in North America and Europe cut operations. With it went thousands of anticipated construction jobs for New Brunswick. “It’s not the end of the world,” the province’s finance minister said at the time. But it was certainly a crushing disappointment for a struggling region of the country.

In May, 2008, Irving Oil had also announced a research project with a local marine-science centre to explore 11 possible sites for generating tidal power on the Bay of Fundy – an alternative energy the company was not alone in considering. In June, 2010, not long before Kenneth’s leave of absence was announced, the project was cancelled. There were also plans to build an upgraded, $30-million headquarters for Irving Oil at Saint John’s Long Wharf, a proposal that had become controversial because the port workers’ union objected to using wharf space for offices. This, too, was cancelled, in February, 2010.

Companies investigate and then abandon new projects all the time – for sound business reasons, or because of changing economic conditions, or simply because the exploratory research doesn’t support proceeding. Still, sources say that these examples became points of tension between Kenneth and Arthur, who felt – sometimes in hindsight – that his son had taken unwarranted gambles.


Meanwhile, there was indeed a fight brewing over money.

In late 2009, on the heels of the breakup of K.C. Irving’s empire, Arthur Irving was working to set up a trust of his own, one worth $1-billion, with quarterly distributions going to himself and his children, along with provisions for his grandchildren. The trust would pay dividends from the profits of Irving Oil. In subsequent years, a rumour grew across New Brunswick that, given his professional contributions to Irving Oil, Kenneth had objected to receiving a share equal to that of his siblings, who had been less involved, or not at all, with running the company.

In fact, says one source with knowledge of the events, Kenneth was increasingly concerned that the trust’s payments to family members would drain Irving Oil of revenue that it might better reinvest into its operations and future expansion . This position, the source says, put him at odds with family members.

“The stress was tremendous,” says one source, referring to the difficult months in 2009 and 2010. “He’s running this huge, complex business, and he is being attacked by his family on every single issue. Like, even though we were performing well, we should have tripled the business. Nothing was ever good enough.”

And while the tension between Arthur and Kenneth was a poorly kept secret, few people truly understood the toll it was taking on Irving Oil’s CEO, whose depression was deepening. His distress came to a head late one night in January, 2010, when Kenneth called Tasha from a hotel room in Toronto. He was worried about what he might do to himself.

“Don’t leave me alone,” he begged her. Tasha understood the meaning behind his words. She called one of his best friends, Greg Thompson, a banking entrepreneur who lives in Toronto and had known him since university. Greg headed to the hotel and sat up with Kenneth until he could fly home to be with Tasha the next day.


“Guilt is where it starts, and then it’s just total disdain for yourself. Total loathing. It is a terrible cocktail – despair, hopelessness and loathing. It just completely consumes you.”

The first time I met up with Kenneth Irving was in early November, in a meeting room at the Royal York Hotel in Toronto. He brought Alison Hall, who had been a nanny for Kenneth and Tasha’s younger daughters when she was at Toronto’s Ryerson University. She is now a TV producer with Inside Edition in New York, and it was her that Kenneth first approached to tell his story.

Ms. Hall interviewed Kenneth on camera – a personal video that was funded by him but edited independently by Ms. Hall and then shared with The Globe and Mail. (You can watch the video below.) Ms. Hall being both a family friend and a journalist, Kenneth requested she serve as the family intermediary with The Globe throughout the project, facilitating follow-up interviews and fact-checking. She did not participate in the interviews, or direct the line of questioning.

I interviewed Kenneth in person for six hours in total, including at a second meeting at the Royal York, in December, at which Tasha and Starling also spoke with me. In addition, I communicated with the family repeatedly by e-mail, filling in gaps in the story, or with Starling and Tasha sharing memories of their experiences together. I also conducted several follow-up interviews by phone with Kenneth.

Additionally, The Globe and Mail reached out multiple times over several weeks to Arthur Irving, leaving messages at his home, and making calls and sending e-mails to both communications and legal staff at Irving Oil. No response was received.

The first time I meet with Kenneth Irving, he is dressed in a plaid shirt, his eyeglasses – the arms are bright mustard green – hooked over a shirt button. It is the casual-chic uniform you’d expect of the co-founder of LUUM, a transportation tech start-up based in Seattle, an oil field away from the suit-and-tie CEO he once was.

Kenneth is a rower and he looks the part: tall, lanky and clean-cut. He is not what I was expecting. I once worked as a journalist in New Brunswick, and the Irvings were known for carefully cultivating a folksy, down-home, billionaires-on-a-budget image. Kenneth, now 55, comes across as warm, polished and a little nerdy – a man who can wax poetic about the meditative qualities of a river at sunrise, and leap into an animated conversation about city traffic. And, of course, in a direct abrogation of the Irving ethos, he is opening up his life to a stranger.

Kenneth wants this to be his story, and his alone. He sees the telling of it, this baring of his soul, as an act of independence, a way to heal, to be seen as an individual, and, he hopes, to help others. “I don’t want to antagonize anybody,” he says. “That people believe that I am sincere, that I don’t have an ulterior motive, is incredibly important.”

In our interviews, he takes his time answering questions, speaking thoughtfully about the nature of his illness, like someone who has spent many hours in therapy. But for all his apparent ease and candour, he often seems to be holding back on details, like someone reaching a dead end in a maze and pivoting in a new direction. That’s not unusual; people always tell their story as they want it be known. But it’s clear there are extra layers of complexity here: He obliquely suggests that he is navigating legal constraints, as well as personal ones.

When asked for details, he tends to fall back on metaphor. I point this out at one juncture, and he offers yet more metaphors, referring to the “tripwires and land mines” that he is trying to avoid. Asked, for instance, about the circumstances of his departure from Irving Oil, he takes a couple runs at an answer that is ultimately not entirely revealing. Finally he offers, with evident frustration, “I don’t want to play games or be evasive, but you can imagine all the ways that I am constrained.”

In that case, I ask, wouldn’t it be easier, safer, to just stay quiet? Perhaps, he says, but there has to be room for his voice to be heard, and he no longer wants to leave others to shape the Kenneth Irving narrative.

When he was 25, Kenneth says, he had his first bout of depression, although he didn’t truly understand the symptoms at the time. He was working as a roughneck on an offshore rig – doing well, he says, proving himself, making friends, living away from under the weight of the Irving name. But he was heading back to Saint John, he recalls; and as the return date approached, he was unable to sleep, and “just feeling constant dread.”

Once in Saint John, single and living alone, the dread grew stronger. “It was really rolling,” he says. “I was just getting up at night, feeling total despair, and not knowing who to talk to.” His fragile psychological state manifested as an irrational fear that he was physically sick – that he was dying, that maybe he had cancer, or even AIDS. Finally he saw a psychiatrist, who prescribed medication, which he took for a while, though it made his legs shake, his mouth dry, and working difficult. Looking back, he describes this time in his life, struggling to heal mostly on his own, as his “first real experience with loneliness.”

Over the next year, with treatment, he recovered. He left Saint John soon after, heading out to Chevron and Alberta. But always, the city – and his responsibility to his family – pulled him back. Not long after returning to Saint John again, he left a voice-mail message on Tasha’s phone, and kick-started their romance. The two had met 10 years earlier at university, through a friend. When Kenneth learned through the same friend that Tasha was living in Boston, he decided to call her.

As Tasha tells it, she heard his voice on the answering machine and “I burst into tears. I turned to my sister, who was my roommate at the time, and I said, ‘I am going to marry this man.'” After a period of long-distance courting, she joined him in New Brunswick. He surprised her with a Steinway grand piano on the night he proposed, in the living room of their first home in Saint John’s north end.

After their second daughter was born, the couple designed and built their dream home on the river. Tasha started an independent co-operative elementary school called Touchstone Academy, in Rothesay, a suburb of Saint John, which currently enrolls nearly 100 children a year. They have four daughters – Starling, now 22; Rein, 19; K. Leigh, 17; and Willow, 14.

Kenneth typically spent more nights travelling for work – meeting crude-oil suppliers in London, for example, or raising investment money in Dallas – than he did at home. To relax, he rowed, or planted trees in his backyard, or listened for hours to Tasha play her Steinway. They are a tight family: To celebrate her father’s birthday last year, Starling made a Facebook list of the lessons he had taught her. Among them: Stack the plates before the waitress clears your restaurant table. Do three slow rotations for the perfect roasted marshmallow. Marry someone who makes you laugh.

No matter what else happened, Kenneth says, his wife and daughters were his solace. “I never dreaded coming up my driveway.”


Kenneth Irving, then the CEO of Fort Reliance, addresses a meeting of New England governors and Eastern Canadian premiers in Saint John on Sept. 15, 2009.ANDREW VAUGHAN/THE CANADIAN PRESS

The first sign of trouble, he says, started toward the end of 2009: He began to notice that his speech would suddenly slow, that his mind would drift; he had trouble staying focused. He describes the early signs as akin to the twinge in your leg just before you pull a muscle. “That was the beginning of it,” he says, “and from there it just got very, very dark.”

At home, Tasha noticed that when Kenneth seemed more stressed he would sometimes come home from work and watch TV instead of talking to the family. “You could see he just had his own thoughts,” she says. “And it was harder to get him back.” He wasn’t sleeping well either. She knew there was tension at work, and that the situation with his father wasn’t easy. But she took comfort in the fact that the dark periods always lifted – some days, he would be just fine, engaged, joking, typical “Irv,” as she and his closest friends call him.

When he was away from his family, though, on the road for work, and alone at nights in hotel rooms, Kenneth himself recalls, his depression and anxiety worsened. “You just have these grooves that are such deep trenches in your mind, that if you get on one thought pattern, it is hard to get out of those ruts.”

To distract himself from such thoughts, he created rituals. He would lay out his clothes for the next morning, and unpack his toiletries in the bathroom in a certain way. He would order room service even when he wasn’t hungry. And then, as the evening wore on, and with no other choice, he would try to sleep. “Quite often that wouldn’t happen, and it just got worse and worse.”

Over time, he started thinking about killing himself, he says, a secret he carried alone, because he felt ashamed.

“I was deeply confused,” is how he puts it now. “I was coming home to someone I am deeply in love with, and yet I was finding peace in the idea of the ultimate betrayal.” He said nothing for weeks, not to Tasha or anyone, hoping it would pass. Nine years earlier, at 40, he had suffered from angina, and travelled to Boston for treatment – implicitly understanding that an Irving should not make such problems public. It was a lesson he could not now shake: Keep your weakness to yourself.

But in January of 2010 – calling Tasha from that Toronto hotel room, begging her not to leave him alone with his thoughts – he finally acknowledged that he’d already waited too long to seek the support of those who loved him.

After that night, Tasha made sure that, wherever her husband went, he was not left alone for long periods. He continued to travel – going with Tasha to the World Economic Forum in Davos, Switzerland, at the end of January; and with a colleague to the Winter Olympics in Vancouver. But Kenneth was struggling, Tasha recalls. By mid-February, she found him a psychiatrist in Boston and he started a treatment regime that involved medication and talk therapy.

At that time, Kenneth explains, he wasn’t in the office as much – the refinery was in the hands of Mike Ashar, and he was setting up Fort Reliance, the holding company. One of his goals was to create a corporate structure that would allow the management team to operate at arms-length from the family shareholders. On work trips, he would make detours to Boston for therapy appointments. He was still, he says, refusing to admit how sick he was. “I thought, ‘Okay, I will just take some pills, they will help me sleep, I went through this before, I will just power through.'”

But, as the early morning of April 17 would demonstrate with a force he did not see coming, he’d been only barely holding the black dogs at bay.


“I am always taken by those studies on lab rats, like the one on intermittent recognition and just how addictive that is, and how a rat can hit a little panel, and get a shock and get a niblet at the same time, and then hit the panel, get a shock and get a niblet, and then hit the panel, get a shock, hit the panel, get a shock, hit the panel, get a shock, and then get a niblet. And if they space it out wide enough, the rat will kill itself, in the hope that they are going to get something … I never felt like a rat, for the record. But I don’t think we should think of ourselves as beyond nature. Some of our needs are pretty basic.”

It is here in Kenneth Irving’s story that a villain would seem primed to appear. And although it’s true that Arthur Irving is an ever-looming influence in his eldest son’s life, Kenneth refuses to lay blame on his father for his depression. Even after everything that has happened since, he describes an intense love and respect for his father.

“I am the product of my dad,” he says unequivocally, in a reflective tone that suggests he has come to own the complexity of that statement. “However it turned out, however it came to be, I like where I am at, and he has to be given credit for that.”

But at the same time, he also describes their relationship as problematic: a demanding father, and a son twisted into knots, consumed with gaining his father’s favour; both men existing in a tightly contained family system thin on encouragement, and impatient with human error.

When in the office, Kenneth tells me, he often walked “on eggshells,” always “trying to please someone else.” As he went about the tall job of running Irving Oil, he spent many days trying to accomplish what felt like an impossible task: to figure out what his father wanted, working overtime “to win his approval,” only to feel, constantly, that his efforts fell short.

As he became more depressed, and more suicidal, he says, “I doubled down on my commitment to understand what my dad wanted and to meet his expectations.” That only made his depression worse, he says.

