Anxiety comes up frequently for people in recovery and moms. When I imagine anxiety, it looks like this:
It is rigid, red and rapidly moving. Usually, we want anxiety to go away. We want to just get rid of it. But when we ask what anxiety has to say, and respond with curiosity or tenderness to the scared-self, a new relationship can emerge. Below are some examples of what the anxiety part of the self might say.
Here’s What Anxiety Says:
- I’ve made a bullet-point list for you. You should do everything on the list and then I will go away.
- (After list is complete): “OK, that was the first one. I now have several more.”
- Other people have it all figured out, so you should pretend like you do. One way to do this is to look good. I will help you with that. Try to look perfect.
- You are the only one that struggles with this anxiety. It makes you isolated, and you don’t belong because of it. Therefore, you should hide it.
- Be very busy. If you’re not busy, doing things, I can help keep your mind be very busy. I can even make your thoughts race.“
- I will always be your friend, but especially from 1:00-4:00am. At that time, I will remind you of the ways you are incompetent, the world is falling apart, and you can’t do anything about it. If you go on social media during this time, I will find lots of evidence for you.
- Other moms are doing it better. You are not qualified to be a good parent. You should read parenting books to illuminate all the ways you are f*cking up.
- Your body is the wrong size/shape. You can (and should) fix that. If you do, I may go away (but I will probably stick around because you will need me to manage you, since you can’t be trusted).
- Not eating, bingeing, purging, drinking, or smoking pot are good ways to get me to go away. (Oh, and you will need to maintain that. And you should hide that you do that, because it is shameful).
- The world is not safe. I have found lots of evidence of this for you.
As you can see, it is not a kind voice, this anxiety. It is relentlessly hypervigilant to the ways that you are inadequate. Strangely enough, this part of the self is often trying to protect you: from vulnerability, from the unknown. In my training as an Imaginal Psychologist, one way we worked with different parts of the self – and integrating them back into wholeness – was to bring fiercely compassionately objective voice into the dialogue. Compassionate awareness can take several different forms: it can be humourous, fierce, gentle. It can be rational and empirical. In my experience, this compassionate part is much more flowing and less rigid than anxiety. It feels like a deep breath down into the cooling water under the anxiety. It might look like this:
Here are some examples of what this voice of might say to anxiety. What the Voice of Compassionate Objectivity Might Say:
- Isn’t it interesting to notice the associations between anxiety and accomplishing or not accomplishing things? So interesting to notice…
- I bet you could choose to do some, all, or none of the items on the list, and your value as a human would remain fully intact and whole. How about you try and I will be the witness observing?
- Is “figured out” an equation? If “it” is figured out, does that mean fear or suffering disappears?
- Who are those “perfect,” and “busy” people? If they exist, might they be struggling with the same fear of inadequacy you are?
- If there are 7.5 billion people (roughly) on the planet, do you really think you are the only one who struggles with these thoughts and feelings? Might it not be the very thing that connects your heart, mind, and body with humanity?
- I wonder what would happen to your thought-speed if I help you breathe. Does it change if you breathe all the way into your abdomen? It doesn’t need to change. But if you are in discomfort from the racing, bringing attention to your breath can help your body shift into parasympathetic (rest) mode. Would you like to try?
- I will do everything I can to help you get a good night’s sleep, honey. I’m going to help you with loving limits: no social media at night. Not helpful.
- We can take stock of your strengths and weaknesses during the day and/or with someone who can add compassion and objectivity to the assessment. When you’re feeling weak, that’s not the time to assess your weaknesses.
- If you can’t sleep, I won’t abandon you. I’ll stay with you and the anxiety. I’ll be right there with you, surrounding you with care and tenderness.
- Body size and shape have nothing to do with your worth, honey. I know you keep really wanting it to be about that. But I’m going to keep reminding you the answers you seek are not there.
- Did you show up to the best of your ability as a Mom today? Your best can be different on different days. That is ok. Mistakes are how we learn. Oh, and put the parenting books down.
- You can tolerate anxiety. It won’t kill you. You can ride the wave of this fear without medicating it.
These are just some examples. The goal is not to get rid of anxiety. The goal is to develop a different relationship with it. Perhaps it might look like this?
Obviously, you will have to see what your own voice of Compassionate Objectivity has to say.
For now, I will leave you with a summary that I and some of the people I work with find helpful:
There is nothing wrong with you.
Nobody has it all figured out.
You are safe right now.
You are not alone.
