Some Observations on Alcoholism
Discuss this article on the EA Forum here.
Like my previous post, I am going to disclaim this one with a rare content warning. Despite this the post does not deal with the standard subjects for these warnings, such as abuse, rape, or suicide. It does, in a sense, deal with self-harm, but not the conventional sort, but rather the kinds that come from addiction. It is probably worth disclaiming though that more conventional forms of self-harm also often accompanied this addiction, as the two became very closely linked for me which might warrant mention as part of my broader set of warnings, but I don’t plan to deal with it here. It was always something of a side issue to me, and discussion of it has often derailed discussions when I have gotten into it more.
Ultimately the main reason that I am writing this content warning is that, despite not specifically getting into these more classically traumatic topics, this post will be blunt, and in many places quite bleak. It is also somewhat unrelenting as written, it is one of my longest blog posts to date, and it is easily my most personal. I’m hoping it can be helpful and insightful for many readers, but if you don’t want to spend a while reading a quite personal and depressing account, I think this post is not for you. The very short summary of it is that I have been an alcoholic for about three years now, at the height of which the problem got very bad. This is a set of observations from this time, the types of ways it has and hasn’t changed my perspective, and roughly how I got there.
What follows is a set of loosely organized thoughts and observations concerning my time as an alcoholic which has spanned from roughly mid 2020 to the present, with the most serious and obvious period being late Fall of 2022 into early Spring of 2023. I am writing this for several reasons. The most obvious one is that I think it is valuable for someone who has intimate experience with a particularly unpleasant, unusual, or misunderstood medical/life experience to share what observations they have in whatever detail they are willing. It might help others understand the subjective experience better, make relevant choices differently in their own life, or just flesh out the abstracted data one can get in aggregates with some hopefully representative elaborations.
Another reason is honestly just to get it off my chest. I have had more than enough of that in a way in the form of therapy and one on one conversations with people, but it has almost always felt to some extent like there were too many cooks in the kitchen – people pushing back on, or analyzing, or in some other way poking at my account of things, which has its value in theory (though it rarely led me to change my mind on very much in practice) but feels quite different from feeling free to just dump my own account of specifically what I think about the events that have happened, and writing lengthy oversharing essays and emails has often been my own way of trying to make sense of what I actually think about what’s going on, and it provides a type of catharsis that always seems missing in these conversations and therapy sessions.
But a third reason is maybe even less interesting or deep, which is that it is a way to “go public” about my problem. Perhaps the most cliched image of the alcoholic experience is someone who drinks to a clear excess in public and makes a fool of themselves, often a middle aged man for whom it has been happening for years, who only admits to being an alcoholic after an intervention by all of the loved ones who already know that he is obviously an alcoholic, even if he doesn’t. This is an interesting depiction, because there is a clear turning point, a single person who needs to know you are an alcoholic before it is a fully recognized problem, and that person is you, the alcoholic. In a way it is all very convenient, the ambiguity and privacy of the ordeal is removed. This was not the case for me. I live alone and have for almost the entire period of my alcoholism. I drank in public sometimes but not terribly often, and sometimes when I was drunk in public no one else knew about it because I had practice at not behaving drunk.
There were various points when people pointed out my drinking and commented on it, sometimes they would express some concern, or sometimes would jokingly call me an alcoholic, but in each case I would adjust my behaviors enough that it didn’t look terribly concerning in the future and mostly the people who commented at all would drop it. This is where perhaps I want to once again offer disclaimers similar to those in my previous post. This is not an invitation to read further into more ambiguous evidence of alcoholism. There is a bit of an arms race dynamic here, where the less it takes to make someone suspicious that you have a problem, the less of your behavior you will be public about, and consequently the less it will take to make someone suspicious, and once again, the yet less that you will share. It ends with the problem being almost entirely internalized and secretive, and non-alcoholics being virtually indistinguishable from alcoholics in the public eye. Best to stop before getting that far down this road.