At one point he asks me, “Have you ever heard of gas-lighting?” – a pattern of behaviour of where one person convinces another to believe a false reality. “I just learned in retrospect,” he continues, “that that was a common theme with a lot of people, that gas-lighting isn’t just something they put into the movies to make it extra scary. Some people actually experience it and don’t know it.” Perhaps the person doing it, he notes, isn’t even conscious of their actions. But the result for Kenneth was that he felt “very disoriented … and when that started to happen, I thought, ‘I am going to let down a lot of people, especially my dad.'”

When pressed for specific examples, he demurs. “It can be blatantly obvious and it can be insidious. It can be ambient. People can be in the room and not even know what is going on. The only person that really knows is the one who is in [the relationship],” he says.

It didn’t help, he says, that for all its perks and as much as he loved his hometown, being an Irving in Saint John can also be emotionally isolating. The head of a company can’t chat about his problems at the water cooler or the lunch table. “Once I went to work, I was on point all the time,” he says. “If I went to a restaurant, or just driving my car down the street, I felt like I was on point.”

But the problem, he insists, was not caused by the standard pressures that come with running a huge enterprise, or the weight of his family name – two responsibilities he seized with enthusiasm. “I felt energized by the people there, and the work that I was doing,” he says. Besides, he claims, the company was still doing well despite a difficult economic climate, even as he himself was starting to feel his worst. “I am quite satisfied,” he says, “that I left the company in very good shape.” This view is echoed by sources familiar with the business side of Irving Oil.

Yet, he refuses to blame his father for all the darkness that visited him. That would be too simple, he says. Rather, he points to what he perceived had become a destructive relationship between two people, and the environment in which it existed. If any one person is to blame, he says, it is himself. If he saw himself as he believed his father did, that was his fault – for also expecting too much.

“Whatever part of my life was successful, it didn’t bring the right response … and perhaps, I have to admit, I put too much hope in that. It was meaning, literally, the world to me. And my world came crashing in when I knew, or some part of me started to learn, that I wasn’t endearing myself by being successful. I put my heart into everything because that is the way I am wired, but I also felt that I would do my dad proud.”

He had inherited the gilded cage of a wealthy scion. “I was given broad opportunity,” he observes, but was “pushed into looking at the world in a very narrow way.” That environment, he says, “when you are in it, is very hard to see. It is even hard to see things that most people consider abuse.”

One day, if you’re lucky, you wake up. As he puts it, later in our second interview, “Eventually, the rat wants to know if he is getting a shock or a niblet.”

He talks about having lived his life twice – once through the eyes of someone else; and now, after therapy, through his own eyes. Looking back, he says, “I just can’t believe I had such a distorted sense of myself and my sense of worth.”

That, he is now convinced, is the path that led to his blackening his own eyes, first, alone in the dark that April night at his kitchen table, and many times after. He was both punishing the person to blame for his misery, and savouring the pain itself. “It brought a temporary relief that was really powerful,” he says. It became its own addiction. “I totally understand why somebody would turn to drink or take drugs.”

Around the time that he was hospitalized, he says, he received a message, through an emissary understood to be acting on his father’s behalf. A source who had contact with the family at the time says that Arthur appeared not to understand the severity of his son’s condition, and that he had an old-fashioned view of mental illness, shared by many of his generation – that depression is something a person can shake off, not a medical condition requiring professional treatment.

Since that day in April when Kenneth’s life irrevocably changed, he says, he and Arthur have spoken only twice – once in person, months later, in what would be their last face-to-face conversation – and then in a one-minute phone call initiated by Kenneth a few years ago. ( “It was civil,” he says, “but I had hoped for more.”) Kenneth says he has sent letters, in an attempt to reconcile with his father, but they have gone unanswered.

He won’t share what was discussed in their last meeting, in 2010, except to say this: “When my dad left, I knew that was it. When he was walking out the door, he wasn’t going to see me again.”


“If someone is reading this story, and they’re in an unhealthy relationship, and they are feeling, ‘Maybe I am going through the same thing,’ I really want them to understand that getting out on your own and being independent is the very first step that you have to take.”

In Boston, Kenneth was admitted into a locked ward. “I was in one of those places where you go through the door, and it’s a heavy door and it closes, and before I went into my room, they took everything from me, my nail clippers and everything else sharp out of my toilet kit, and took my belt, and I remember Tasha crying and I just wanted to lie on the bed and I wanted them to shut the door.”

The hospital, Tasha says, was a difficult environment, an acute-care facility that treats patients with severe psychiatric illnesses, such as schizophrenia. With the support of Greg Thompson, who flew into Boston, Kenneth was released into Tasha’s care. For a few days they tried to stay in a hotel suite with a nurse present, while he sought help as a hospital outpatient. This wasn’t sustainable. Soon Tasha – nicknamed “the sentry” by Kenneth’s psychiatrist, for her near-constant watchfulness – was exhausted, and not sleeping herself, and Kenneth was finally admitted to a private psychiatric hospital.

During his first week there, he remembers thinking, “Okay, now they will send me home.” He had responsibilities waiting for him. “I had to return to New Brunswick, to get back at it, and I convinced myself that it was not that big of a deal.”

But his doctors and his family knew otherwise. He would remain in hospital, for nearly two months, until the end of June. There, he began an intense round of treatment, involving both medication and cognitive-behavioural therapy. “In the beginning, it was just … chair … pen … glass … bottle,” he says, pointing to those objects on the table at the Royal York. “That’s how far gone I was. You have got to get into the present. I had gone elsewhere.”

Cognitive-behavioural therapy is a psychological approach that tries to teach the patient to reframe their thoughts, to notice where their perception of events or people may have distorted their lived reality. One of its chief aims is to provide coping skills, including positive self-talk, to control negative thoughts. “It is incredibly difficult,” says Kenneth. “Rebooting your brain is serious work. It is not just flicking the switch on your computer. You have to go back and do some reprogramming, and it is not easy.”

He didn’t want his daughters to see him in the condition he was in, not least because his ongoing self-harm was evident in the bruises around his eyes – but Tasha suggested that his daughters would want to be involved in his recovery and could handle the truth. The two youngest, being cared for by a rotation of babysitters in Saint John, went down regularly to Boston; Starling and Rein, who were boarding at the Groton private school not far from Boston, also visited. Kenneth’s closet friends paid visits, too, occasionally bringing their own children, to walk the grounds with him as his condition improved.

Kenneth Irving with his wife, Tasha, left, and daughters Willow, K.Leigh, Starling and Rein.

Kenneth Irving with his wife, Tasha, left, and daughters Willow, K.Leigh, Starling and Rein.

LISSY THOMAS

But Kenneth’s father, and his extended family, did not come. His daughters, he says, did not hear from their grandfather, and have not since. On this point, Ken is less circumspect in laying the blame where he believes it belongs. “My children needed support, and that is hard for me. If there is one place where I have a different emotion, where I find it disturbing and sad, it’s how my children were treated. Because they were just little girls.”

He pauses and looks away, as if reeling in his thoughts. “But every family has their dynamics. And it plays out in different ways.”

In the meantime, the treatment began to work. He credits the professional care, on the one hand, and the kindness and acceptance of his immediate family and friends, on the other, with playing a big part in his recovery. He participated in group-therapy sessions, listening to teenagers describe their self-image in wretched terms, and thought, “How can they believe this about themselves?” In particular, he still remembers the strength of a mother whose two children had died, and who was beginning to emerge from the trauma of her grief. “If you think you are special and you don’t have something in common with these other people, then you are lost,” he tells me.

The self-harm continued even as he worked through the depression – the urge to punch himself was hard to shake, like giving up drinking or smoking, and he struggled, for weeks, to stop. “Once you cross over,” he says, “you are a runaway train.” During our first interview, when I ask him about the self-harm, he pulls out his iPad and shows me a photo. It was taken during his brief stay in the Boston hotel, before he went to the private hospital. Kenneth and Willow, his youngest, are curled up together on a cot. He is looking at the camera, expressionless; his eyes are black circles; his eyelids are swollen, like a boxer who has lost the fight.

“That was not the worst of it,” Tasha will tell me later. In private, when he was supposed to be sleeping in the hotel suite, or later in the hospital, he still hit himself. Sometimes his wife would also catch him rubbing at his bruises, as if he didn’t even realize he was doing it.

Asked to explain what was driving him to hurt himself, he says, “It is so hard to put into words. Waking up in the morning and having to, literally and figuratively, look at yourself in the mirror and be in that state, where I didn’t know what to do. I wanted to do good. I wanted things to be different, but they weren’t. And I ended up not being able to process it. I just became overwhelmed with those feelings.”

As forthcoming as he is, he struggles to talk about that time. “It is a very dark moment in my life; it doesn’t reflect how I generally felt about myself. And it’s hard to imagine that something would present itself so catastrophically. It’s just, Bam! One morning Tasha wakes up, and sees that I just went … ” He says there was no single event that drove him to it, “no particular catalyst.”

On the weekends, he attended Starling’s rowing regattas, where she was the cox for a men’s four. Her teammates would see his bruised eyes, and ask him, “Irv, are you okay?” He would make his fallback joke, Starling recalls: ‘You should see the other guy.” She waits a beat, like a seasoned comic. “‘Cause he was the other guy.” She is, just barely, holding back tears.

After one particular visit, Starling remembers that her father broke down, overcome with worry that he was embarrassing her. He wasn’t, she says. “I was happy to have him at my races, for him to see this part of my life,” she says. “That broke my heart the most – the idea that he could think he was somehow an embarrassment to me.”

At the end of June, he was released from the private hospital. He became an outpatient, travelling on the train from Portland, where they had rented a home, and getting off at Boston’s North Station, a short walk to Massachusetts General. There, in addition to the medication he was already taking, he had individual, one-hour sessions of cognitive-behavioural therapy. He would often stay for group therapy as well. By the fall, Kenneth and Tasha knew they were not returning to Saint John, and that he was not going back to Irving Oil. They chose instead to go to Toronto.

It took time to get better, he says. “It’s not like you suddenly feel, ‘Oh, well, the sun has just come out.’ It’s more like starting to understand things, coming to terms with things. In some cases, it might be giving up false hope.” He says he began to grieve the conflict and estrangement with his father as the loss that it was. But “replacing depression with mourning is not something you understand at the time as getting better, because it feels terrible.”

He declines to discuss what communications he was having with his father and the people at Irving Oil during these long months. One senior manager recalls that for weeks it was as if the boss had vanished, with no explanation offered. Kenneth also won’t discuss the manner of his departure, except to say that at some point, a decision about his future “was put to him.” (Sources say that Kenneth initially expected to go back to Irving Oil. But he was asked – and eventually agreed – not to return, the details of his departure hammered out as he continued to recover in Boston.) It was hardly the time to be signing off on a permanent decision, Kenneth himself notes. But, in hindsight, he says, it was the right path to take.

That fall, on a Thursday in early November, his official “retirement” from Irving Oil was announced in a perfunctory press release. The brief, blandly worded statement made note only of his 27-year-history with the company, as if he were any other departing CEO, and not a devoted son and the founding father’s namesake leaving the family business. A spokeswoman told The Globe and Mail at the time that the departure “was a personal decision, and one that we will not speculate on.”


Kenneth Irving with dogs Kuujjua, named after a river he and his father paddled in the Arctic, and Casis, named after the Kennebecasis River in New Brunswick.

Kenneth Irving with dogs Kuujjua, named after a river he and his father paddled in the Arctic, and Casis, named after the Kennebecasis River in New Brunswick.

STARLING IRVING

“I was brought up, like so many other people, to just think that you suck it up if you’re not feeling good, and get out there and get stuff done. And if you are taking a lot of time to go in and talk about yourself, it didn’t seem like a very productive thing to do … and clearly I don’t feel that way any more. I feel like that is one of my greatest accomplishments – that I somehow found the strength to deal with it, when I thought strength was really found in ignoring it and just sucking it up.”

There is plenty to this tale that Kenneth Irving declines to discuss. This includes the rumour reappearing periodically in newspaper pieces and in books about the Irvings: that his departure from the family business, his decamping from Saint John, his fateful rift from the father who was once his best man – that this was all, at the core, the result of a squabble over money. Kenneth will say this much, and he does so forcefully: His illness and his departure from Irving Oil were not related to a “temper tantrum,” as he puts it, over any inheritance.

But the messy, emotional relationship between father and son eventually did land in court, and that document is remarkably revealing.

After K.C. Irving’s trust was dissolved, Arthur set about creating a new trust, worth, according to the court, roughly $1-billion, the proceeds of which would be distributed among family members. (Kenneth declines to comment on the details of the trust, or the 2012 court ruling in Bermuda.)

The details of the trust are murky, and the court document provides an incomplete picture, but among the recipients were Arthur himself, the four children from his first marriage – Kenneth, Arthur Jr., Jennifer and Emily – and their offspring. (Arthur has another daughter, in her 20s, Sarah Irving, from his marriage to Sandra.)

Arthur’s trust took about a year to constitute. It was finalized in December, 2010, the judgment states, the same month that Kenneth was released as an outpatient in Boston; so, certainly a substantial portion of the negotiations occurred while Kenneth was ill. Most of its details are sealed, part of the design of the trust, agreed to by those involved. This includes how much each party received.