The holidays can be hard. They can be especially difficult for people recovering from disordered eating, alcoholism, depression, or anxiety. The intention of this blog is to help you be a bit more fierce with your own self-care and a bit more compassionate with yourself and others. This is not a list to use to beat up on yourself for not doing enough or being imperfect! May it be helpful, useful, and ease some of your suffering during this time.
Try not to let yourself get too Hungry, Angry, Lonely, or Tired. Getting too tired, hungry/hypoglycemic, resentful, or isolating is a recipe for addictive behaviors and/or depression. Imagine yourself to be a little one (this will not be hard for you parents to imagine) who needs regular meals and snacks, regular emotional understanding, and regular sleep. If little ones get too tired/hungry/emotionally not heard, there will be meltdowns. Be a kind parent to yourself. Pack a self-care bag with protein snacks, water, get to bed on time, make plans with friends and/or providers that “get” you so you can feel nourished and grounded. Practice what a friend of mine calls “aggressive self-care.”
2. Keep 1 Thing Constant
Choose one thing – morning meditation, weekly support group, your meal plan, sobriety, journaling, daily inspirational reading… To read more, go to EDBlogs
Just as a reminder, the intention here is to help you be a bit more fierce with your own self-care and a bit more compassionate with yourself and others… not to beat up on yourself for not doing enough or being imperfect.
Stay tuned for part two next week!
A controversial article by Gabriel Glasner came out last month in the Atlantic titled “The Irrationality of Alcoholics Anonymous” . As a Psychologist who has witnessed the power of 12-step Programs transform lives, I wanted to share my perspective.
AA is not evidence-based treatment. It is a peer-led support system.
In her article, Glasner states, “Nowhere in the field of medicine is treatment less grounded in modern science.”
12 step meetings are a community-based support group. AA is not a treatment program, nor is it evidenced-based research. AA or any other 12-step program is not therapy or medicine. It is a group of people assisting each other to stay sober or free from other addictive behaviors and learn new tools to manage their emotions. There is no double blind research going on during meetings. There are no medical professionals such as Psychiatrists, Social workers, or Medical Doctors facilitating the meetings and collaborating on the care of patients attending meetings. AA is a peer-led support group. As one member of AA said to me ironically “it’s not named “Well-Persons’ Anonymous.” By its very definition, AA is made up of sick people becoming well helping other sick people become well. The Preamble to AA and Tradition 3 of the twelve steps and twelve traditions both state:
“The only requirement for A.A. membership is a desire to stop drinking… A.A. is really saying to every serious drinker, ‘you are an A.A. member if you say so. You can declare yourself in; nobody can keep you out.’” 
The history of AA is a fascinating story of two alcoholics, Bill and Bob, discovering experientially that the only thing effective in keeping them sober was supporting and being of service to another alcoholic struggling to be and stay sober.
AA and other 12-step programs complement treatment
This peer support can lend itself to complementing treatment such as individual cognitive behavioral therapy, family systems therapy, psycho-education, and/or medication. Many addictions/addictive behaviors (including but not limited to alcohol use, disordered eating, compulsive spending, sexual addiction) are medicating underlying mood disorders such as anxiety or depression. In terms of evidence-based treatment, cognitive behavioral therapy (CBT) has been found to be the most effective treatment for recovering from mood disorders such as anxiety or depression. CBT in combination with pharmacotherapy is often found to be the best treatment. 
Common to addictive behaviors, as well as the underlying anxiety and depression, are “cognitive distortions” and “automatic negative thoughts.” Cognitive behavioral therapy uses a collaborative approach to challenging these thoughts by asking the client to look for evidence in their life to see if they actually true. Some cognitive distortion categories and examples are:
“If there’s something wrong here, it must be my fault”
Jumping to conclusions and Mind Reading:
“I know she hates me because she just frowned. She is thinking I’m a bad Mom,”
“I really shouldn’t be feeling this way. I should pull myself up by my bootstraps and be happy already”
“I feel stupid, boring, and ugly, therefore it must be true.” 