My situation is basically the reverse of the stereotypical middle aged public alcoholic with the family intervention. I was the very first person who knew I was an alcoholic, and I spent years trying to address it on my own, even as I was uncertain myself whether I should even consider myself one. Gradually I told more and more people as logistical necessity or just plain closeness to them made silence unworkable, and in each case it was like pulling teeth. Some of the time I did it while drunk in a very uncontrolled way because that was the one time I would be impulsive enough and when I wouldn’t feel so bad about it. I messaged at least one chat I was on with a pretty simple and blunt exclamation that I was an alcoholic, which received no interaction from anyone except for the one person on the chat who already knew, and which I subsequently deleted the next day. At least one other time that I accidentally told someone about it, it did stick, that one was brutal, possibly the most brutal I went through, given the way and time I said it.
Given all this, it’s hard for me to just tell everyone I know one after another, or even decide that if the topic ever comes up again going forward, I’ll just be completely blunt about it rather than hiding it to some degree or dancing around the topic. There will never be any clean way for me to just get it all over with at once, especially since most people I know don’t read my blog, but at the very least this feels like an important symbolic step, a point of no return. I’m hoping it will make it easier for me to just be less secretive about it, knowing that whatever denials or coverups I use with people going forward will be easy to debunk with a single quick google search. Even if I’m not super open about it, there’s no hiding now. I will also talk about what various aspects of alcoholism are like, in quite general terms. Note that this is largely my personal experience, and others might have different ones, but constant disclaimers or rewordings would break the flow of how I wrote this, so I just want to offer this one disclaimer at the beginning instead. So without further ado, these are my thoughts on alcoholism, as I have experienced it.
What it feels like:
One thing that I think people on the outside of this get wrong is the way conscious and unconscious feelings work in this context. I have been asked many times, especially in therapeutic contexts, what it feels like to get urges to drink. Truthfully, it doesn’t feel like much of anything as far as I can tell. It isn’t like thirst or hunger where there is some identifiable physical sensation. The easiest description of how the “urges” start, is with intrusive thoughts. Not necessarily something as consciously obvious as “hey, you should drink”, but often more abstract things about drinking. “Do you think you’re going to drink tonight?” “what happens if you drink tonight?” “what happens if you don’t drink tonight?” “if you do this, then you can drink tonight”. Argue with these, and they keep going all day until you drink. Drinking, in fact, is largely how you settle the argument, how you release the building tension.
Do not argue with these thoughts, it does not help, or at least helps very rarely, especially when they are persistent. Not arguing isn’t perfectly adequate either. Ignore them and they aren’t replaced either by silence or by an identifiable urge sensation like hunger, but rather by, when one reflects on the idea of a night without drinking, a vague sense of sadness, even of indignity, at being cheated out of drinking when all the other surrounding nights you got to, and one night won’t make a difference anyway, and your reward for good behavior is to wind up getting punished by being denied alcohol.
By all means, replace the reward if you can. I have found it difficult because anything I might have wanted to do if I stayed sober, I would do when I drink and get too impulsive to control this incentive. Make it an incentive that you actually can’t do well when drunk, something like playing video games or something else you know is too active for you to actually do or to do well when drunk, that could help. But even that may not last. Eventually you convince yourself that you will do this while drunk anyway. Then you will get drunk and not do that thing. You wind up in the increasingly disheartening position of spending every day looking forward to activities you won’t do, either drunk or sober, that you used to greatly enjoy. Sometimes it was even something that used to specifically be an enjoyable part of drinking, but now isn’t part of it at all, as you get drunker and drunker on the nights you do drink. You get to a point where you do virtually nothing while drunk, you lay around, trying to stay awake and watch some low effort shows or videos. The only reason to avoid just passing out at a certain point is that if you don’t drink enough water you will have a massive headache the next day. Sometimes you pass out anyway, wake up a few hours later, and cram down pain medicine and like a liter of water as fast as you can.
So what does alcoholism feel like? It doesn’t feel like developing a hunger analogue for alcohol, it feels like reasoning with a brain whose circuitry has been altered so that normal feeling thoughts point in unordinary directions. It feels like going partially insane.
This has convinced me, to whatever degree I wasn’t already convinced, that various day to day activities that give people’s mental circuitry a reward signal can create genuine full-blown addictions, given the right pre-existing chemistry and frequency of use, things like gambling and sex and even exercise. Withdrawal may not be so devastating, but the addiction isn’t to some magical alcohol chemical, it is to dopamine, and it feels like the same old thoughts that normally direct you towards things that gave you this reward in the past, but dug into a canal that all thoughts wind up flowing down after a while.