In response to questions about rumours suggesting he was upset about his share, Kenneth declines to go into specifics. “But I can say this,” he offers, “it is not true … For someone who is looking for an answer, it sounds like a pretty reasonable scenario, if you throw in a lot of other drama. But it’s not true.”

Most of what is known can only be surmised from the background provided in the Bermuda ruling. In January, 2011, according to the document, a month after the trust was finalized, Kenneth received a negotiated “preferential payment,” vaguely noted to be “in the millions.” Two sources suggest that this was payment akin to severance, and that Kenneth, having not expected to leave Irving Oil so precipitately, had not received compensation commensurate with a typical CEO’s, and had not signed a contract, as is standard practice, detailing the financial terms of departure from the company.

In February, Kenneth filed, through his lawyers, a request for additional information about the contents of the trust. Reading between the lines, and based on his testimony in court, the timing suggests that, now recovered and out of treatment, Kenneth had questions, in particular, about a potential conflict of interest involving the trust’s managers, as well as concerns about the management of the funds being derived from Irving Oil. But Arthur fired back with his own legal action, insisting that the contents of the trust be kept secret, arguing that Kenneth, through his lawyer’s action, had violated the conditions of the trust – and should have his preferential payment rescinded.

In the end, the judge sided with Arthur on the injunction, but declined to take away any of Kenneth’s payment as a penalty. This wasn’t about money, Justice Ian Kawaley, now Bermuda’s Chief Justice, suggested; it was about family. He noted that Kenneth became “overcome emotionally” on the stand when talking about his break from Irving Oil, his estrangement from his father, and what it had meant for his own daughters. These events, the judge wrote, appeared “to have a greater influence on his present motivations than he was willing or able to acknowledge.” The judge described the court challenge as a misguided attempt to open up communication.

In his testimony, which stretched over two days, Kenneth is quoted as saying that he felt he was being “isolated” from information, and said he was trying to do right by his siblings. The judge accepted that the civil suit was not motivated by greed, but was, rather, “to a significant extent based on legitimate feelings of hurt.” Kenneth was, the judge said, “seeking to recover a lost extended family and lost working relationship nurtured in a cherished family business which had been brought to an abrupt end.”

Although Justice Kawaley sided with Arthur on his main claim – that the contents of the trust were to be kept private – he also cast judgment, of a different sort, upon him. His anger at his son’s perceived “disobedience,” Justice Kawaley suggested, had blinded Arthur to the possibility that “scars in his relationship” with Kenneth could be healed, as well as to the “collateral damage” that their estrangement was inflicting on other family members, including his own grandchildren.

In his ruling, the judge noted that Kenneth had previously agreed to withdraw his claim, on a few conditions. He wanted a retirement party that would acknowledge his contribution; and to have a family meeting, attended by a professional facilitator, with his siblings, with whom he was not then in contact. He also wanted to attend “a family activity” with his father.

No agreement was reached on these conditions, since the case proceeded to judgment. Although several retirement parties were held, they were thrown by friends, not by Irving Oil. Kenneth has since reconnected with his siblings on his own – he says he now speaks to or sees all three regularly. But from his father, he still hears nothing.

Irving Oil is on its third CEO since Kenneth left. Mr. Ashar, who replaced him as CEO in 2010, left in 2013, and would claim in a lawsuit two years later that he was pushed out of his job early, and not fairly compensated. His statement of claim referred to “many instances of misconduct and inappropriate behaviour involving members of the Irving family that created an intolerance and poisoned work environment.” Irving Oil denied the allegations, and the case settled out of court. Mr. Ashar declines to comment on the lawsuit, or to speak about Arthur Irving.

Arthur Irving Jr., Kenneth’s younger brother, has also left the company. Sources suggest there is little contact between Arthur and any of his four oldest children. Kenneth’s half-sister, Sarah, a recent MBA graduate, is now executive vice-president and chief brand officer, and the rising heir apparent. According to the company website, she is “being mentored by her father, Arthur.”


“Where I am in life is a good place … I wouldn’t want anyone to go through a dark period in life, but there is a lot that can be learned from it. And one of the things I wouldn’t encourage anyone to do is blame somebody for anything that’s not a positive. If you are going to find peace, you have got to just accept everything as your own.”

At the Royal York, Kenneth pulls out a pair of plastic hearts from his pocket – one, silver; the other, rainbow-coloured. They were given to him by his daughters, who developed a tradition of putting a heart in their father’s pocket when he went on a trip, after “juicing it up” with kisses.

“Because today was a big day, I put two in my pocket,” he says.

As Kenneth, Tasha and I sit together in a private meeting room in the hotel’s business centre, they hold hands under the table. Tasha mostly just listens, interjecting once in a while, especially when she worries that her husband is saying too much, about to utter something that might get him in trouble. She is worried, she acknowledges, about the response that might come from his speaking so openly about the past.

The mood lightens when they tell stories of their “dates” while he was receiving treatment. One night, they ate at a favourite restaurant – it was their second night back in two weeks, and the chef came out to say how happy he was to see them again.

“The only reason he recognized me was because my face was a mess,” says Kenneth.

“You were very recognizable,” Tasha confirms. “There were funny moments. We could still laugh. 

Kenneth Irving understands that his story, that of an heir to one of Canada’s largest fortunes, is not typical. He repeatedly says that he was lucky in many ways, that it’s not his intent for people to “feel sorry for him.”

But he also wants to join the conversation about mental illness. He hopes his story reaches employers and families, and convinces them that they have to take mental health seriously. He wants his story to be instructive, to perhaps speak to someone caught in a bad situation or relationship, who might then seek help sooner than he did. He has always thought of himself as a “pretty self-aware guy,” he says, but “I had to take a two-by-four across the side of the head to wake up and realize that you are not in a place that was sustainable.”

He also hopes his story reaches employers and families, and convinces them that they have to take mental health seriously.

Kenneth Irving and his wife, Tasha.NED HORTON

Today, he says, life is good. He has a close-knit, loving family, on evidence in our meeting at the Royal York. Of Tasha, he says, “I was dealt my hand of cards. I pulled out the Joker, and, of course, that wasn’t fun. But I also married the Queen of Hearts. Not everyone is as fortunate.” He lives in Toronto, has a property in Maine, and has been back to Fredericton a few times; but his heart, he says, still pines for Saint John. The family’s former 7,000-square-foot home and 50 acres of riverside forest is now a National Water Centre, a retreat for environmentalists and artists.

In addition to non-profit work relating to the environment and the protection of personal data, he continues to focus on LUUM (the name is a play on the word loom, as in weaving people and society together), which has created a platform for businesses to improve the commutes of their employees and promote more environmental forms of transportation. Kenneth doesn’t have a formal title – he has an “allergy” to them, he tells me. Instead, he goes by “expedition leader.” In an interview, Sohier Hall, the company’s CEO, recalled the early days when Kenneth and his team would work on their laptops in a local coffeehouse, surrounded by patrons jamming on guitars and bongo drums. “I remember Ken saying, ‘How did I get here?'” Mr. Hall says.

Relations have also improved with the rest of his family. In addition to reconnecting with his siblings, Kenneth celebrated his mother’s 80th birthday and communicates with her regularly. Time, he says, has brought a new clarity to those old relationships. “When I came out of the hospital, there were certain people waiting for me,” he says. And others, he adds, emerged later. He says he has learned, for the most part, to accept family circumstances that he may not ever change.

“When my time is up, nobody is going to say, ‘Poor guy,'” he says. “I don’t want this one chapter to be the defining chapter of my life. I have a history leading to up to it, and I have, I think, a wonderful present and future. I have to be thankful for the opportunity I was given, to experience it, and learn from it, and come out the other side.”

But toward the end of the interview, as we are wrapping up, I put a final question to him. In so many ways, he has been extremely open. In others, he has been evasive, citing legal restraints. But on one point, I suggest, he is not convincing: that is, when he says he does not care what his father might think of his story.

“I can’t think about that,” he told me, the first time I asked, in our first interview.

This time, sitting holding Tasha’s hand, the answer is different. “I won’t crawl under a rock,” he says. “If he can’t love me,” he continues, his voice suddenly cracking, “maybe he will respect me.” And then, he weeps. After a moment, regaining his composure, he adds: “My mind can get there. But I don’t think my heart ever will.”

Suddenly, this feels like the story Kenneth really wants to tell. He is healed and happy. But, even after all that has happened, he is still a son who misses his father. “I would happily meet my dad, any place, anywhere, any time, to talk about anything he wants to talk about,” he says.

Arthur Irving is now 86. The time for meetings, the chance to repair what’s been broken, is running out.

Erin Anderssen is a feature writer at The Globe and Mail. Follow her on Twitter:@ErinAnderssen

What/why is there an emphasis on a higher power in AA? It is assumed that “higher” is understood to be of great value. What do you think?

Quora discussion – our answer:

There are many good answers here already, but we will chime in only to say that for many, the concept of “higher power” as they understand it in the context of AA can be one heck of a road block, and in many cases, it can be an “Exit Only” from AA.

To be clear – we support virtually *anything* that people can use to get past addiction, and depression. If a higher power does it for you? Great. If it does not? You can still recover.

We believe that the roots to most addictions run much deeper than the addiction itself. Psychotherapy can be the saving grace for so many of us.

Just know that if AA is not working for you, you still have options. And if it is working for you? Congrats! Whatever works… 🙂

17 Things Not to Say to Someone Who’s Suicidal — and What to Say Instead

By Juliet Virzi for The Mighty

When someone you know is feeling suicidal or struggling with thoughts of suicide, it can sometimes feel difficult to know what to say. Loved ones often strive to come across as caring, but sometimes things said with the best intentions can still come across as insensitive.

For loved ones who want so badly to know what the “right” thing to say to someone who is feeling suicidal, this one’s for you.

While knowing what you shouldn’t say to someone who is feeling suicidal is definitely important, we didn’t want to just leave it there without discussing what to say instead. To open this discussion, we asked members of our Mighty community to share one thing that didn’t help them when they were struggling with suicidal thoughts, and what they wished others had said instead.

Here’s what they had to say:

1. Don’t say: “Suicide is selfish.”

“Please do not tell someone who is suicidal they are selfish. It’s probably the worst feeling in the world when you are accused of being selfish.” — Mackenzie W.

“I hate when someone tells me I was selfish because I attempted suicide. When we reach that point, we aren’t being selfish — we feel hopeless, we are tired of the pain, we feel worthless [and] we just want it to stop. These feelings can’t be ‘shaken off’ or gotten over as I have been told to do… It isn’t something that just ‘passes.’” — Melissa B.

Say instead:

“Acknowledge my feelings. Tell me how much I matter to you.” — Tanya W.

I think every person is different in terms of what they need to hear in those moments. As long as you don’t say anything that puts them down anymore. Like telling them to go do it or that it’s selfish. I think any positive attempt to stop someone from taking their life is a [try] worth making. Talking someone out of suicide is not an easy task. Its hard to know what the right words to say are… To me, the most important thing [is] engaging that person in conversation when they are feeling their most vulnerable.” — Sarah C.

MIGHTY PARTNER RESOURCES

2. Don’t say: “There are other people who have it worse than you.”

“I actually hate it when someone tells me I’m not depressed [enough] to even think about suicidal thoughts or [when they say] ‘others have it worse.’ It only makes me feel more worthless that some people think I am not entitled to my feelings and thoughts just because my reasons are not as bad as the others.” — Tris N.

“Invalidating my pain makes me not able to talk about it, which makes me worse. And quite frankly, how bloody dare you draw my illness into a comparison game! You would never tell someone they couldn’t be happy because someone else was happier.” — Vicki M.

Say instead:

“The best thing anyone said to me was something along of the lines of ’Is there anything I can do?’ or ‘How can I help you?’ I don’t need judgment. I need someone willing to sit with me and be there for me. At times that looked like someone just sitting in silence with me, or listening to me scream and cry. Other times it looked like someone driving me to the ER and sitting with me until I was taken back.” — Shelby H.

“What I’d love to hear: I understand you’ve been to hell and back but you will get through this and I am going to be there with you every step of the way.” — Rebecca H.

3. Don’t say: “I get sad too sometimes.”

“Please do not say, ‘You’ll get over it, I get sad too sometimes.’ People don’t realize being suicidal is more than just a feeling. It’s the numbness that forces you to harm yourself in order to feel something.” — Bree N.

Say instead:

“Instead say, ‘I’m here for you. You’re not alone. It’s OK to feel the way you do and I’m sorry I can’t understand better. Please know I do care for and love you. If you need someone, I’m here.’” — Bree N.

 Reasons You Might Not Notice Your Friend Is Thinking About Suicide

 4. Don’t say: “Suicide is the easy way out.”

“I hate when people say someone lost by suicide has taken the ‘easy’ way out. Unfortunately, I have [attempted suicide] and it took literally everything in me to do it. It’s by no means easy at all. Also, the years of suffering are not easy at all. Its a long hard process and is by no means easy at all in any way!” — Travis C.

Say instead:

Express to them how much you care and offer your love and compassion. Stay with them. Hold their hand. Just the simple presence of someone they feel safe with could make a huge difference, and it’s even OK to not say anything at all. Just be there. If you feel that they will proceed with the act of self-harm, get them medical attention immediately.” — Sandy S.