Cognitive distortions are not limited to those suffering with addictive behavior or drinking problems. We all have cognitive distortions. However, these distortions become magnified and appear to be the truth in the mind of someone suffering with anxiety or depression, often triggering them to drink. Alcohol, however, is a depressant, and therefore often leads them further into the very cognitive distortions from which they are trying to escape. In AA, group members will often state things like “My best thinking got me here,” or “I am working on my stinkin thinkin.” In therapy, an environment of collaborative empiricism (“Is it really true that she is thinking you’re a bad mom? Is there any evidence to support that thought?”) can help decrease the negative power that cognitive distortions hold over someone. Often these cognitive distortions grow and get reinforced from family systems with parents with alcoholism or mood disorders. (Children don’t have the executive functioning developed yet to reason things out without personalizing and so “it must be my fault” as a child’s interpretation grows into an adult thinking “it must be my fault” when someone else gets angry or depressed or their boss blames them for doing an imperfect job.)
12 Step Programs help break isolation and provide frequent and accessible support.
For someone suffering from anxiety or depression, isolation can be one of the worst triggers to worsen the symptoms. And, as many clients can attest to, the symptoms for anxiety and depression are often at the peak during hours most therapists are unavailable for support. AA and other 12 step programs are available 24/7. If you look up AA meetings in your area, you will most likely find them meeting on the hour, every hour, often more than one! I looked up AA meetings for Sunday in San Francisco: there are 71 meetings available to attend (not including the bilingual ones). Smart Recovery (which I also am in favor of as a compliment to treatment) offers 3 meetings per week in San Francisco. In 12-step fellowship, people often share their phone numbers and provide sponsorship mentoring, which is guidance from someone further along in the recovery journey. This fellowship is available during weekends, evenings and other “triggering” times during which someone struggling with the desire to drink cannot call or will not reach their therapist for support.
Brain chemistry, Neuroscience and Medication
Neuroscientists and researchers are discovering more and more about how alcohol affects the brain. Functional Magnetic Resonance Imaging (fMRI) is allowing researchers to “see” blood flow to particular regions of the brain and identify which ones are active. This is allowing them to track not only how alcohol affects brain function but also how it changes as alcohol dependence develops. There are many medications used to treat alcohol withdrawal, to prevent consumption, or to reduce cravings, Naltrexone being the one that Glasner focuses on in her article. There are also many medications used to treat the anxiety and/or depression that cause many people to “self-medicate” with drinking. As a Psychologist, my opinion on medications is that they are useful as a tool, just as therapy is useful as a tool; just as support groups are useful as a tool. They all help in the healing process. However, using one alone can risk being not enough and miss an important aspect of the healing process. I would never recommend to a client to take naltrexone (For the record I am a Psychologist so it is not in my scope to prescribe medication) alone for recovering from alcohol use disorder. It would be like offering a pill to my sick child and then sending them off to the playground. The pill, should it be the right kind of medication for the sickness, would certainly help, but the pill alone without the essential rest and human kindness would be missing the mark on healing an entire person. Alcoholics and addicts are particular susceptible to the cognitive distortion that “if you take a pill, you will feel emotionally better and it will all go away.” Even in the information pamphlet for naltrexone, it states:
Naltrexone is only one component of a program of treatment for alcoholism including counseling; help with associated psychological and social problems and participation in self-help groups. In both studies where naltrexone was shown to be effective, it was combined with treatment from professional psychotherapists.
There is no contradiction between participation in AA and taking naltrexone. Naltrexone is not addictive and does not produce any “high” or pleasant effects. It can contribute to achievement of an abstinence goal by reducing the craving or compulsion to drink, particularly during early phases of recovery. It is most likely to be effective when the patient’s goal is to stop drinking altogether. 
In other words, naltrexone can be helpful for treatment and is not contraindicated with peer-led support, such as AA.
What are Alcoholism, Problem Drinking, and Alcohol Use Disorder?
Glasner seems intent on distinguishing between “alcoholism” and “problem drinking” in order to determine for whom abstinence would benefit and who can realistically continue drinking in moderation. The thought being that some people (“problem drinkers” but not “alcoholics”) can learn to drink in moderation without it interfering in their life (or needing to attend Alcoholics Anonymous). Alcoholism and problem drinking are layperson terms distinguishing between severities of alcohol use.
However, I have administered the Michigan Alcohol Screening Test (MAST) to a client who scored a 3 and absolutely identifies herself as an alcoholic. The MAST is a 22 question screening tool that clinicians often use to determine the severity of someone’s drinking problem. A total score of six or more indicates “hazardous drinking” or “alcohol dependence.” The woman who scored a 3 is a high-functioning working mom who has been sober and attended AA meetings for the past eight years (some details changed to protect confidentiality) in order to “be a better mom and stay connected in my marriage without drinking to stuff and avoid anxiety.” I have also administered this test to a client who scored a 7 and still looked me straight in the eye and stated, “I don’t have a problem with my drinking.” This was someone who had missed work weekly due to hangovers, blacked out frequently, and lost relationships due to her drinking. (She later discovered that she does in fact have a problem with alcohol and is not drinking. She does not attend AA, but attends therapy, women’s groups, and has started painting instead of drinking. Again, details changed to protect confidentiality.)
