Physical Recovery

By John L.

Physical recovery is downplayed or even ignored by Alcoholics Anonymous, both in its literature and in practice. This is unfortunate. Next to staying away from the First Drink, without which there can be no sobriety, nothing is more important for many of us than getting our health back. This grave shortcoming stems from AA’s religiosity, its emphasis on achieving “spirituality” (whatever that is). Here AA is following a long Christian tradition of regarding the spiritual and the physical as antagonistic — the soul imprisoned in the body. When Christianity became the state religion of the Roman Empire in the 4th century, it crusaded against all remnants of paganism, including the physical fitness ideals of the Ancient Greeks and Romans: the Olympian games, which had flourished for 1200 years, were closed, as were the public baths; self-mortification and uncleanliness came to be regarded as attributes of sanctity.

I can best explain why I stress the physical by telling my own story — and I stress that this is my own. Each of us has his or her own road to recovery. For the last few months of my drinking and several months of sobriety I was close to death. My goal was simply to survive, and in the beginning the hope seemed slender that I would.

I drank alcoholically for ten years — from my first bender when I was 18 to my last drink when I was 28. I crossed the “invisible line” early on, in terms of blackouts; hangovers, with horrible headaches, shakes, and wet and dry heaves; and disasters in my personal life. But, like many alcoholics, I deluded myself. I was a combination of daily drinker and periodic drinker. My father had counselled me that men became alcoholics because they didn’t know how to drink — implicitly, that they couldn’t drink like gentlemen — and I tried to drink the right way. For a decade I drank daily, usually as a moderate-to-heavy social drinker. For long periods of time — for months or even a year once — I could drink like this, and assure myself it was all right. However, periodically, with no warning whatever, I would lose control, and then anything could happen. And in time the drinking got worse. A lot worse.

My father in his day was an outstanding athlete, and our home was saturated with the jock ethos. Although I didn’t have what it took to be a star, I was on the track team and was a good swimmer. In my freshman year at college I learned a calisthenics routine, which has remained with me ever since, in alcoholism and in sobriety. All during the decade of my alcoholic drinking, I continued to exercise. Every day I took a strong vitamin B-complex capsule, having read somewhere that this lessened alcoholic deterioration. On the outside I looked good enough; on the inside my body was being destroyed.

Things changed in the last year of drinking. My tolerance fell. Even a small amount of alcohol would upset me, but at the same time I could no longer get drunk. Two images come to mind: one is sticking my finger in an electric socket, the effect of the first drink; the other is a sieve, alcohol going in, but nothing happening. I was not well, but didn’t know how or why.

On Thanksgiving Day 1967 I had dinner with a friend, whose father brought a bottle of Old Overholt (100 proof rye, regarded by some as the Great American Whiskey). Apparently we finished it together, although I remember nothing. Another friend escorted me home. In the middle of the night I woke up, as though struck by a thunderbolt. I couldn’t get air in my lungs, and my heart was going wild. I was shaking violently, as though my body were a rag doll being rudely shaken by a giant hand. I heard and saw things that weren’t there. These were delirium tremens, the DTs, although I didn’t know it — only that I was fighting for my life.

My body burned up in the next month, although I remember very little. In this month I had one convulsion (alcoholic epilepsy), which I know only from the after-evidence: waking up with my face and pillow and sheets covered with blood. I had bitten a small piece off the tip of my tongue, and it was still bleeding. Somehow I stanched the bleeding with a styptic pencil. In my madness I never called for an ambulance, being in terror of doctors and hospitals, and not knowing what to tell them.

Of the few bits and snatches I remember from this month, one memory is looking at myself in the mirror, and seeing a feeble, shriveled old man, a deaths-head, a starving prisoner liberated from a concentration camp. Another memory is discovering my wasted upper arm, where I could put my hand around it, thumb and third finger meeting, as easily as I could around my slender wrist. During this month I may have wandered out of the apartment, and I may have continued to drink, but I remember nothing.

Towards the end of December my friend Andy found me. He had been sober in AA for one month, and thought he was ready to do his first 12th Step, with me at the head of the list. Andy told me that I was in end-stage alcohol withdrawal, the DTs. Since I refused to go to a hospital, Andy did the next best thing — he got some orange juice and gave me one of his girl friend’s Valiums. This helped. My shaking subsided, and my heart relaxed a bit. I was able to eat some food.