5. Don’t say: “Oh, don’t say that.”

“Don’t tell someone not to say that thought. Sometimes expressing that thought aloud can make a massive difference in their life. By not allowing them to express themselves, you can invalidate their feelings and experiences which can have very negative consequences.” — Emily J.

Say instead:

“Instead of saying that [say:] ‘What can we do to help your feelings become more positive? I’m sorry you feel trapped, how can I help?’ [Those words] would be ideal for me.” — Karlee B.

6. Don’t say: “Are you doing this for attention?”

“You must never call them ‘insane’ or ‘irrational’ or even ‘attention-seekers.’ When a person reaches the stage of suicidal thoughts/trials,(s)he has gone through so much already and all the rationality has gone…” — Tasneem M.

Say instead:

Help them out by reminding them they are important in your life and they mean so much to you and life is far more spectacular and worth living than death.” — Tasneem M.

7. Don’t say: “Tomorrow is a new day.”

“I understand the intent here, but for many people, recovery is a very slow process and the idea of living another day is painful itself. Chances are, they could feel much worse tomorrow. For many people, suicidal ideation is fleeting, but for many others it lasts much longer.” — Lily C.

Say instead:

“Sometimes all is needed is understanding, no judgments and someone to just listen.” — Sharni B.

8. Don’t say: “You have no reason to feel like this.”

“’Your life is perfect. You have no reason to feel like this.’ To me this was the absolute worst. I’ve become great at hiding things from people so most of them don’t believe me when they find out about my struggles. They only see what I allow them to see and it hurts that they don’t understand.” — Jessica E.

“Never ever say ‘You have nothing to be sad about.’ Yes, it may be said with the best intentions, but it belittles somebody’s issues so much and makes them feel [ashamed] for feeling that way.” — Mollie O.

Say instead:

“Tell them they’re not alone and reassure them they have your support. Check up on them and don’t make them feel isolated.” — Mollie O.

9. Don’t say: “Think of how your family would feel.”

“‘Imagine the pain of your family members.’ That just totally and completely invalidates the [person’s] feelings.” — Julia F.

“’Don’t you think about your kids at all? Don’t you care about them?’ There are days when they are the only reason I am still here, but sometimes my mind becomes such a dark place that I become convinced they will be better off without me.”  — Mijenou M.

Say instead:

“Something more helpful would be to ask what they need, what can they do to help and validate their feelings by empathizing rather than saying how selfish and horrible it is.” — Julia F.

“When I am in this place, I could use a hug, not your shock and disbelief at my perceived ‘lack of caring’ or ‘selfishness.’” — Mijenou M.

10. Don’t say: “Push through it.”

“My dad always tells me to just not think about it and push through it. He says that’s how he does it, so it works. But that doesn’t work for me, it comes up on me so slow I never see the meltdown coming.” — Sierra K.

Say instead:

“The one thing I do like is being told I’m strong and I have beat it before and will again.” — Sierra K.

11. Don’t say: “I don’t want to talk about this.”

“’I don’t want to hear about it. I don’t want to talk about this.’ I don’t either. The last thing I want to say to a loved one (and I’m sure one of the reasons many don’t reach out) is that I don’t want to live. I know what people will hear: I love you, but that’s not enough. This shadow is heavier than you, it’s darker than the light you bring. But it’s not that simple. It’s never that simple. It’s not a math equation. It’s the human mind, which is infinitely complex. It always hurts to know you want to leave people who would miss you. But it can reach a point where that knowledge is purely academic. Where the weight of things, it squashes everything else…” — Lacey M.

Say instead:

If I talk, I need you to listen. You don’t want to hear it or talk about it? I don’t want to live it. That’s sort of the point…” — Lacey M.

12. Don’t say: “But your life is so good!”

“Don’t say, ‘But your life is so good!’ It might seem good to you, but there’s a reason a suicidal person is struggling. It doesn’t matter if you think our reasons are valid or ‘big’ enough. The point is that our reasons are making us suicidal, and it might be irrational, or seem silly to you, but to us — it’s huge and it hurts. Telling us we shouldn’t be suicidal despite our ‘good’ lives just adds to the guilt we already feel.” — Jessica C.

Say instead:

“Just say ‘I’m right here, I’m with you,’ and mean it with your whole being.” — Laken S.

13. Don’t say: “Don’t be silly.”

“If someone comes to you telling you they feel like no one wants them and you reply with: ‘Oh that’s silly,’ even if you didn’t mean it in a negative light we’re going to take it as such…” — Santana M.

“Don’t tell them their feelings are ‘stupid’ or they are overreacting to something.” — Kim L.

Say instead:

“Maybe instead ask them what has them feeling this way… Don’t tell us it’s silly.” — Santana M.

“Instead remind them these feelings aren’t permanent even though they can’t feel this is true. [Tell them] you will hold onto enough hope for both of you until they come out the other side of this very dark place. And just be there without complaining.” — Kim L.

14. Don’t say: “You’re not praying enough.”

“[Please don’t say:] ‘You have so many things to be thankful for. You need more faith in God. You’re not praying hard enough.’” — Rhonda M.

Say instead:

“Instead try saying, ‘I don’t understand what you are going through, but you won’t be alone. I’ll go through it with you.’” — Rhonda M.

15. Don’t say: “Have you taken your meds?”

“For me, having people list off things to do on my own that may help (listen to music, take your meds, go for a walk, put on a fun movie, call a hotline, etc.) are the least helpful. It can feel minimizing, like assuming I haven’t already tried everything or that my pain is as superficial as me just needing to watch a comedy off Netflix. It also continues the isolation.” — Katie N.

Say instead:

“[Tell them] you love them no matter what. I’ve been suicidal since I was 8. I recently went through a depressive episode where I came to closer to suicide than I have in a long time. The one thing that kept me from doing i, was the one person who checks in on me all the time. The one person in my life who shows me love the way I need to be shown. The tangible, provable love that my brain needs to understand that I am loved, not ‘Oh you are loved by so many people.’ Depressed people need active love, and lots of it!” — Matthew G.

16. Don’t say: “You need to relax.”

“‘You need to relax and breathe instead of letting the drama get to you.’ We ‘know,’ OK?” — Jennifer D.

Say instead:

“Instead [say], ‘Im glad you brought this to my attention. I will do what I can to get you the help you need.” — Christa R.

17. Don’t say: “It’s all in your head.”

“That’s the worst because people who don’t understand mental illness really do believe your suicidal ideations are manipulations for attention or that it’s simply a matter of an attitude adjustment or new outlook on life. Please educate yourselves if you know someone with mental illness.” — MaryLou W.

Say instead:

“It’s better to ask if I’m safe. To show you care and not question me for my thoughts. You can’t always control it.” — Chayene B.

“I wanted to hear: I am here for you. I’m not going anywhere. You are not alone. I will help you through this. I love you. That’s it.” — Reg D.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

Thinkstock photo via John Takai.

 

Why Alcoholics Anonymous Works

For NYMag

In a story in the April issue of The Atlantic that was posted online earlier today, journalist Gabrielle Glaser harshly criticizes Alcoholics Anonymous. AA and similar 12-step programs, she argues, simply don’t offer the benefits they claim to for those struggling with addiction, and they have become entrenched in both our culture and legal system — judges frequently refer defendants to 12-step programs as an alternative to jail time — as a result of faddishness and cultural appeal rather than sound science.

As with any story about a complicated social-science issue, there are aspects of Glaser’s argument with which one could easily quibble. For one thing, she repeatedly conflates and switches between discussing AA, a program that, whatever one thinks about it, is clearly defined and has been studied, in one form or another, for decades, and the broader world of for-profit addiction-recovery programs, which is indeed an underregulated Wild West of snake-oil salesman offering treatments that haven’t been sufficiently tested in clinical settings. Her argument also leans too heavily on the work of Lance Dodes, a former Harvard Medical School psychiatrist. He has estimated, as Glaser puts it, that “AA’s actual success rate [is] somewhere between 5 and 8 percent,” but this is a very controversial figure among addiction researchers. (I should admit here that I recently passed along this number much too credulously.)

But on Glaser’s central claim that there’s no rigorous scientific evidence that AA and other 12-step programs work, there’s no quibbling: It’s wrong.

She makes her strongest version of the argument in two places near the beginning of the piece. First, she writes that “Unlike Alcoholics Anonymous, [other methods for treating alcohol dependence] are based on modern science and have been proved, in randomized, controlled studies, to work.” In other words, “modern science” hasn’t shown AA to work. A little while later, she writes:

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

Here and throughout the piece, Glaser is simply ignoring a decade’s worth of science.

No, that’s not true,” said Dr. John Kelly, a clinical psychologist and addiction specialist at Massachusetts General Hospital and Harvard Medical School, when I ran Glaser’s argument by him. “There’s quite a bit of evidence now, actually, that’s shown that AA works.” Kelly has a front-row view of the current generation of research: Alongside Dr. Marica Ferri, the original report’s lead author, and Dr. Keith Humphreys of Stanford, he’s currently at work updating the Cochrane Collaboration guidelines (he said they expect to publish their results in August).

Kelly said that in recent years, researchers have begun ramping up rigorous research on what are known as “12-step facilitation” (TSF) programs, which are “clinical interventions designed to link people with AA.” Dr. Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group who has conducted TSF studies, explained that while these programs take on different forms, they’re generally oriented toward preparing participants for the (potentially weird-seeming, especially at first) culture and philosophy of 12-step programs like AA. By randomly assigning a group of study participants to either TSF programs or standard treatment, researchers can overcome some of the self-selection issues inherent to studying AA “in the wild” (that is, it could be that people who choose to go to AA are simply more motivated to kick their addiction).

The data from these sorts of studies, argued Kelly, Kaskutas, and other researchers with whom I spoke, suggest that it outperforms many alternatives. “They show about a 10 to 20 percent advantage over more standard treatment like cognitive behavioral therapy in terms of days abstinent, and typically also what we find is that when people are engaged in a 12-step-oriented treatment and go to AA, they have about 30 percent to 50 percent higher rates of continuous abstinence,” said Kelly.

The original Cochrane paper that Glaser cites came out before the latest round of studies did, so that research wasn’t factored into the conclusion that there’s a lack of evidence for AA’s efficacy. In a followup email, Kelly said he expects the next round of recommendations to be significantly different:

Although we cannot as yet say definitively what the final results will bring in the updated Cochrane Review, as it is still in progress, we are seeing positive results in favor of Twelve-Step Facilitation treatments that have emerged from the numerous NIH-sponsored randomized clinical trials completed since the original review published in 2006. We can confirm that TSF is an empirically-supported treatment, showing clinical efficacy, and is likely to result also in lowered health care costs relative to alternative treatments that do not link patients with these freely available recovery peer support services. Another emerging finding is that a central reason why TSF shows benefit is because it helps patients become actively involved with groups like AA and NA, which in turn, have been shown to enhance addiction recovery coping skills, confidence, and motivation, similar to professional interventions, but AA and NA are able to do this in the communities in which people live for free, and over the long-term.

In other words, the most comprehensive piece of research Glaser is using to support her argument will, once it takes into account the latest findings, likely reverse itself.

In an email and phone call, Glaser said that TSF programs are not the same thing as AA and the two can’t be compared. But this argument doesn’t quite hold up: For one thing, the Cochrane report she herself cites in her piece relied in part on a review of TSF studies, so it doesn’t make sense for TSF studies to be acceptable to her when they support her argument and unacceptable when they don’t. For another, Kelly, Katsukas, and Humphreys, while acknowledging that TSF programs and AA are not exactly the same thing, all said that the available evidence suggests that it’s the 12-step programs themselves that are likely the primary cause of the effects being observed (the National Institutes of Health, given the many studies into TSF programs it has sponsored, would appear to agree).

Glaser said that her broader issue is with the culture of AA. “The therapeutic alliance is so hugely important when people are trying to get better from anything,” she said. “And understanding who’s going to thrive under different settings is really, in my opinion, the key to effective treatment.” She explained that she had encountered many people turned off by AA’s atmosphere, but she also acknowledged, as she does in her piece, that it works for others.

It’s worth pointing out that while critics of AA paint it as a bit cultlike and out-there, what with its reliance on “higher powers” and such, to the researchers who believe in its efficacy, there’s actually very little mystery to the process. “We have been able to determine WHY these 12-step facilitation interventions work,” said Kaskutas in an email. “And we have also been able to determine WHY AA works.”

Simply put, “People who self-select to attend AA, or people who are randomized to a 12-step facilitation intervention, end up having people in their social network who are supportive of their abstinence,” she said. Reams of research show that social networks, and the norms contained therein, are powerful drivers of behavior, so to Kaskutas — who noted that she is an atheist — the focus on AA’s quirks and spiritual undertones misses the point. “When you think about a mechanism like supportive social networks, or the psychological benefit of helping others, well, they have nothing to do with faith, or God — they have to do with the reality of what goes on in AA, with people meeting others in the same boat as they are in, and with helping other people (for but two examples of these mechanisms of action),” she said. So it can be the case both that AA rests on overly judgmental moral language, takes the unlikely view that God himself (or “a higher power”) is what cures people’s alcoholism, and has various other flaws — and that it still works for a lot of people, simply by connecting them to others going through the same struggles.