Clinically, the Diagnostic and Statistical Manuel (DSM-IV) used to distinguish between alcohol abuse and alcohol dependence, the latter being more severe. It required that a person have three symptoms during a 12-month period from a list including such criteria as:
- Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol
- The characteristic withdrawal syndrome for alcohol; or drinking (or using a closely related substance) to relieve or avoid withdrawal symptoms
- Drinking in larger amounts or over a longer period than intended.
- Persistent desire or one or more unsuccessful efforts to cut down or control drinking
- Important social, occupational, or recreational activities given up or reduced because of drinking
- A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking
- Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking. 
In the most recent manual, DSM–V, anyone meeting any two of the 11 criteria during the same 12-month period would receive a diagnosis of Alcohol Use Disorder (AUD). The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met. DSM–5 eliminates legal problems as a criterion, and adds craving as a criterion for an AUD diagnosis. 
Research is not what heals. Relationships heal.
When Glasner states that AA is not supported by research (the subtext implying that therefore it is therefore not effective in healing from alcohol use disorder), I’m not that impressed. Research absolutely has its place. Research is necessary. I needed to do research to earn my doctorate in psychology. Research keeps the fields of psychology and medicine growing, as well as help track what is and is not working in all kinds of treatment. Research has even discovered the following in terms of what is most helpful in the therapeutic process and healing:
- The therapy relationship makes substantial and consistent contributions to patient success in all types of psychotherapy studied (for example, psychodynamic, humanistic, cognitive, behavioral, systemic).
- The therapy relationship accounts for why clients improve (or fail to improve) as much as the particular treatment method.
- Efforts to promulgate best practices or evidence-based practices (EBPs) without including the relationship are incomplete and potentially misleading. 
In other words, it does not matter what modality the therapist is trained in if their bedside manner is crap. In clinical practice, I have discovered my clients generally want to know three things:
1) Do I care? Do I truly care about them and their process?
2) Do I know what I am talking about when I offer feedback and suggestions?
3) As they trust me, can they learn to trust themselves in this healing process?
Never have I had a client say to me: “But what did your doctoral research findings state?”
12 Step Meetings are Low cost and therefore available to everyone, regardless of whether they have insurance or the ability to pay for treatment or therapy.
I won’t be popular stating this as a therapist, but let’s be honest: therapy is expensive. 12 step meetings are not. The preamble of any 12-step meeting includes: “There are no dues or fees for membership. We are self-supporting through our own contributions.” What this looks like in practice is that if it is your first 12-step meeting, you are invited to attend for free. If you are an ongoing member, you are invited to make a small donation to cover the cost of renting the meeting room and contributing to the 12-step world service organization, which is largely run by volunteers. The current standard donation amount is about $2 per meeting. Group therapy costs in the bay area are currently $60 per group session. A 24-hour stay at a private treatment facility is $1,000- $1,500 per day.
12 Step Programs help teach humility and service to narcissists in ways that other treatment modalities fail
Because AA was developed by two male alcoholics and strongly influenced by the Oxford group teachings (more on this later), there is a strong focus on ego deflation, service to others, and dependence on God (a Power Greater than ones’ self). Back in my pre-doc experience working as a substance abuse counselor, I found that one of the few psychological interventions that worked with narcissists (who are notoriously impervious to interventions reflecting on the need or desire to change themselves) was another narcissist effectively challenging them. If the “challenger” was intent on sobriety and recovery, than this would often land in an open-ness toward his peer’s desire for recovery. They could hear it from each other. They weren’t very interested in hearing it from the doctor or the facilitator, unless the doctor or facilitator “had what they wanted.” This would often need to be a strong male figure that had recovered himself and was radiating a sense of power and confidence. As a newbie woman therapist, I didn’t have much of what they wanted other than perhaps a date, with which I was a) not interested and b) had professional boundaries.