Then Andy explained alcoholism and AA to me. Alcoholism is a progressive disease, which is fatal unless arrested. It can kill in a hundred ways: from accidents, murder and suicide to cirrhosis of the liver, pneumonia, strokes, and DTs. In the past, a few individuals were able to stop drinking on their own — like Dashiell Hammett — but this is very difficult. It is much easier with the moral support of other recovering drunks. AA members help each other stay away from the First Drink, a day at a time, and help each other rebuild their shattered lives.

Andy believed that one had to attend a beginners meeting before attending a regular AA meeting, and so we waited for three days. On Thursday, the beginning of January 1968, Andy and another AA member helped me walk across town, from my apartment in Manhattan’s East Village to the Perry Street Workshop in Greenwich Village. I sat there shaking, my teeth chattering, unable to focus my eyes. People said I should go immediately to a hospital, but I refused, saying that I was there for my first meeting — so they covered me with overcoats and set an electric space heater in front of me. It would be an understatement to say that I identified with the man who spoke. Everything came together. I experienced hope and an intense desire to live.

That weekend Andy had a relapse and disappeared, but I was  not alone. I had a meeting list and phone numbers. People were good to me, and I got to know very well a cohort of people who came in when I did. Although Andy never did achieve lasting sobriety, he saved my life. He was the only sponsor I have ever had.

My Physical Recovery

Some things happened very soon in sobriety. Within days the whites of my eyes became white again, not the dark yellow they had been. I no longer had hangovers. Coming out of alcoholic anesthesia, I experienced new alertness and energy, and for several days was unable to sleep at all. I was able to get around, but was still very weak and thin. When I got on a weight-balance scale at the corner drugstore, I weighed 105 pounds in winter clothes — and I am 6 feet tall.

But I was still in withdrawal, still shaking, even weeks after my last drink. My heartbeat was irregular, my skin was an unhealthy greyish color, I could not really focus my eyes, I felt as though I weren’t getting air in my lungs, and I was weak and emaciated. I went to at least ten meetings a week, and got to know people. To everyone I put the same question: “What do I do to stop withdrawal?” Some of them said that I should go to a doctor, but I hesitated, having heard too many stories about relapses and deaths caused by doctors. The consensus at Perry Street was that only three doctors in New York could be trusted with alcoholic patients. Others said that I should meditate or pray or work the Steps. One guy, a body-builder, took a special interest in me, perhaps because I reminded him of the 97-pound weakling in the old Charles Atlas ads; he said I should lift weights, and he would be my trainer.

My breakthrough came at Grace Church (Broadway and 10th Street in Manhattan), which used to have a large speaker-discussion meeting on Saturday evening. The woman who spoke was a matron who lived in one of the best suburbs in Connecticut. She was a secret drinker, who had successfully deceived her family up to the day they found her having an alcoholic convulsion on the living room floor. Since she had mentioned a convulsion, I went up to her after the meeting: “What do I do to stop withdrawal?” She looked at me, listened to my story, and took charge.

Early the next morning I received a call from the nurse of Dr. Frank Seixas, the top alcoholism specialist in New York. Because of the urgency of my case, he agreed to see me the same day. After examining me he tried to have me admitted to a hospital, but was unable to find a bed. In those days alcoholism was considered more a moral than a medical issue, and alcoholics were low priority.

At any rate, he believed that I was suffering from hypoglycemia, and gave me a glucose tolerance test the next day. After fasting before the test, I drank a bottle of sugar water, and then urine and blood specimens were taken every half hour. The results were dramatically decisive. My blood sugar levels rose initially, and then suddenly crashed, owing to an over-production of insulin. Although the test was supposed to last for five hours, it had to be terminated early to prevent me from going into insulin shock. I was given a snack and sent home in a cab, since travelling on the subway would have been dangerous.

The primary treatment for hypoglycemia is diet: no sugar, almost no simple carbohydrates (like white flour products), little or no coffee or tea, and six small rather than three large meals per day. In retrospect it is clear why I was still in withdrawal two months after my last drink. I was going to as many as three AA meetings a day, and at each I would drink several cups of coffee with sugar — a deadly combination for someone with hypoglycemia.

Three days after going on the diet I was on Fifth Avenue, waiting for the traffic light at 46th Street. Suddenly, as I began crossing the street, everything changed: I felt oxygen coming into my lungs, my eyes focussed, my heart relaxed, my skin became warm, and I stopped shaking. In this moment I knew that I was going to get better. When I got back to the office after lunch — for I had returned to work, even while still in withdrawal — my co-workers were amazed at the difference in my appearance.