Glaser is right to point out that it is foolish, if not harmful, to treat AA and 12-step programs as one-size-fits-all panaceas. They’re not. She’s also right to point out that other treatments, including promising pharmaceutical options, may not always get the attention they deserve. But untangling a problem as complex as addiction requires taking into account all the best, most recent research. Glaser didn’t do that, and as a result she and The Atlantic simply aren’t giving readers an accurate view of the current addiction-research landscape.

The Irrationality of Alcoholics Anonymous

Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective.

By GABRIELLE GLASER for The Atlantic

j.g. is a lawyer in his early 30s. He’s a fast talker and has the lean, sinewy build of a distance runner. His choice of profession seems preordained, as he speaks in fully formed paragraphs, his thoughts organized by topic sentences. He’s also a worrier—a big one—who for years used alcohol to soothe his anxiety.

J.G. started drinking at 15, when he and a friend experimented in his parents’ liquor cabinet. He favored gin and whiskey but drank whatever he thought his parents would miss the least. He discovered beer, too, and loved the earthy, bitter taste on his tongue when he took his first cold sip.

His drinking increased through college and into law school. He could, and occasionally did, pull back, going cold turkey for weeks at a time. But nothing quieted his anxious mind like booze, and when he didn’t drink, he didn’t sleep. After four or six weeks dry, he’d be back at the liquor store.

By the time he was a practicing defense attorney, J.G. (who asked to be identified only by his initials) sometimes drank almost a liter of Jameson in a day. He often started drinking after his first morning court appearance, and he says he would have loved to drink even more, had his schedule allowed it. He defended clients who had been charged with driving while intoxicated, and he bought his own Breathalyzer to avoid landing in court on drunk-driving charges himself.

In the spring of 2012, J.G. decided to seek help. He lived in Minnesota—the Land of 10,000 Rehabs, people there like to say—and he knew what to do: check himself into a facility. He spent a month at a center where the treatment consisted of little more than attending Alcoholics Anonymous meetings. He tried to dedicate himself to the program even though, as an atheist, he was put off by the faith-based approach of the 12 steps, five of which mention God. Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.

J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence. He went back to rehab once more and later sought help at an outpatient center. Each time he got sober, he’d spend months white-knuckling his days in court and his nights at home. Evening would fall and his heart would race as he thought ahead to another sleepless night. “So I’d have one drink,” he says, “and the first thing on my mind was: I feel better now, but I’m screwed. I’m going right back to where I was. I might as well drink as much as I possibly can for the next three days.”

He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like J.G., Alcoholics Anonymous says that person must be deeply flawed. The Big Book, AA’s bible, states:

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.

J.G.’s despair was only heightened by his seeming lack of options. “Every person I spoke with told me there was no other way,” he says.

For J.G., it took years of trying to “work the program,” pulling himself back onto the wagon only to fall off again, before he finally realized that Alcoholics Anonymous was not his only, or even his best, hope for recovery. But in a sense, he was lucky: many others never make that discovery at all.

The debate over the efficacy of 12-step programs has been quietly bubbling for decades among addiction specialists. But it has taken on new urgency with the passage of the Affordable Care Act, which requires all insurers and state Medicaid programs to pay for alcohol- and substance-abuse treatment, extending coverage to 32 million Americans who did not previously have it and providing a higher level of coverage for an additional 30 million.

Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over booze, make amends to those they’ve wronged, and pray.

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered. According to AA, these figures are based on members’ experiences.

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

I spent three years researching a book about women and alcohol, Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, which was published in 2013. During that time, I encountered disbelief from doctors and psychiatrists every time I mentioned that the Alcoholics Anonymous success rate appears to hover in the single digits. We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?

When my book came out, dozens of Alcoholics Anonymous members said that because I had challenged AA’s claim of a 75 percent success rate, I would hurt or even kill people by discouraging attendance at meetings. A few insisted that I must be an “alcoholic in denial.” But most of the people I heard from were desperate to tell me about their experiences in the American treatment industry. Amy Lee Coy, the author of the memoir From Death Do I Part: How I Freed Myself From Addiction, told me about her eight trips to rehab, starting at age 13. “It’s like getting the same antibiotic for a resistant infection—eight times,” she told me. “Does that make sense?”

“I honestly thought AA was the only way anyone could ever get sober, but I learned that I was wrong.”

She and countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine. “Well, no kidding.”

Alcoholics Anonymous has more than 2 million members worldwide, and the structure and support it offers have helped many people. But it is not enough for everyone. The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods. At the top of the list are brief interventions by a medical professional; motivational enhancement, a form of counseling that aims to help people see the need to change; and acamprosate, a drug that eases cravings. (An oft-cited 1996 study found 12-step facilitation—a form of individual therapy that aims to get the patient to attend AA meetings—as effective as cognitive behavioral therapy and motivational interviewing. But that study, called Project Match, was widely criticized for scientific failings, including the lack of a control group.)

As an organization, Alcoholics Anonymous has no real central authority—each AA meeting functions more or less autonomously—and it declines to take positions on issues beyond the scope of the 12 steps. (When I asked to speak with someone from the General Service Office, AA’s administrative headquarters, regarding AA’s stance on other treatment methods, I received an e-mail stating: “Alcoholics Anonymous neither endorses nor opposes other approaches, and we cooperate widely with the medical profession.” The office also declined to comment on whether AA’s efficacy has been proved.) But many in AA and the rehab industry insist the 12 steps are the only answer and frown on using the prescription drugs that have been shown to help people reduce their drinking.

People with alcohol problems also suffer from higher-than-normal rates of mental-health issues, and research has shown that treating depression and anxiety with medication can reduce drinking. But AA is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help.

AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma. “You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack,’ ” Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, told me. He threw up his hands. “Absurd.”

Part of the problem is our one-size-fits-all approach. Alcoholics Anonymous was originally intended for chronic, severe drinkers—those who may, indeed, be powerless over alcohol—but its program has since been applied much more broadly. Today, for instance, judges routinely require people to attend meetings after a DUI arrest; fully 12 percent of AA members are there by court order.

Whereas AA teaches that alcoholism is a progressive disease that follows an inevitable trajectory, data from a federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions show that nearly one-fifth of those who have had alcohol dependence go on to drink at low-risk levels with no symptoms of abuse. And a recent survey of nearly 140,000 adults by the Centers for Disease Control and Prevention found that nine out of 10 heavy drinkers are not dependent on alcohol and, with the help of a medical professional’s brief intervention, can change unhealthy habits.

We once thought about drinking problems in binary terms—you either had control or you didn’t; you were an alcoholic or you weren’t—but experts now describe a spectrum. An estimated 18 million Americans suffer from alcohol-use disorder, as the DSM-5, the latest edition of the American Psychiatric Association’s diagnostic manual, calls it. (The new term replaces the older alcohol abuse and the much more dated alcoholism, which has been out of favor with researchers for decades.) Only about 15 percent of those with alcohol-use disorder are at the severe end of the spectrum. The rest fall somewhere in the mild-to-moderate range, but they have been largely ignored by researchers and clinicians. Both groups—the hard-core abusers and the more moderate overdrinkers—need more-individualized treatment options.

“We cling to this one-size-fits-all theory even when a person has a small problem.”

 

The United States already spends about $35 billion a year on alcohol- and substance-abuse treatment, yet heavy drinking causes 88,000 deaths a year—including deaths from car accidents and diseases linked to alcohol. It also costs the country hundreds of billions of dollars in expenses related to health care, criminal justice, motor-vehicle crashes, and lost workplace productivity, according to the CDC. With the Affordable Care Act’s expansion of coverage, it’s time to ask some important questions: Which treatments should we be willing to pay for? Have they been proved effective? And for whom—only those at the extreme end of the spectrum? Or also those in the vast, long-overlooked middle?

For a glimpse of how treatment works elsewhere, I traveled to Finland, a country that shares with the United States a history of prohibition (inspired by the American temperance movement, the Finns outlawed alcohol from 1919 to 1932) and a culture of heavy drinking.

Finland’s treatment model is based in large part on the work of an American neuroscientist named John David Sinclair. I met with Sinclair in Helsinki in early July. He was battling late-stage prostate cancer, and his thick white hair was cropped short in preparation for chemotherapy. Sinclair has researched alcohol’s effects on the brain since his days as an undergraduate at the University of Cincinnati, where he experimented with rats that had been given alcohol for an extended period. Sinclair expected that after several weeks without booze, the rats would lose their desire for it. Instead, when he gave them alcohol again, they went on week-long benders, drinking far more than they ever had before—more, he says, than any rat had ever been shown to drink.

Sinclair called this the alcohol-deprivation effect, and his laboratory results, which have since been confirmed by many other studies, suggested a fundamental flaw in abstinence-based treatment: going cold turkey only intensifies cravings. This discovery helped explain why relapses are common. Sinclair published his findings in a handful of journals and in the early 1970s moved to Finland, drawn by the chance to work in what he considered the best alcohol-research lab in the world, complete with special rats that had been bred to prefer alcohol to water. He spent the next decade researching alcohol and the brain.

Sinclair came to believe that people develop drinking problems through a chemical process: each time they drink, the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol—until almost anything can trigger a thirst for booze, and drinking becomes compulsive.

Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to the specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less. He published his findings in peer-reviewed journals beginning in the 1980s.

Subsequent studies found that an opioid antagonist called naltrexone was safe and effective for humans, and Sinclair began working with clinicians in Finland. He suggested prescribing naltrexone for patients to take an hour before drinking. As their cravings subsided, they could then learn to control their consumption. Numerous clinical trials have confirmed that the method is effective, and in 2001 Sinclair published a paper in the journal Alcohol and Alcoholism reporting a 78 percent success rate in helping patients reduce their drinking to about 10 drinks a week. Some stopped drinking entirely.

I visited one of three private treatment centers, called the Contral Clinics, that Sinclair co-founded in Finland. (There’s an additional one in Spain.) In the past 18 years, more than 5,000 Finns have gone to the Contral Clinics for help with a drinking problem. Seventy-five percent of them have had success reducing their consumption to a safe level.

The Finns are famously private, so I had to go early in the morning, before any patients arrived, to meet Jukka Keski-Pukkila, the CEO. He poured coffee and showed me around the clinic, in downtown Helsinki. The most common course of treatment involves six months of cognitive behavioral therapy, a goal-oriented form of therapy, with a clinical psychologist. Treatment typically also includes a physical exam, blood work, and a prescription for naltrexone or nalmefene, a newer opioid antagonist approved in more than two dozen countries. When I asked how much all of this cost, Keski-Pukkila looked uneasy. “Well,” he told me, “it’s 2,000 euros.” That’s about $2,500—a fraction of the cost of inpatient rehab in the United States, which routinely runs in the tens of thousands of dollars for a 28-day stay.

When I told Keski-Pukkila this, his eyes grew wide. “What are they doing for that money?” he asked. I listed some of the treatments offered at top-of-the-line rehab centers: equine therapy, art therapy, mindfulness mazes in the desert. “That doesn’t sound scientific,” he said, perplexed. I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors.

As i researched this article, I wondered what it would be like to try naltrexone, which the U.S. Food and Drug Administration approved for alcohol-abuse treatment in 1994. I asked my doctor whether he would write me a prescription. Not surprisingly, he shook his head no. I don’t have a drinking problem, and he said he couldn’t offer medication for an “experiment.” So that left the Internet, which was easy enough. I ordered some naltrexone online and received a foil-wrapped package of 10 pills about a week later. The cost was $39.

The first night, I took a pill at 6:30. An hour later, I sipped a glass of wine and felt almost nothing—no calming effect, none of the warm contentment that usually signals the end of my workday and the beginning of a relaxing evening. I finished the glass and poured a second. By the end of dinner, I looked up to see that I had barely touched it. I had never found wine so uninteresting. Was this a placebo effect? Possibly. But so it went. On the third night, at a restaurant where my husband and I split a bottle of wine, the waitress came to refill his glass twice; mine, not once. That had never happened before, except when I was pregnant. At the end of 10 days, I found I no longer looked forward to a glass of wine with dinner. (Interestingly, I also found myself feeling full much quicker than normal, and I lost two pounds. In Europe, an opioid antagonist is being tested on binge eaters.)

Patients on naltrexone have to be motivated to keep taking the pill. But Sari Castrén, a psychologist at the Contral Clinic I visited in Helsinki, told me that when patients come in for treatment, they’re desperate to change the role alcohol has assumed in their lives. They’ve tried not drinking, and controlling their drinking, without success—their cravings are too strong. But with naltrexone or nalmefene, they’re able to drink less, and the benefits soon become apparent: They sleep better. They have more energy and less guilt. They feel proud. They’re able to read or watch movies or play with their children during the time they would have been drinking.

In therapy sessions, Castrén asks patients to weigh the pleasure of drinking against their enjoyment of these new activities, helping them to see the value of change. Still, the combination of naltrexone and therapy doesn’t work for everyone. Some clients opt to take Antabuse, a medication that triggers nausea, dizziness, and other uncomfortable reactions when combined with drinking. And some patients are unable to learn how to drink without losing control. In those cases (about 10 percent of patients), Castrén recommends total abstinence from alcohol, but she leaves that choice to patients. “Sobriety is their decision, based on their own discovery,” she told me.