Where therapy failed with the great Dr. Carl Jung and the spirituality of the twelve steps worked
One of the first members of Alcoholics Anonymous was a gentleman named Rowland. Rowland spent a year under the care of Dr. Carl Jung due to his despair over the inability to control his drinking. After this year, thinking he had been cured, he left and promptly became intoxicated:
Sometime in 1931…a young, talented, and wealthy financial wizard, had found himself on the verge of despair over his inability to control his drinking. Having attempted virtually every other “cure,” he turned to one of the greatest medical and psychiatric talents of the time, traveling to Zurich, Switzerland, to … Dr. Carl Gustav Jung. For close to a year, Rowland H. worked with Jung, finally leaving treatment with boundless admiration for the physician and almost as much confidence in his new self.
To his consternation, Rowland soon relapsed into intoxication. Certain that Jung was his last resort, he returned to Zurich and the psychiatrist’s care. There followed, in Bill Wilson’s words written to Dr. Jung in 1961, “the conversation between you [and Rowland] that was to become the first link in the chain of events that led to the founding of Alcoholics Anonymous.” That conversation, in Wilson and Jung’s later memory, had made two points. “First of all, you frankly told him of his hopelessness, so far as any further medical or psychiatric treatment might be concerned.” Second, in response to Rowland’s frantic query whether there might be any other hope, Jung had spoken of “a spiritual or religious experience — in short, a genuine conversion.”
“You see, ‘alcohol’ in Latin is ‘spiritus’ and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.”
This metaphorical understanding of what Rowland was truly seeking in turning to alcohol deeply influenced the spiritual underpinnings of AA. He wasn’t looking for alcohol- he was looking to have a spiritual experience. In the twelve steps, there are two kinds of spiritual experiences: the “lightning bolt” kind (the Aha’s! that are inspirational, sudden, and life changing) and the “educational variety,” that develop slowly over time.
I often work with clients with both of these kinds of experiences. The challenging part is often that many want the “Aha!” but not the “slow educational variety.” Let’s be honest, it is much more enticing to have a sudden experience of seeing God or of completely understanding in a flash why there is suffering in the world. It is not as pleasant to learn, slowly over time, such things as how parking meters apply to you, and needing to still wash the dishes. As the author and meditation master Jack Kornfield so aptly put it “after the ecstasy, the laundry.”  Healing and growth occur slowly, over time, with both sustained effort and surrender. Attending 12 step meetings regularly, doing a spiritual practice such as prayer or meditation, and having a support system of trusted peers giving you feedback on your blind spots can help create and sustain this healing and growth. As they say in 12-step “you can’t kiss your own ear.” Having people you trust, both peers and a therapist, give you feedback on where to turn toward/lean in and where to turn away/detach can be invaluable to growth.
What about women?
It is often suggested that women recovering from alcoholism attend women-only AA meetings. Sexism can still exist in ways such as having men called on to speak more frequently and “the old boys network” of calling on your friends to speak in AA meetings often keeps women feeling even more shame and silence. In addition, many women have the unwelcome experience being “hit on” for dates in a place where they are seeking emotional safety during a vulnerable time of healing.
In women-only meetings, there can be an atmosphere of camaraderie, compassion, and encouragement that can be harder to find in co-ed meetings. The language of 12 step and its “bible” (The “Big Book of Alcoholics Anonymous”) is masculine and this can be a barrier for many women, especially those who are recovering from trauma in their past, whether it be religious, sexual, physical, or emotional. Recovering a sense of internal and/or feminine (instead of external and/or masculine) can be an important piece of the recovery process for some women. Stephanie Covington’s work discusses many of these issues. As shame is such a silent epidemic among women, particularly those struggling with any form of addiction or disordered eating, finding safe spaces to break the isolation of this toxicity is essential to unveil and transform it. For many women using alcohol or process addictions such as codependency or disordered eating, the “ego deflation” process developed through the early AA members is not helpful because they have a weak, underdeveloped ego. This weak sense of self needs bolstering, not deflation.
Limitations of 12 step Programs
Spirituality and Moderation:
As mentioned earlier, AA historically grew out of the Oxford group, which was a religious group focused on dependence on God, service to others, spiritual experience, continuous change for growth, and fellowship. These are tenets that continue to be strongly held in 12 step philosophy and practice and do not work for everyone. Not everyone wanting or needing to recover from alcohol or any other substance/process addiction wants or needs to find recovery through spirituality. And as already mentioned, for those that do, the masculine or Christian language can be a barrier, re-traumatizing shame. Spirituality is not for everyone, nor is abstinence-based recovery. For those wanting to recover without using spiritual terminology or explore how to drink in moderation while using different tools to manage life skills, there are alternatives approaches such as: Harm Reduction, Rational Recovery, LifeRing, and Secular Organizations for Sobriety.