I remember during the longest period of sobriety I’ve had in nearly two years, I dreamed of getting my hands on alcohol and drinking every night for days. I didn’t feel good during these dreams, I felt shame, I didn’t feel regret that it wasn’t real when I woke up, I felt relief. But I think this is a good summary of what addiction eventually is. It is this persistent new aspect of the architecture of your mind, where that mind drifts and gets caught up. It is barely even a desire, much less a feeling.
If there is something that winds up working at this late stage, it is just putting yourself in a position where getting more alcohol isn’t logistically feasible. Eventually the thought becomes less salient if it isn’t even an option. Eventually the sadness and indignity get duller. This is especially true if you are going to spend time with someone, or do some fun, distracting activity throughout the rest of the day and especially night.
Some alcoholics I have met who seem to have coped better than I have were living with a significant other when I met them. This is strongly strongly recommended. Virtually no strategy I have devised for succeeding on my own has lasted very long. Something as simple as staying the night with a family member has worked virtually every time, even without further monitoring, even with additional alcohol in the house, even when sleeping in a separate private room. Pretty much the worst situation you can be in is living alone in a tiny studio apartment in the city that never sleeps.
All this is how things went for me, I expect it varies a good deal individual to individual. Someone who became an alcoholic while they lived with someone else rather than while they lived alone might find some of the more personal strategies more important as long-lasting breakthroughs, and staying with someone else to be, barring stronger control measures by that person, largely useless. Ultimately, the most important thing might not be any specific strategy. Any specific strategy, in the long run, can fail. Either because it is not strict enough, or because you can’t implement it forever. The important thing is to go further than seems strictly necessary at the time, closer to the last resort than just the next resort, to try to reach escape velocity. Otherwise getting to escape velocity may mean riding the next resort all the way down to the very last resort anyway. Maybe you will know this already to some extent already, but it will be hard to feel justified in strong measures before you have reached a really bad place. I can’t really deny this sense, but if you are at a point where you think something likely to help is just at the edge of your justificatory range, then at least do that.
So that’s the “feeling” of the alcoholism itself. In sharp contrast to this, and to go on a bit of a tangent, I get the impression from what people have written about it, including people with experience in medicine and psychiatry, that a common misconception about the addiction medicine Naltrexone is that it acts largely through unconscious reinforcement (or deinforcement). That you don’t notice any effects at all at first, but need to keep taking it over a long time, and over time drinking just becomes less appealing to you without any obvious sudden change in sensations along the way. I’m sure this is partly true, but the effect is facilitated pretty… directly, at least in part. The urge to drink alcohol doesn’t feel like anything in particular, but the reward from drinking alcohol does – there’s a reason people drink, it feels good.
Naltrexone works the very first day you take it from my experience. When you drink, the reward sensation is gone. You don’t simply feel vaguely unfulfilled or something, the good part of the drunk feeling is just gone. The only place that I did research that acknowledged this rather than using vague wording about gradually reducing reward was the documentary “One Little Pill” about the Sinclair Method of using Naltrexone. The documentary is pretty anecdote based, and like most documentaries of its type I am virtually certain it massages the evidence significantly. But it got this part right, and I wish more actual doctors would too – if you generally drink a good deal, at least liquor where the euphoria normally hits quickly, you notice Naltrexone the first time you try getting drunk on it.
I am, to some extent, in awe of this medicine, and think it is genuinely very useful for people to know about when planning how to reduce consumption. It is also pretty risky, which few people were anxious to tell me. The dirty secret of Naltrexone, which I am almost hesitant to even mention (I think it might be worth being warned right off the bat overall), is that if you drink enough, you can get some of the euphoria back. You have to drink a truly disgusting amount, and you only get a little of it back, but you really really don’t want to do this. Aside from the obvious issue that drinking this much is a bad idea, the combination of remaining mental impairment and lack of a notable part of the sensation of being drunk makes you not realize how drunk you are, and not feel as much restraint. On top of this the Naltrexone adds some extra strain on your liver. The combination of these things means that if you try to drink enough to overcome the medicine, you will feel very sick the next day, and if you keep doing this repeatedly you might be in pretty bad trouble.