Claudia Christian, an actress who lives in Los Angeles (she’s best known for appearing in the 1990s science-fiction TV show Babylon 5), discovered naltrexone when she came across a flier for Vivitrol, an injectable form of the drug, at a detox center in California in 2009. She had tried Alcoholics Anonymous and traditional rehab without success. She researched the medication online, got a doctor to prescribe it, and began taking a dose about an hour before she planned to drink, as Sinclair recommends. She says the effect was like flipping a switch. For the first time in many years, she was able to have a single drink and then stop. She plans to keep taking naltrexone indefinitely, and has become an advocate for Sinclair’s method: she set up a nonprofit organization for people seeking information about it and made a documentary called One Little Pill.

In the United States, doctors generally prescribe naltrexone for daily use and tell patients to avoid alcohol, instead of instructing them to take the drug anytime they plan to drink, as Sinclair would advise. There is disagreement among experts about which approach is better—Sinclair is adamant that American doctors are missing the drug’s full potential—but both seem to work: naltrexone has been found to reduce drinking in more than a dozen clinical trials, including a large-scale one funded by the National Institute on Alcohol Abuse and Alcoholism that was published in jama in 2006. The results have been largely overlooked. Less than 1 percent of people treated for alcohol problems in the United States are prescribed naltrexone or any other drug shown to help control drinking.

To understand why, you have to first understand the history.

The american approach to treatment for drinking problems has roots in the country’s long-standing love-hate relationship with booze. The first settlers arrived with a great thirst for whiskey and hard cider, and in the early days of the republic, alcohol was one of the few beverages that was reliably safe from contamination. (It was also cheaper than coffee or tea.) The historian W. J. Rorabaugh has estimated that between the 1770s and 1830s, the average American over age 15 consumed at least five gallons of pure alcohol a year—the rough equivalent of three shots of hard liquor a day.

Religious fervor, aided by the introduction of public water-filtration systems, helped galvanize the temperance movement, which culminated in 1920 with Prohibition. That experiment ended after 14 years, but the drinking culture it fostered—secrecy and frenzied bingeing—persists.

In 1934, just after Prohibition’s repeal, a failed stockbroker named Bill Wilson staggered into a Manhattan hospital. Wilson was known to drink two quarts of whiskey a day, a habit he’d attempted to kick many times. He was given the hallucinogen belladonna, an experimental treatment for addictions, and from his hospital bed he called out to God to loosen alcohol’s grip. He reported seeing a flash of light and feeling a serenity he had never before experienced. He quit booze for good. The next year, he co-founded Alcoholics Anonymous. He based its principles on the beliefs of the evangelical Oxford Group, which taught that people were sinners who, through confession and God’s help, could right their paths.

AA filled a vacuum in the medical world, which at the time had few answers for heavy drinkers. In 1956, the American Medical Association named alcoholism a disease, but doctors continued to offer little beyond the standard treatment that had been around for decades: detoxification in state psychiatric wards or private sanatoriums. As Alcoholics Anonymous grew, hospitals began creating “alcoholism wards,” where patients detoxed but were given no other medical treatment. Instead, AA members—who, as part of the 12 steps, pledge to help other alcoholics—appeared at bedsides and invited the newly sober to meetings.

A public-relations specialist and early AA member named Marty Mann worked to disseminate the group’s main tenet: that alcoholics had an illness that rendered them powerless over booze. Their drinking was a disease, in other words, not a moral failing. Paradoxically, the prescription for this medical condition was a set of spiritual steps that required accepting a higher power, taking a “fearless moral inventory,” admitting “the exact nature of our wrongs,” and asking God to remove all character defects.

Mann helped ensure that these ideas made their way to Hollywood. In 1945’s The Lost Weekend, a struggling novelist tries to loosen his writer’s block with booze, to devastating effect. In Days of Wine and Roses, released in 1962, Jack Lemmon slides into alcoholism along with his wife, played by Lee Remick. He finds help through AA, but she rejects the group and loses her family.

Mann also collaborated with a physiologist named E. M. Jellinek. Mann was eager to bolster the scientific claims behind AA, and Jellinek wanted to make a name for himself in the growing field of alcohol research. In 1946, Jellinek published the results of a survey mailed to 1,600 AA members. Only 158 were returned. Jellinek and Mann jettisoned 45 that had been improperly completed and another 15 filled out by women, whose responses were so unlike the men’s that they risked complicating the results. From this small sample—98 men—Jellinek drew sweeping conclusions about the “phases of alcoholism,” which included an unavoidable succession of binges that led to blackouts, “indefinable fears,” and hitting bottom. Though the paper was filled with caveats about its lack of scientific rigor, it became AA gospel.

Jellinek, however, later tried to distance himself from this work, and from Alcoholics Anonymous. His ideas came to be illustrated by a chart showing how alcoholics progressed from occasionally drinking for relief, to sneaking drinks, to guilt, and so on until they hit bottom (“complete defeat admitted”) and then recovered. If you could locate yourself even early in the downward trajectory on that curve, you could see where your drinking was headed. In 1952, Jellinek noted that the word alcoholic had been adopted to describe anyone who drank excessively. He warned that overuse of that word would undermine the disease concept. He later beseeched AA to stay out of the way of scientists trying to do objective research.

But AA supporters worked to make sure their approach remained central. Marty Mann joined prominent Americans including Susan Anthony, the grandniece of Susan B. Anthony; Jan Clayton, the mom from Lassie; and decorated military officers in testifying before Congress. John D. Rockefeller Jr., a lifelong teetotaler, was an early booster of the group.

In 1970, Senator Harold Hughes of Iowa, a member of AA, persuaded Congress to pass the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. It called for the establishment of the National Institute on Alcohol Abuse and Alcoholism, and dedicated funding for the study and treatment of alcoholism. The NIAAA, in turn, funded Marty Mann’s nonprofit advocacy group, the National Council on Alcoholism, to educate the public. The nonprofit became a mouthpiece for AA’s beliefs, especially the importance of abstinence, and has at times worked to quash research that challenges those beliefs.

In 1976, for instance, the Rand Corporation released a study of more than 2,000 men who had been patients at 44 different NIAAA-funded treatment centers. The report noted that 18 months after treatment, 22 percent of the men were drinking moderately. The authors concluded that it was possible for some alcohol-dependent men to return to controlled drinking. Researchers at the National Council on Alcoholism charged that the news would lead alcoholics to falsely believe they could drink safely. The NIAAA, which had funded the research, repudiated it. Rand repeated the study, this time looking over a four-year period. The results were similar.

After the Hughes Act was passed, insurers began to recognize alcoholism as a disease and pay for treatment. For-profit rehab facilities sprouted across the country, the beginnings of what would become a multibillion-dollar industry. (Hughes became a treatment entrepreneur himself, after retiring from the Senate.) If Betty Ford and Elizabeth Taylor could declare that they were alcoholics and seek help, so too could ordinary people who struggled with drinking. Today there are more than 13,000 rehab facilities in the United States, and 70 to 80 percent of them hew to the 12 steps, according to Anne M. Fletcher, the author of Inside Rehab, a 2013 book investigating the treatment industry.

The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.

Marvin D. Seppala, the chief medical officer at the Hazelden Betty Ford Foundation in Minnesota, one of the oldest inpatient rehab facilities in the country, described for me how 28 days became the norm: “In 1949, the founders found that it took about a week to get detoxed, another week to come around so [the patients] knew what they were up to, and after a couple of weeks they were doing well, and stable. That’s how it turned out to be 28 days. There’s no magic in it.”

Tom McLellan, a psychology professor at the University of Pennsylvania School of Medicine who has served as a deputy U.S. drug czar and is an adviser to the World Health Organization, says that while AA and other programs that focus on behavioral change have value, they don’t address what we now know about the biology of drinking.

Alcohol acts on many parts of the brain, making it in some ways more complex than drugs like cocaine and heroin, which target just one area of the brain. Among other effects, alcohol increases the amount of gaba (gamma-aminobutyric acid), a chemical that slows down activity in the nervous system, and decreases the flow of glutamate, which activates the nervous system. (This is why drinking can make you relax, shed inhibitions, and forget your worries.) Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure.

Over time, though, the brain of a heavy drinker adjusts to the steady flow of alcohol by producing less gaba and more glutamate, resulting in anxiety and irritability. Dopamine production also slows, and the person gets less pleasure out of everyday things. Combined, these changes gradually bring about a crucial shift: instead of drinking to feel good, the person ends up drinking to avoid feeling bad. Alcohol also damages the prefrontal cortex, which is responsible for judging risks and regulating behavior—one reason some people keep drinking even as they realize that the habit is destroying their lives. The good news is that the damage can be undone if they’re able to get their consumption under control.

Studies of twins and adopted children suggest that about half of a person’s vulnerability to alcohol-use disorder is hereditary, and that anxiety, depression, and environment—all considered “outside issues” by many in Alcoholics Anonymous and the rehab industry—also play a role. Still, science can’t yet fully explain why some heavy drinkers become physiologically dependent on alcohol and others don’t, or why some recover while others founder. We don’t know how much drinking it takes to cause major changes in the brain, or whether the brains of alcohol-dependent people are in some ways different from “normal” brains to begin with. What we do know, McLellan says, is that “the brains of the alcohol-addicted aren’t like those of the non-alcohol-dependent.”

Bill Wilson, AA’s founding father, was right when he insisted, 80 years ago, that alcohol dependence is an illness, not a moral failing. Why, then, do we so rarely treat it medically? It’s a question I’ve heard many times from researchers and clinicians. “Alcohol- and substance-use disorders are the realm of medicine,” McLellan says. “This is not the realm of priests.”

When the hazelden treatment center opened in 1949, it espoused five goals for its patients: behave responsibly, attend lectures on the 12 steps, make your bed, stay sober, and talk with other patients. Even today, Hazelden’s Web site states:

People addicted to alcohol can be secretive, self-centered, and filled with resentment. In response, Hazelden’s founders insisted that patients attend to the details of daily life, tell their stories, and listen to each other … This led to a heartening discovery, one that’s become a cornerstone of the Minnesota Model: Alcoholics and addicts can help each other.

That may be heartening, but it’s not science. As the rehab industry began expanding in the 1970s, its profit motives dovetailed nicely with AA’s view that counseling could be delivered by people who had themselves struggled with addiction, rather than by highly trained (and highly paid) doctors and mental-health professionals. No other area of medicine or counseling makes such allowances.

There is no mandatory national certification exam for addiction counselors. The 2012 Columbia University report on addiction medicine found that only six states required alcohol- and substance-abuse counselors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever—not even a GED or an introductory training course was necessary—and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery.

Fourteen states had no license requirements for addiction counselors—not even a GED or an introductory course.

Mark Willenbring, the St. Paul psychiatrist, winced when I mentioned this. “What’s wrong,” he asked me rhetorically, “with people with no qualifications or talents—other than being recovering alcoholics—being licensed as professionals with decision-making authority over whether you are imprisoned or lose your medical license?

“The history—and current state—is really, really dismal,” Willenbring said.

Perhaps even worse is the pace of research on drugs to treat alcohol-use disorder. The FDA has approved just three: Antabuse, the drug that induces nausea and dizziness when taken with alcohol; acamprosate, which has been shown to be helpful in quelling cravings; and naltrexone. (There is also Vivitrol, the injectable form of naltrexone.)

Reid K. Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque, says there has long been resistance in the United States to the idea that alcohol-use disorder can be treated with drugs. For a brief period, DuPont, which held the patent for naltrexone when the FDA approved it for alcohol-abuse treatment in 1994, paid Hester to speak about the drug at medical conferences. “The reaction was always ‘How can you be giving alcoholics drugs?’ ” he recalls.

Hester says this attitude dates to the 1950s and ’60s, when psychiatrists regularly prescribed heavy drinkers Valium and other sedatives with great potential for abuse. Many patients wound up dependent on both booze and benzodiazepines. “They’d look at me like I was promoting Valley of the Dolls 2.0,” Hester says.

There has been some progress: the Hazelden center began prescribing naltrexone and acamprosate to patients in 2003. But this makes Hazelden a pioneer among rehab centers. “Everyone has a bias,” Marvin Seppala, the chief medical officer, told me. “I honestly thought AA was the only way anyone could ever get sober, but I learned that I was wrong.”

Stephanie O’Malley, a clinical researcher in psychiatry at Yale who has studied the use of naltrexone and other drugs for alcohol-use disorder for more than two decades, says naltrexone’s limited use is “baffling.”

“There was never any campaign for this medication that said, ‘Ask your doctor,’ ” she says. “There was never any attempt to reach consumers.” Few doctors accepted that it was possible to treat alcohol-use disorder with a pill. And now that naltrexone is available in an inexpensive generic form, pharmaceutical companies have little incentive to promote it.