Eating Disorders and Process Addictions
As a Psychologist currently in private practice, I specialize in working with women recovering from disorder eating, body image distress, and perinatal mood disorders. With eating disorder recovery, there obviously can’t be an “abstinence-based” (abstinence from food) recovery. You need to eat to live. Food related 12-step programs take a variety of positions on this very issue: some have a suggested plan of eating that is considered abstinent for recovery for everyone, some suggest determining what your recovery food plan is with your sponsor and healthcare professional(s), and some
“endorse sound nutrition and discourage any form of rigidity around food. Balance not abstinence is our goal.” 
Philosophically, I align most with EDA, as “it is not about the food” and recovery is about learning other emotion regulation tools to cope with life. I do not often recommend clients attend Food Addicts Anonymous (FAA), as it can feel triggering and shaming for someone who has been alternating between dieting and bingeing for much of their life to be given yet another food plan that resembles a restrictive diet as a solution to a life problem. Some meetings actually do not allow members to speak if they have not followed this food plan for 30 days, which can feel quite shaming and re-traumatizing for someone who is already struggling with food, finding one’s authentic voice, allowing imperfection, and being less rigidly black and
Other process (as opposed to substance) addictions such as gambling, spending/debting, and sex/relationship/codependent addictions also have 12-step programs for people to abstain from what they identify as their addictive behavior in order to develop other tools to cope with life, on life’s terms. Again, these are not for everyone. However, AA paved the way to make available low-cost, readily available, peer-based support for many people struggling with many kinds of issues.
12-step Programs are certainly not for everyone. And I work with many therapy clients who attend 12-step meetings and many clients who do not. All of them are on their own healing path. However, I would ask Ms. Glasner to not throw out the baby with the bath water or simplify the recovery process by simply replacing AA with Naltrexone. Recovery is a multifaceted and individualized journey in which many people may actually benefit from both AA and Naltrexone or neither of these. And without AA, without the inspiration of two men simply trying to stay sober, 1 day at a time over 60 years ago, there would be no other 12-step programs in the world today. Twelve step programs help millions of people every day all across the world. Let’s not spend our time criticizing what works quite well for some, advocate what works for each person in their own journey of healing, and by all means invest time and money researching what can work even better in the future.
Why AA “declined to talk”
One of the traditions, tradition 11, of 12-step program is anonymity. It states that “Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.” And so the Glasner article leaves a big void for members of AA to challenge if they are to remain true to the very program that has helped them. As a Psychologist who has seen 12 step programs transform lives, I wanted to speak up in service of the miracles I have seen 12-step programs facilitate in the people with whom I work.
Dr. Linda Shanti McCabe is a Licensed Clinical Psychologist practicing in San Francisco. She has worked in residential, partial hospitalization, and outpatient treatment for alcohol and substance use as well as eating disorders. She currently specializes in assisting women recover from disordered eating, body image struggles, anxiety, and perinatal mood disorders. To read more about her work, visit www.DrLindaShanti.com or her Mommy blog at www.Recoverymama.com
 Glasner, Gabrielle, “The Irrationality of Alcoholics Anonymous” The Atlantic, April 2015
 “Cognitive Behavioral Therapy for Depression and Anxiety Disorders,” Systematic Review, National Registry of Evidence-based Programs and Practices, Substance Abuse and Mental health Services Administration, a branch of the US Dept. of Health and Human Services http://www.nrepp.samhsa.gov/cbt.aspx
 Beck, A. T. (1976). Cognitive therapies and emotional disorders. New York: New American Library.
Burns, D. D. (1980). Feeling good: The new mood therapy. New York: New American Library.
 Nagel, B.J., and Kroenke, C.D. “The use of magnetic resonance spectroscopy and magnetic resonance imaging in alcohol research,” Alcohol Research & Health 31(3): 243–246, 2008.
 Rounsaville, Bruce J., M.D., O’Malley, Stephanie, Ph.D., and O’Connor, Patrick, M.D., “Guidelines for the Use of Naltrexone in the Treatment of Alcoholism,”, The APT Foundation, 904 Howard Avenue, New Haven, CT 06519, 1995.
 Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: APA, 2000.