Taking Naltrexone is valuable, but also to an extent it is something of a game of chicken. I have never heard this advice myself so I would like to share it now: Naltrexone is a more amazing and a more terrible medicine than I have seen anyone really acknowledge – consider having it as an option, but be careful.
I think an obvious thought that people will have about my alcoholism is that it relates somehow to my Effective Altruism. This is understandable, as I am highly involved in Effective Altruism, and there are various reasons that Effective Altruism might make practitioners more stressed and perhaps in need of certain coping mechanisms. I want to explore the degree of the connection somewhat, but my ultimate conclusion is that my involvement in Effective Altruism has had relatively little to do with my overall trajectory.
I started drinking during early 2020, when as far as I can tell there was no special drama going on with Effective Altruism, and I had already been involved with it in a similar capacity for a couple years. Most of the alcoholics I’ve met at this point either got started or got significantly worse during the pandemic, I was no different.
But the truth is my drinking even then wasn’t terribly dramatic a coping mechanism. There was never anything that meaningfully “drove me to drink”. The idea that drinking at this point could land me here wasn’t part of my decision at all, I was just kind of bored and lonely and decided it would be a fun treat to drink a beer or two at night – something I had very rarely done before.
As the pandemic wore on, it became something I looked forward to more and more, and eventually I discovered the appeal of hard liquor, which I never switched back from, and eventually I started working on my thesis for my first MA. The combination of my thesis and hard liquor turned a casual habit and minor coping mechanism into something more obviously hard for me to let go of. Over the course of the next three years things got slowly worse from there, and I came to realize more and more how little control I had.
It wasn’t some meaningful part of the larger story of my life, replete with a buried darkness in my soul coming to the forefront, or a unique challenge driven by terrible circumstances. I have had to push back in therapy repeatedly on these subtler and more interesting attempts to make something of the event. The truth is sober reflection makes it all look like little more than a meaningless tragedy.
Over this time period Effective Altruism played very little role in my alcoholism. The closest it came was for a few months starting around April of 2022, when the combination of Yudkowsky’s Death With Dignity post and the various AI advancements released around the same time caused me to look into AI risks more than I had been, and for them to suddenly feel real in a way they hadn’t before. During this period I was regularly wracked with fear and sadness, especially at night, and often drank more just to forget a little, just to get to sleep. Ultimately this improved after a few months, and I can’t really tell to what extent even this made my drinking worse in the long term.
Aside from this, the main way the various stresses of Effective Altruism interacted with my drinking was as one of a longer string of day to day issues that I handled poorly as a result. I was sober for the first time in months, for instance, around the same time that both the FTX collapse was announced, and that I unrelatedly got sick with some kind of cold. The result was that I spent about three days doing almost nothing but staying inside feeling crappy and doomscrolling in real time about the most devastating event in the history of the EA movement. Needless to say I drank every one of these nights. It is arguable whether this had a long-term effect on the trajectory of my alcoholism, but at the very least it occurred at basically the worst possible time, and wound up diverting me from what could have been a major turning point, and instead back down the same track I had just left, and which I wound up just going deeper and deeper down.
Aside from this, miscellaneous other scandals also drove me to drink, never at as crucial a point as FTX, never for as long as the 2022 AI terror, but sometimes to a quite significant degree, extending to day drinking and on days that I otherwise might have met my withdrawal goals. I also at various points had interactions with other EAs that were polluted by my drunkenness, often oversharing or uncharitable. Some of these were only a little regrettable, others were humiliating, and I still think about them regularly. Few if any led me to revealing my problem in a way that stuck – the closest I came was the group chat message mentioned in the introduction.
A final way that Effective Altruism could affect alcoholism is perhaps the oldest part of the Effective Altruism canon – your resources can do much more good in other hands, and at the very least one should prefer to spend on the good of those who need it much more than on trivial expensive luxuries. The occasional drink perhaps doesn’t merit strict personal control for any but the most ambitious altruists, but this was not remotely my situation.