In one recent study, O’Malley found naltrexone to be effective in limiting consumption among college-age drinkers. The drug helped subjects keep from going over the legal threshold for intoxication, a blood alcohol content of 0.08 percent. Naltrexone is not a silver bullet, though. We don’t yet know for whom it works best. Other drugs could help fill in the gaps. O’Malley and other researchers have found, for example, that the smoking-cessation medication varenicline has shown promise in reducing drinking. So, too, have topirimate, a seizure medication, and baclofen, a muscle relaxant. “Some of these drugs should be considered in primary-care offices,” O’Malley says. “And they’re just not.”

In late august, I visited Alltyr, a clinic that Willenbring founded in St. Paul. It was here that J.G. finally found help.

After his stays in rehab, J.G. kept searching for alternatives to 12-step programs. He read about baclofen and how it might ease both anxiety and cravings for alcohol, but his doctor wouldn’t prescribe it. In his desperation, J.G. turned to a Chicago psychiatrist who wrote him a prescription for baclofen without ever meeting him in person and eventually had his license suspended. Then, in late 2013, J.G.’s wife came across Alltyr’s Web site and discovered, 20 minutes from his law office, a nationally known expert in treating alcohol- and substance-use disorders.

J.G. now sees Willenbring once every 12 weeks. During those sessions, Willenbring checks on J.G.’s sleep patterns and refills his prescription for baclofen (Willenbring was familiar with the studies on baclofen and alcohol, and agreed it was a viable treatment option), and occasionally prescribes Valium for his anxiety. J.G. doesn’t drink at all these days, though he doesn’t rule out the possibility of having a beer every now and then in the future.

I also talked with another Alltyr patient, Jean, a Minnesota floral designer in her late 50s who at the time was seeing Willenbring three or four times a month but has since cut back to once every few months. “I actually look forward to going,” she told me. At age 50, Jean (who asked to be identified by her middle name) went through a difficult move and a career change, and she began soothing her regrets with a bottle of red wine a day. When Jean confessed her habit to her doctor last year, she was referred to an addiction counselor. At the end of the first session, the counselor gave Jean a diagnosis: “You’re a drunk,” he told her, and suggested she attend AA.

The whole idea made Jean uncomfortable. How did people get better by recounting the worst moments of their lives to strangers? Still, she went. Each member’s story seemed worse than the last: One man had crashed his car into a telephone pole. Another described his abusive blackouts. One woman carried the guilt of having a child with fetal alcohol syndrome. “Everybody talked about their ‘alcoholic brain’ and how their ‘disease’ made them act,” Jean told me. She couldn’t relate. She didn’t believe her affection for pinot noir was a disease, and she bristled at the lines people read from the Big Book: “We thought we could find a softer, easier way,” they recited. “But we could not.”

Surely, Jean thought, modern medicine had to offer a more current form of help.

Then she found Willenbring. During her sessions with him, she talks about troubling memories that she believes helped ratchet up her drinking. She has occasionally had a drink; Willenbring calls this “research,” not “a relapse.” “There’s no belittling, no labels, no judgment, no book to carry around, no taking away your ‘medal,’ ” Jean says, a reference to the chips that AA members earn when they reach certain sobriety milestones.

In his treatment, Willenbring uses a mix of behavioral approaches and medication. Moderate drinking is not a possibility for every patient, and he weighs many factors when deciding whether to recommend lifelong abstinence. He is unlikely to consider moderation as a goal for patients with severe alcohol-use disorder. (According to the DSM‑5, patients in the severe range have six or more symptoms of the disorder, such as frequently drinking more than intended, increased tolerance, unsuccessful attempts to cut back, cravings, missing obligations due to drinking, and continuing to drink despite negative personal or social consequences.) Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or a lack of social support. “We can provide treatment based on the stage where patients are,” Willenbring said. It’s a radical departure from issuing the same prescription to everyone.

The difficulty of determining which patients are good candidates for moderation is an important cautionary note. But promoting abstinence as the only valid goal of treatment likely deters people with mild or moderate alcohol-use disorder from seeking help. The prospect of never taking another sip is daunting, to say the least. It comes with social costs and may even be worse for one’s health than moderate drinking: research has found that having a drink or two a day could reduce the risk of heart disease, dementia, and diabetes.

To many, though, the idea of non-abstinent recovery is anathema.

No one knows that better than Mark and Linda Sobell, who are both psychologists. In the 1970s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence. Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely. (Both groups were given a standard hospital treatment, which included group therapy, AA meetings, and medications.) The Sobells published their findings in peer-reviewed journals.

In 1980, the University of Toronto recruited the couple to conduct research at its prestigious Addiction Research Foundation. “We didn’t set out to challenge tradition,” Mark Sobell told me. “We just set out to do good research.” Not everyone saw it that way. In 1982, abstinence-only proponents attacked the Sobells in the journal Science; one of the writers, a UCLA psychologist named Irving Maltzman, later accused them of faking their results. The Science article received widespread attention, including a story in The New York Times and a segment on 60 Minutes.

Over the next several years, four panels of investigators in the United States and Canada cleared the couple of the accusations. Their studies were accurate. But the exonerations had scant impact, Mark Sobell said: “Maybe a paragraph on page 14” of the newspaper.

America spends $35 billion a year on substance-abuse treatments, yet heavy drinking causes 88,000 deaths a year.

The late G. Alan Marlatt, a respected addiction researcher at the University of Washington, commented on the controversy in a 1983 article in American Psychologist. “Despite the fact that the basic tenets of [AA’s] disease model have yet to be verified scientifically,” Marlatt wrote, “advocates of the disease model continue to insist that alcoholism is a unitary disorder, a progressive disease that can only be arrested temporarily by total abstention.”

What’s stunning, 32 years later, is how little has changed.

The Sobells returned to the United States in the mid-1990s to teach and conduct research at Nova Southeastern University, in Fort Lauderdale, Florida. They also run a clinic. Like Willenbring in Minnesota, they are among a small number of researchers and clinicians, mostly in large cities, who help some patients learn to drink in moderation.

“We cling to this one-size-fits-all theory even when a person has a small problem,” Mark Sobell told me. “The idea is ‘Well, this may be the person you are now, but this is where this is going, and there’s only one way to fix it.’ ” Sobell paused. “But we have 50 years of research saying that, chances are, that’s not the way it’s going. We can change the course.”

During my visit to finland, I interviewed P., a former Contral Clinic patient who asked me to use only his last initial in order to protect his privacy. He told me that for years he had drunk to excess, sometimes having as many as 20 drinks at a time. A 38-year-old doctor and university researcher, he describes himself as mild-mannered while sober. When drunk, though, “it was as if some primitive human took over.”

His wife found a Contral Clinic online, and P. agreed to go. From his first dose of naltrexone, he felt different—in control of his consumption for the first time. P. plans to use naltrexone for the rest of his life. He drinks two, maybe three, times a month. By American standards, these episodes count as binges, since he sometimes downs more than five drinks in one sitting. But that’s a steep decline from the 80 drinks a month he consumed before he began the treatment—and in Finnish eyes, it’s a success.

Sari Castrén, the psychologist I met at Contral, says such trajectories are the rule among her patients. “Helping them find this path is so rewarding,” she says. “This is a softer way to look at addiction. It doesn’t have to be so black and white.”

J.G. agrees. He feels much more confident and stable, he says, than he did when he was drinking. He has successfully drunk in moderation on occasion, without any loss of control or desire to consume more the next day. But for the time being, he’s content not drinking. “It feels like a big risk,” he says. And he has more at stake now—his daughter was born in June 2013, about six months before he found Willenbring.

Could the Affordable Care Act’s expansion of coverage prompt us to rethink how we treat alcohol-use disorder? That remains to be seen. The Department of Health and Human Services, the primary administrator of the act, is currently evaluating treatments. But the legislation does not specify a process for deciding which methods should be approved, so states and insurance companies are setting their own rules. How they’ll make those decisions is a matter of ongoing discussion.

Still, many leaders in the field are hopeful—including Tom McLellan, the University of Pennsylvania psychologist. His optimism is particularly poignant: in 2008, he lost a son to a drug overdose. “If I didn’t know what to do for my kid, when I know this stuff and am surrounded by experts, how the hell is a schoolteacher or a construction worker going to know?” he asks. Americans need to demand better, McLellan says, just as they did with breast cancer, HIV, and mental illness. “This is going to be a mandated benefit, and insurance companies are going to want to pay for things that work,” he says. “Change is within reach.”

 

Happy Thoughts: Here Are the Things Proven To Make You Happier

By Eric Barker for Time

What’s the secret to a head full of happy thoughts?

Time to round up the research on living a happy life to see what we can use.

First, yeah, a good chunk of happiness is controlled by your genes but there’s a lot you can do to make yourself happier. Many of these techniques have been repeatedly tested and even worked with the clinically depressed.

Gratitude, Gratitude, Gratitude

I can’t emphasize this one enough. Showing gratitude for the good things you have is the most powerful happiness boosting activity there is.

Entitled People Are Often Disappointed

Entitled people are more likely to be disappointed by life, study finds. http://ti.me/2cWQhbP

Posted by TIME on Friday, September 23, 2016

It will make you happier.

It will improve your relationships.

It can make you a better person.

It can make life better for everyone around you.

Bronze medalists are happier than silver medalists. Why? They feel grateful to get a medal at all.

Every night before you go to bed write three good things that happened to you that day. Jotting those down is pretty much all it takes to get a boost in well-being over time.

There’s a second lesson here: the reverse is also true. Keeping track of the bad things will make you miserable. A convenient memory is a powerful thing. Do not train your brain to see the negative, teach it to see the positive.

Wanna make yourself and someone else extremely happy? Try a gratitude visit. Write someone a letter thanking them and telling them how much what they have done for you means. Visit them and read it in person. It’s a proven happiness WMD. More info here.

Do what you are good at as often as you can

Signature strengths” are the things you are uniquely good at and using them increases happy thoughts. Exercising signature strengths is why starving artists are happier with their jobs.

Think about the best possible version of yourself and move toward that. Signature strengths are the secret to experiencing more “flow” at work and in life.

Spend as much time as possible with people you like

Spend as much time as possible with people you like. The happiest people are social with strong relationships. Not spending more time with people we love is something we regret the most.

Being able to spend more time with friends provides an increase in happiness worth up to an additional $133,000 a year. (Values for your other relationships are here.)

Being compassionate makes us happier (causal, not correlative.) Share the best events of your day with loved ones and ask them to do the same. And compliment them — we love compliments more than money or sex.

But I’m an introvert, you say? A little bit of extraversion here would do you good. Happiness is more contagious than unhappiness so with amount of exposure to others well-being scales.

Money is good. Many other things are better.

After about 75K a year, money has minimal effects on happiness. Read that again. Not that money won’t increase happiness but if you want to be happier your time and energy are better spent elsewhere. It will not increase your moment to moment mood.

The Amish are as satisfied as billionaires and slumdwellers can be surprisingly happy. The happiest of all income groups is people making 50-75k a year. Money is good but wanting money can be bad.

Give

Giving makes us happier than receiving. In fact, it can create a feedback loop of happiness in your life. Volunteering makes us happier and can therefore be the most selfless way to be selfish.

Helping others reach their goals brings joy. Doing nice things for others today can literally make you happier for the rest of the week.

Savor

Take time to really enjoy the good things. What are the best ways to savor?

  • Positive mental time travel : Happy memories or looking forward to something
  • Being present : Not letting your mind wander and being absorbed in the moment.

Savoring is one of the secrets of the happiest people. Focusing on the limited time you have in this life is a good way to remind you to savor what is important.

Strive

You don’t usually do what brings you joy, you do what is easy. Set ambitious goals and strive. Thinking about what happens to you in terms of your self-esteem will crush you — look at life as growing and learning.

Sitting on the couch watching TV does not make you happy. You are happier when you are busy and are probably have more fun at work than at home. Thinking and working can beat sad feelings. A wandering mind is not a happy mind. Mastering skills is stressful in the short term and happiness-boosting in the long term.

Be optimistic, even to the border of delusion

Optimism is key. Yes, pessimism softens the blow of bad news but it isn’t worth it.

Does this make you out of touch with reality? Maybe but being a little deluded is good:

Love means being slightly deluded. Happy people believe their partner is a little more awesome than they really are. Someone you think is great who also thinks you’re great — it’s one of the primary things you should look for in a marriage partner.

Thinking happy thoughts, giving hugs and smiling sound like unscientific hippie silliness but they all work.

Fundamentals are fundamental

Cranky? Before you blame the world, eat something. Take a nap — it can purge negative emotions and increase happy thoughts. Sleep is vital because your mood in the morning affects your mood all day.

Get your sleep. You cannot get away with cheating yourself on sleep and being tired makes it harder to be happy.

Frequency beats intensity

Lots of little good things is the path to happiness. You want frequent boosts not rare big stuff. (And this explains the best method of how to split a dinner bill with friends.) For the most part, don’t bother to try and reduce the bad so much as you increase the good.

Stop thinking about big events that might make you thrilled — it’s the little things of everyday life that make lasting improvements to our happiness. You’re not going to win the lottery and it wouldn’t have the impact you think it would.

Avoid life’s most common regrets

We know what people most often regret before they die:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

2. I wish I didn’t work so hard.

3. I wish I’d had the courage to express my feelings.

4. I wish I had stayed in touch with my friends.

5. I wish that I had let myself be happier.

There are things you can do every day to improve your life.