 As stated by Bill W at THE IMPACT OF ALCOHOLISM HEARINGS BEFORE THE SPECIAL SUBCOMMITTEE ON ALCOHOLISM AND NARCOTICS OF THE COMMITTEE ON LABOR AND PUBLIC WELFARE, UNITED STATES SENATE NINETY-FIRST CONGRESS, FIRST SESSION ON EXAMINATION OF THE IMPACT OF ALCOHOLISM
JULY 23, 24, AND 25, 1969 and printed in the original “AA Grapevine” newsletter of Alcoholics Anonymous.
 Kurtz, Ernest, Not-God: A History of Alcoholics Anonymous, Center City: Hazelden, 1979
 As quoted by William James in Appendix II, “Spiritual Experience,” Alcoholics Anonymous, New York: Alcoholics Anonymous World Service, 1994.
 Kornfield, Jack, After the ecstasy the laundry: How the heart grows wise on the spiritual path, New York: Bantam Books, 2000.
 Covington, Stephanie, A Woman’s way through the 12 Steps, Center City: Hazelton, 1994.
 Eating Disorders Anonymous, FAQ’s
 Anonymous, Alcoholics, Twelve Steps and Twelve Traditions of Alcoholics Anonymous, Alcoholics Anonymous World Service Inc, Copyright 1952, 2004.
Body image can be a source of distress and/or relapse trigger for recovering women. This is not a superficial issue, but a deeper question around identity transition and transformations that happen for moms-to-be. For more on body image during pregnancy and postpartum, see “Does being a mom make me look fat?”
Fertility and secondary infertility can be challenging for women with histories of disordered eating or drug/alcohol use. Many women have damaged their fertility due to the eating disorder and can be challenged at becoming or unable to become pregnant. According to one study (Sterwart et al, 1990) “a total of 16.7% of infertility patients were found to suffer from an eating disorder. Among infertile women with amenorrhea or oligomenorrhea 58% had eating disorders. Because women often fail to disclose eating disorders to their gynecologists and may appear to be of normal weight, it is recommended that a nutritional and eating disorder history be taken in infertility patients, particulary those with menstrual abnormalities. It has previously been shown that disordered eating and nutrition can affect menstruation, fertility, maternal weight gain, and fetal well-being.” (1)
Along with the choice about whether to and if so, how long and to what extent do fertility treatment is the often grueling process of trying successfully or unsuccessfully to become pregnant. Therapy can be helpful in this process in dealing with all the complicated issues and feelings this can include. One recent blog resource by Susan Allen, who is a LMFT in San Francisco, is: coping skills to center yourself through infertility
Family of origin attachment patterns can be deeply imprinted in the way we parent. This is something to be mindful of in not repeating past traumas and being conscious of what patterns we would like to keep and which we would like to change. Therapy is the most helpful resource in this regard.
Childcare Support from their families may be closer geographically or more emotionally available to women from families without eating disorders, alcoholism, or depression/anxiety. Building an “attachment village” of fellow mom friends and/or professional childcare support like nannies, babysitters, daycare, preschool can be an important part of keeping recovering moms sane and supported if the grandparents, aunts, uncles, etc aren’t available to help. One local mom resource is: Golden Gate Mother’s Group
Self care practices like getting enough sleep, the right kind of food, and not using/abusing substances such as alcohol, caffeine, and other drugs that can be difficult to maintain become excruciatingly during pregnancy and postpartum. Night doulas can be a helpful support resource for some moms. In the bay area, one such resource is bay area night doulas.
Many 12 step meetings also have phone support meetings for those people (like new moms) who are having trouble getting out of the house. Here is a link to phone meetings for Alcoholics Anonymous: aa phone meetings, and here is one to eating disorder anonymous phone meetings.
Perinatal mood disorders (ex Postpartum Depressiona and Anxiety) are common for women in recovery, as these are often what were beneath the disordered eating or alcoholism. Having a treatment team (Psychiatrist, Psychologist, support group specializing in perinatal mood disorders) ready and in place can be a crucial part of prevention and treatment for ongoing recovery. Postpartum Support International is a wonderful resource for moms and families struggling with perinatal mood disorders.
Survivors of abuse are often triggered at many points during the labor and delivery as well as breast feeding process. Many aspects of feeling one’s body is not your own or physical experiences that mimic what happened in abuse can be confusing for mothers who have abuse in their history. When Survivors Give Birth is a book published this past year that provides survivors and their maternity caregivers with extensive information on the prevalence and short- and long-term effects of childhood sexual abuse, emphasizing its possible impact on childbearing women. For more information: Penny Simpkin’s website
Being “Advanced Maternal Age” (or over 35 years old) is becoming more common for many women during pregnancy, especially those that have chosen to solidify their own recovery and/or career path prior to having a child/children. Being an older mom brings with it potential medical challenges and choices during pregnancy as well as postpartum. The “advanced maternal age” project is a resource of information and stories: advanced maternal age project
1. Stewart, Donna, Robinsonm Erlick, Goldbloom, David, Wright, Charlene, 1990, “Infertility and Eating Disorders,” American Journal of Obstetrics and Gynecology, Volume 163, Issue 4, 1196–1199.