Every week or so when I took out the recycling, I was reminded by the avalanche of bottles I poured into the recycling, that I was voluntarily paying a small second rent for the privilege of slowly killing myself. This would be bad enough news for someone who knew they were going into debt for their schooling anyway, but for an Effective Altruist it is hard not to think about how many lives are being lost to this self-destruction on top of it.
At first this is one of many things that can be motivating – it is a very inspiring Effective Altruist story to say that you managed to make yourself stop drinking because you felt you had a moral duty that this was keeping you from meeting. It is, at least by a certain point and in my experience, one of many framings that worked and then worked less and then stopped working. This is all the more disheartening – a sense of purpose is the thing I’ve felt most in need of for pulling myself up, and everything I appeal to in this regard gets worn down and abandoned in time. A sort of gradual moral injury, and erosion of identity.
There was, however, one unexpected piece of good news in the midst of this depressing spiral. Moral action that had a constraint rather than benefit flavor was not a place where I recall ever faltering. Most notably I would have expected to slip up on my veganism occasionally. This would not have been the end of the world, but I do feel a certain comfort, a retention of moral identity, in the fact that this never happened. I was never so impulsive that I just decided “eh, who cares, what does one piece of cheese matter?” Likewise I can’t think of other moral boundaries I consider myself to have crossed. My communications with others while drunk, especially very drunk, were occasionally too impulsive, oversharing, uncharitable, or just nonsensical, but when I said something I latter regretted it was never something that I thought would be bad in the moment. This is little solace in some cases, and mostly I have just tried hard to avoid much contact with others at all while drunk, or at least figured out ways to attach disclaimers about my state when I sent a message (but never so often that people could figure out that I had a problem).
Another thing I have considered throughout this is how my experience may have changed my ideological views on other related issues. The most obvious one is how I think about alcohol in society more broadly. I’m going to give you the perhaps unsurprising spoiler that I didn’t suddenly become a prohibitionist. Maybe the more interesting question is if I became a teetotaler a la Tyler Cowen. This position is perhaps unusually common and influential within my ingroup already, in part because of Cowen’s influence – the idea that alcohol is a highly dangerous drug that society recklessly encourages people to use in a wide variety of situations, and which we should voluntarily abstain from, and perhaps heavily regulate and tax. This is not on the face of it an unreasonable position, and I didn’t think it was back before I was an alcoholic either.
Contrasting the way our society treats, for instance, cigarettes and alcohol, is rather astonishing. Both are very harmful addictive drugs, but drinking is widely advertised and something that most people indulge in fairly regularly, which is casually promoted all over popular culture, whereas smoking is now nearly taboo. Most people, especially in the US where I live, don’t smoke, its promotion is heavily frowned upon and regulated, there are basically no occasions where it is simply expected as a social default. Can a difference here really be justified?
Here is where I want to step back a bit from my main goal of this post, which is to really explore my own experience, and to try to view this from a broader social angle. I think it is perfectly consistent to both believe that it would have been better for me if society treated alcohol more like cigarettes, but it would be worse for most people. Unlike smoking tobacco, alcohol is something of an event for people, a way that they can unwind at the end of a long week, or socialize in a different and more enjoyable way, I think the difference is quite genuine in that I have a hard time picturing much that nonsmokers are actually missing out on. Most people, it seems to me, have a relatively positive relationship with alcohol, this is something I really don’t want my own experience to distort.
It is likely that those who have an unhealthy relationship with alcohol have a more dramatically bad one than the good experiences are dramatically good, but given the difference in numbers I don’t want to get ahead of myself on the aggregates, and overall I hesitate to recommend that people disappear alcohol from many public rituals. More understandable is treating alcohol more carefully within this framework, being extremely unpushy about drinking, not engaging in events where being drunk is basically expected, glorifying it less in the media. And really avoiding drinking alone. But I don’t feel some righteous anger at the thought of a group of students or workers going to a bar on a Friday night and laughing over a little too much booze.
I’m even torn on sin taxes in this context, is there a happy middle where they effectively reduce the number of alcoholics without being really costly to those who do become alcoholics? It’s a question I rarely seen asked, as the defense of these taxes is heavily focused on just reducing consumption, but there’s something to be said against paternalist measures that make a behavior even worse for someone’s life if they do engage in it, I’d need to see research on this to form a solid opinion. Overall, despite intimate experience with the grounding of the Cowenian worldview and a good deal of sympathy and respect for it, I remain skeptical of most of the measures he seems to encourage. It is possible this is just my bias against social conservatism and paternalism generally, I am at least on the fence.