The next week Seixas told me that I should join a gym, that exercise was an essential part of my recovery. I said I was too weak to exercise, but he smiled and said that I would like the YMCA on West 63rd Street. So I joined it and bought a gym bag and clothes. In the YMCA exercise room I cautiously did part of my old calisthenics routine, and then thought I might try a few pushups. Getting down on the floor in pushups position, I pushed as hard as I could. Nothing happened. My poor wasted arms couldn’t even begin to push me up. But I was still young, and my body was healing itself. Within a few months I was doing pushups in sets of ten. Within half a year I was joyously doing difficult exercises on the high bar and rings. For many years I continued going to the YMCA at least twice a week.

I continued seeing Seixas for a year, and we became friends. He always saw me at the end of his day, and we would talk for as much as an hour, about his concerns as well as mine — his frustration at the ignorance of his medical colleagues. Even after I had become a senior executive with a high salary, he continued to charge me the ridiculously low fee he had at first.

After I had been sober for a year, Seixas gave me a complete physical examination. When the results came in, he was delighted to tell me that I was in good health, and that my liver was as good as anyone else’s. I had a great sense of physical well-being — and gratitude for being alive.

About this time Seixas gave up his private practice in order to become Medical Director of the National Council on Alcoholism. His mandate was to enlighten his fellow physicians, who learned almost nothing true or useful about alcoholism in medical school. I never saw him again, but continued to follow his recommendations on diet and exercise. When he died there was a long obituary in the New York Times:

Dr. Seixas campaigned for society and especially the medical profession to recognize and treat alcoholism as a major health problem rather than as a moral or behavioral lapse. (NYT, 11 May 1992)

At this point let me backtrack to say that I gave up cigarettes at the same time I stopped drinking, because I wanted to give myself every chance to survive — and I had been a heavy smoker. What nicotine withdrawal I might have experienced was overwhelmed by alcohol withdrawal. Many years later I had a cigarettes relapse, which lasted for a few months, and knew the full agony of nicotine withdrawal. I stopped cold turkey, and suffered for about five days — but even as I was desperately craving a cigarette, I was starting to feel better.

I have told my own story, which will not apply in whole to most recovering alcoholics. Over the years I have met others who also had DTs and convulsions, but we are rare birds. Most alcoholics either die or stop drinking before reaching the stage of terminal alcohol withdrawal. Once alcoholics are on the edge of death, most of them don’t stop; they go on to die. Those of us who escaped at the last moment are the fortunate few.

By and large my health over the years has been good, but not without temporary setbacks caused by dietary slips. These would creep up on me — a bit of pasta here, a potato or dessert there, and before I knew it I’d be eating several bowls of ice cream before going to bed. The consequences were predictable and not nice: fatigue, high blood pressure, grogginess, overweight, and type 2 diabetes. After going back on the diet, these health problems would all go away. I am almost 74 now, and still go to the gym twice a week. At home I do my old calisthenics routine and use a rebounder. In summer I ride a bicycle, sunbathe and swim in salt water.

I should say a few words about hypoglycemia, since this condition not only caused the “protracted withdrawal syndrome” in my case, but affects most alcoholics to some degree:

There is no question that the great majority of alcoholics suffer from chronic low blood sugar. When given the 5-hour glucose tolerance test, over 95 percent of both early- and late-stage alcoholics experience a spike in blood sugar level after intake of sugar and then a rapid plunge. If their erratic blood sugar level is not controlled, alcoholics suffer chronic symptoms of depression, irritability, anguish, fatigue, insomnia, headaches, and mental confusion. Worst of all, low blood sugar causes a craving for substances such as alcohol and sweets which can quickly raise the blood sugar and relieve the symptoms. Sober alcoholics, therefore, must learn to control their sugar intake in order to avoid mood fluctuations, anxiety, and depression, and recurring impulses to drink.  (James R. Milam, Ph.D., and Katherine Ketcham, Under The Influence: A Guide to the Myths and Realities of Alcoholism)

Under The Influence is, in my opinion, the best of all books on alcoholism. It has a full discussion of hypoglycemia, including sample diets — as well as the hypoglycemia controversies, in which many physicians came to believe it was a “fad” disease, a psychological problem — just as they believed that alcoholism itself was a moral or psychological problem. To the contrary, Milam and Ketcham put forward the biogenic approach: “Alcoholism is a physical addiction — not the symptom of a psychological problem.”

There is more to be said about physical recovery, although I hope I’ve touched on the major bases. There are also other areas of recovery for alcoholics — financial recovery, social recovery, intellectual recovery, psychological recovery — which have little, if anything, to do with “spirituality”.  But these are topics for other discussions.

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