This blog is not to be used to diagnose or treat eating disorders, alcohol use problems, or psychological illness. If you would like to schedule an assessment for treatment, including a perinatal mood disorder, you are welcome to contact Dr Linda Shanti at Linda@DrLindaShanti.com.
For immediate assistance/crisis, call 911 and for a National Suicide Prevention Hotline and Website: 1-800-273-8255 www.suicidepreventionlifeline.org
The term “Mommy juice” is new to me. Perhaps I have been living in a bubble of friends, colleagues, and clients who are all “recovering” or “recovered” from something, but when I came across the term I actually had to look it up. I then found this:
“On some play dates these days, the clinking of wine glasses accompanies the laughter of children as parents relax with a drink while their kids frolic.” 1
That is a bit frightening. And yet I know the stress of parenting, I know many moms who drink moderately and responsibly, and I know how difficult “the witching hours” can be. How to know if “mommy juice” is a moderate (and safe) stress reliever or a problem? The connection between women and stress seems to be a big factor. According to the National Council on Alcohol and Drug Addiction,
“Alcohol is the most commonly used addictive substance in the United States- 17.6 million people, or one in every 12 adults, suffer from alcohol abuse or dependence along with several million more who engage in risky, binge drinking patterns that could lead to alcohol problems. More than half of all adults have a family history of alcoholism or problem drinking, and more than 7 million children live in a household where at least one parent is dependent on or has abused alcohol.”
“…research tends to support the link between coping with stress and problem drinking. For many women, alcohol becomes a means of coping with stresses like…dealing with issues of parenting.” 2
When is drinking interfering with being a Mom and when is a glass of wine relieving stress?
Some key indicators of a woman who may be in trouble with alcohol:
- Missing work or skipping child care responsibilities
- Drinking in dangerous situations, such as before or while driving a motor vehicle, transporting kids, etc.
- Being arrested for driving under the influence (DUI/DWI)
- Hurting someone while drinking: emotional/physical abuse
- Continuing to drink even with ongoing alcohol-related tensions with family, friends, workplace, partners 2
Some symptoms of alcoholism include if you:
- Feel a strong need or compulsion to drink
- Develop tolerance to alcohol so that you need more to feel its effects
- Drink alone or hide your drinking
- Experience physical withdrawal symptoms — such as nausea, sweating and shaking — when you don’t drink
- Do Not remember conversations or commitments, sometimes referred to as a “black out”
- Make a ritual of having drinks at certain times and become annoyed when this ritual is disturbed or questioned
- Are irritable when your usual drinking time nears, especially if alcohol isn’t available
- Keep alcohol in unlikely places at home, at work or in your car
- Drink to feel “normal” 3
Other risk factors?
Just like eating disorders and perinatal mood disorders, having a history of anxiety or depression, past abuse, hormonal or brain chemistry imbalances, and alcoholism in the family system are all potential risk factors to be mindful of if you are concerned about alcohol use (abuse).
And, once again, shame and isolation (just like with eating disorders and postpartum depression) are both risk factors as well as barriers to recovery. The message of hope bears repeating. YOU ARE NOT ALONE. THERE IS HOPE. THERE IS HELP. Women like Marty Mann, founder of NCADD, paved the way back in 1944, to start a discussion within the medical and scientific community about women and alcoholism’s damaging effects. Fortunately, as a result, more women are living lives in long-term recovery than ever before! More recently, Elizabeth Vargas told her story of recovery after being a “closet alcoholic” hitting the “mommy juice” for decades. Bless both of these women for sharing their experience, strength, and hope!
Here are a few places to look if you are concerned about your own or someone else’s alcohol(ism):
Information on alcohol: http://ncadd.org/learn-about-alcohol
Support from Recovering women: http://www.thebubblehour.com/p/who-we-are.html
Alcoholics Anonymous: http://www.aa.org/pages/en_US/need-help-with-a-drinking-problem
Alanon support for family members: http://www.al-anon.org/affected-by-someones-drinking