More happy thoughts in your head now? If you enjoyed this post, share it with friends. We all deserve to be living a happy life.

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This piece originally appeared on Barking Up the Wrong Tree.

Dear Alky: My Friend Says I’m Not Sober (Humor!)

By Alky for TheFix

I know what you’re thinking—pot never shepherded you down the path of making out with the cashier at 7-Eleven, so what’s the big deal?

A woman sitting behind a desk

How can I help you?

Q: I haven’t had a drink in four months but I still smoke pot sometimes (I have RA). My friend says this means I am not “sober” but since I am not waking up in weird dudes’ beds anymore, I kinda wanna to tell her to f**k off. Curious what you think.

A: While I am inclined to advocate for telling anyone to f**k off, in my experience it’s not usually a good idea. I will say that, according to Merriam-Webster Dictionary, “sober” is defined as not being drunk or addicted to an intoxicating drink and puts no parameters whatsoever on smoking weed. Therefore, technically speaking, you could tell your friend to go f**k herself and feel pretty self-righteous about it. But what your friend is likely proselytizing is her personal definition of “sober,” shared by many people in the recovery community. Those in active recovery (working some kind of program beyond abstinence) generally feel that using any kind of drugs (at least the kind that typically causes muchos problemas) means a person is not sober.

I know what you’re thinking—pot never shepherded you down the path of making out with the cashier at 7-Eleven, so what’s the big deal? That’s a fair question, especially if you are smoking/eating/Jolly-Ranchering the kind of cannabis that relieves pain but doesn’t get you high. Here are my thoughts: if drinking made your life unmanageable (i.e. waking up in bed with the cab driver), then it’s a good thing you stopped. Four months without a drink is nothing to shake a stick at but it’s also not long enough to really weigh in about whether just removing booze from the equation will solve your life’s problems. If you are truly using medical marijuana to deal with a real medical issue, and not just mounting a 4-foot bong every Friday night and high-dialing Little Caesars, then you are probably going to be just fine.

Q: I have been clean and sober for over five years now, but I live in the Denver area and pretty much have to walk into clouds of pot smoke half a dozen times a day. I thought I would get used to it but I’m actually getting more and more pissed off, to the point where I am worried I am going to clock someone or relapse. Any ideas on how to deal with this growing (pun intended) issue?

Bro, I feel you. My favorite 12-step meeting is in the back of this coffee shop and one day, a bunch of little a-holes just started hanging out in front, drinking café au laits and blazing up. There is nothing that will rub a clean/sober person the wrong way more than being forcefully shotgunned on their way to hand out day-count chips and hugs. But here’s the deal—other than your other friends in recovery and maybe your mom, no one else gives a rat’s ass that you are clean. Whether we realize it or not, many of us carry a proverbial chip on our shoulder about what we had to go through to get and stay sober and how much better people we are now in comparison. While all of these notions are 100% valid, you’ll have to forgive the rest of the planet for not stopping what they are doing to pat us on the back for finally becoming functioning and respectable human beings.

Now that we have the tough love part out of the way, I urge you to try and see your situation in a different way. Rather than feeling like a victim of all these stoners who get to frolic through the streets of Denver with a one-hitter and a dream, remember that getting clean was a choice you made and one you most likely made for a damn good reason. Try and put yourself in their Chacos and be grateful that you don’t have to waste anymore of your life thinking Doug Benson is funny.

In Defense of 12-Step Programs

By Helaina Hovitz for TheFix

Relying less on others, dramatically cutting back on meetings and calls to my sponsor, and actually trusting my own thinking and decisions is a sign that the program really does work.

A group of people in a circle holding hands

It feels like our world is increasingly being pushed to take a position on one side or another, pigeon-holing us into a realm of black and white thinking that, in recovery, only causes us even more pain.

“The gray” is actually a great place to live, and it’s quite relaxing if you can manage to make yourself at home; but it’s a bitch to try and settle into.

While taking on the important work of researching new approaches to treatment for alcohol and drug addiction, some reporters and scientists have, in the process, attempted to strengthen their own argument by tossing 12-step programs like AA under the bus, referring to them as dated and irrational.

I got sober in AA when I was 22 and haven’t had a drink or puffed a joint since (or lit up a cigarette, if you can believe it). That’s five and a half years so far. I was a social binge drinker, a frequent “toker,” and a high functioning reporter/college student/publishing intern. I had never been to rehab, but I did try to stop on my own until I realized that wasn’t my only option. To this day I think the only reason I ultimately even thought of AA was because I read it in Caroline Knapp’s Drinking: A Love Story six months before I hit my “high bottom” and remembered underlining it in my copy.

Some people might disagree with me when I say that relying less on others, dramatically cutting back on meetings and calls to my sponsor, and actually trusting my own thinking and decisions is a sign that the program really does work. Whether or not you agree with me is none of my business.

What I can tell you is that I think one of the reasons I was so prepared to tackle the steps was because I had a few years of Cognitive Behavioral Therapy and Dialectical Behavioral Therapy (for a Post Traumatic Stress Disorder diagnosis) under my belt, and the steps felt like the next grade level up. More learning, practicing, and finally, consistently doing things differently after a real effort to learn new ways of thinking, doing, behaving, and perceiving, literally changing the way our minds work.

Also, times are changing. We can speak to other sober people through Skype or Facebook or texts whenever we need to. We can dial into phone meetings or attend virtual ones. We live in a world where social support is available in many different forms, not just meeting rooms. What we need changes as we grow, which is why nobody stays in Kindergarten forever.

As a journalist, I have stayed on top of and researched new forms of methodology and alternative forms of treatment. Maybe I’m biased, but I think the 12-step model still holds up, despite articles featuring interviews with people who will say that the “program doesn’t work.” Newsflash: a program isn’t a thing that works or doesn’t. It’s there for you to work. There is psychology in those 12 steps, and the model has been replicated in tons of recovery programs that we call “alternative.” Where people start to get persnickety is around God, the concept of powerlessness, and having faith.

First of all, “faith” simply means you’re willing to trust something greater than yourself, willing to consider other points of view and willing to come to terms with the fact that the world doesn’t revolve around you. Anyone who pushes a specific idea of God on you is marching to their own tune, and one that is a real ear-sore to listen to at that.

Second of all, regarding the notion of God, one of the first things they tell you, especially when you’re a newcomer and believe God has left the building, is that you can be an atheist for all they care—you just have to believe in something that’s not you. You, who kind of made a mess of things. When I came in, I said, “My higher power is just the concept that everything happens for a reason.”

I also don’t believe that something is “dated” just because it’s been around for 80 years. I remember reading Living Sober and thinking, “Holy crap, how do they know? They’re in my head!” If anything, I was amazed that it was so spot-on. So make fun of all of the Big Book references to John Barleycorn and get pissed at the references to gender roles of women at the time, but outside of that, if you want data to prove efficacy: there are over two million active members in 181 countries, and nearly 118,000 groups that meet regularly.

Take that and leave the rest, if you need to.

My experience has not been sunshine and butterflies all the way through, by the way.

In my first six months, I was dumped by two sponsors who had an issue with my taking medications, and I was left doing steps 1-4 twice, holding onto my 4th step in desperation, trying to find some random woman to go over it with me.

I’ve heard horrendous stories of sponsors who talk down to grown women who have years under their belt and who try to act as their doctors or their keepers.

I’ve been in meetings that end with “Our Father” and got really pissed, and I strongly disagree with those who say we are permanently sick and can never trust our thinking.

As my current sponsor says—and she’s one of these women in the New York Circuit that everyone knows and respects—as women in recovery, we learn to rely on ourselves and become people who are capable of trusting their own thinking again because we’ve grown and changed, and learned to do that.

Just like any other community on earth—your local government, your workplace, your book club, your yoga class, your MeetUp Group—you’re going to encounter personalities you don’t like and people who are overbearing and difficult to deal with.

But when we’re talking about changing and saving lives, it’s important not to toss any one approach under the bus. Explore alternatives, do what works for you, and keep in mind that just like one medication may help someone’s depression and do nothing for the other’s, different people respond to different treatment. Ultimately, there is enough room for all of us to exist here without putting one another down.

So please play nice.

5 Ways I Stay Sober Without AA

By Beth Leipholtz for TheFix

There are many ways to recover from alcoholism without 12-step programs. Here’s how it’s worked for me.

A woman standing and smiling at the camera, fingers pointing outward.

Four years ago, I got sober through an outpatient treatment program. The rehabilitation facility I went to followed the 12-step format and stressed the importance of AA meetings and a sponsor. In a way, I owe my sobriety to this form of treatment. I’m so grateful for it. For the first year or so of recovery, this is the format I followed because it was what I knew and it was what was working. But over time I found that I wasn’t necessarily comfortable at AA meetings. Part of it was the God talk, since I’m not necessarily religious, but it was more than that, too. The way sobriety was discussed just didn’t always click for me, and I found myself leaving meetings with a frustrated feeling hanging over me. Though I occasionally still go to meetings, I’ve stayed sober for three of my four years largely without AA involvement. Here’s how:

1. I have a recovery network online. The internet is an amazing resource for those in recovery. It allows you to connect with men and women all over the world, of all ages. There are various websites, chat rooms, Facebook groups, and more which are all about sobriety and recovery. There are hundreds of bloggers who cover sobriety and recovery from numerous standpoints. There are videos and podcasts. The list goes on. The internet has been a lifesaver for my sobriety. Not only has it allowed me to begin a blog and write about recovery, but it has connected me with many men and women who are going through or have gone through the same feelings and circumstances that I have. I’ve found that it doesn’t matter if we haven’t met in real life, that connection still exists because we have been through the same struggles and we’ve all decided to change our lives for the better. The women I have met through technology have become constants in my life and are always there to offer advice and love.

2. I have an outlet for stress and fear. Like many who are in recovery, I used to use alcohol to release stress and fear. Upon getting sober, that was clearly no longer an option. I had to find new ways to cope with my emotions, which was scary at first. I didn’t know how to just sit with them and feel them without burying them. I had heard from many people that writing about recovery was a healthy way to work through this array of emotions. Because I have always been a writer/journaler, this was the outlet where I found the most comfort. Since getting sober four years ago, writing has remained a constant in my life. I write when I’m happy, sad, frustrated, confused, hysterical. There is something about putting words down on paper that makes life seem just a little more manageable. Though writing has been a good way for me to find relief from difficult emotions, I’ve found I can only solve so much through words. I recently decided I needed another healthy outlet, something I could put my all into and walk away knowing I’d done everything I could. So I started Crossfit. To be honest, I don’t know how I managed stress and anxiety before I started working out. Moving your body and pushing it to its limits has a way of making the hard things in your life seem a little less hard. I still write often, but I also move often. Sometimes the most effective solution may be a combination of outlets that allow you to lead the healthiest life possible.

3. I think back to the way life was when I was drinking. This may seem like a small tool, but it’s a powerful one. Like most people in recovery, I have off days. I have days where I wish I could drink and forget about what is happening in my life. I have days where I want to feel “normal.” Sometimes I even consider what would happen if I did allow myself to drink. However, I can usually snap out of this mindset pretty quickly when I think back to the way my life was when I was drinking. Towards the end of my drinking career, my life was headed in a quick downward spiral. I had damaged many of the closest relationships in my life. I had let myself go physically and I often felt rundown or hungover. I wasn’t happy with the person I had become. I keep some photos of myself during this period of time because all of these things are reflected in the way I looked and the way I carried myself. When I’m feeling down about recovery, I look at these photos. And then I look at photos of the person I am today. And the choice to not drink becomes an easy one, because no part of me wants to return to that person I was before.

4. I keep words of wisdom on hand. Words are powerful, and there are so many words about recovery and sobriety out there. I have a board on Pinterest dedicated to quotes about recovery, as well as bookmarked blog posts on my phone. I’ve also saved emails or texts from people telling me they are proud of the journey I have been on. For some reason, revisiting words like these has a way of grounding me and making me remember why it is that I began this journey. In difficult moments, when I am wishing I could be more like other people my age, I grab my phone and pull up these quotes or blog posts or emails. I take five minutes to read, and after doing so I usually feel refreshed and remember why I set out on this journey four years ago. It was because I wanted a better life, and for me, drinking will never be the way to a better life.

5. I talk to people about how I am feeling and why. This is perhaps the most vital tool in my sobriety. Before getting sober, I disliked talking about my emotions. I felt like it made me weak to acknowledge that I was struggling and I preferred to just bury any difficult emotions instead. This often involved drinking in order to forget why I was feeling the way I was, which just made the feelings worse upon sobering up.

But when I found myself in treatment, I had to learn how to vocalize my feelings and figure out what was at the root of them. This was something I hated at first, but as time has passed I have become wholly comfortable expressing my emotions. Today I feel comfortable reaching out to the people in my life and asking for help. I can talk through my emotions and dig to the bottom of them to figure out what the root cause is and what I can do to get myself back on track. There are still days where confronting emotions is difficult, but it always proves to be worth it.

It’s important to note that staying sober without AA isn’t the right path for everyone. For some, AA is necessary in order to get sober and maintain recovery. And that’s just fine, because everyone’s path is different. Those living a life of recovery need to know that they have every right to find what works for them in their own personal journey. There is no right or wrong way to stay sober.