Given that this is a matter my opinions have changed relatively little on, I also want to look at a couple of more subtle ways my outlook has changed. Maybe the biggest one is related to withdrawal. I always had the sense that alcohol withdrawal was unpleasant, but it wasn’t until I started researching it because of my own drinking that I realized just how dangerous it can be. Rapid alcohol withdrawal has a non-ignorable chance of causing seizures and even death, on top of the more typical unpleasantness of it. This is true of several depressant drugs like benzos and barbiturates, as your body gets used to chemical depression and behaves abnormally when it isn’t being depressed.
This has been especially notable to me because of a typical attitude towards the homeless I often see people express. In particular, the idea that if you give them money, they will just spend it on alcohol or other drugs. Considering how common alcoholism is amongst street addicts, the pseudo-benevolent tone of this worry bothers me. To begin with I have always been uncomfortable with arguments like these for the simple reason that it wouldn’t feel like justification to me if I was in the position of the person on the streets. It would come off as a rather hollow “you aren’t worth the risk” from someone who clearly would forget about the money they just spent ten minutes from now. Learning more about things like delirium tremens has given me a different, more serious worry however.
If you do expect someone to spend this money on alcohol, then you are, in expectation, probably not helping them by refusing to give them the money. It is strictly safer for long-term alcoholics, who live on the streets with poor access to quick help or healthcare, to continue taking the drug they are on in roughly the same way for longer, than for them to be rapidly withdrawn. Maybe you could argue rapid withdrawal is safer than staying an addict forever, debatable but not implausible to me, but you have to consider that all you are accomplishing is short term rapid withdrawal, it is very unlikely to make much marginal impact on how likely they are to stay an addict anyway afterwards.
The very best-case scenario is that the person uses this money for some alcohol but less, and they go through a gradual withdrawal. This is not something you can remotely guarantee with your money one way or another, and even someone living on the streets who’s motivated to do this will have a very hard time holding themself to it. My own successful gradual withdrawals took months as a rule because I failed to meet the target amount so often, and I had a much more supportive environment and people to check in on me. Homeless addiction is a very hard problem which you are doing a very bad job of helping by just refusing to give money to homeless people who ask for it. Insofar as there is any plausible scalable solution, it has to be a policy one that for instance gets homeless addicts into an environment where withdrawal and monitoring is possible, and relapse can also be monitored and mitigated. 1
The other way that this experience has shaped my perspective somewhat subtly, is that I am increasingly worried about the impact of different psychoactive drugs on movements, which once again brings me back to the Effective Altruism movement. A quite obvious, and frequently discussed class of drugs in this vein is psychedelics. Now I like psychedelics as a rule, they have shown early promise in reducing some of the most severe forms of human medical suffering on earth, when little else helps. But they can be used for manipulation and abuse, and in the Bay Area EA scene in particular this seems to have become a problem among adjacent figures like Michael Vassar and Ziz.
Additionally many EAs use stimulants for a combination of ADHD/concentration problems, and as nootropics to work more efficiently. I don’t know how much people have written about worries about the impact this can have on EA behavior more generally, but I recall one memorable interaction with an EA who seemed very hyper and as though they might be on some sort of stimulant like this, who, in one of the only interactions I’ve had like this, pretty much explicitly and casually endorsed a sort of “naïve utilitarianism”. This was especially worrying for me because of the speculation, largely forgotten now it seems, that part of Sam Bankman Fried’s own behavior could have been influenced by stimulants that he was taking. This is highly controversial, but my own interaction with psychoactive drugs has made this worry more salient to me. Even if the impact is only on the margins, could widespread use of certain drugs among EAs influence certain types of bad behavior in a way that isn’t well recognized?
I have noticed, even more speculatively, behavior among some EA or EA adjacent people that was uncharitable and defensive in a way that seemed familiar to me from my own worst moments having arguments when drunk. It is probably overfitting, but I couldn’t help but come away from some of them wondering how many of the worst of these interactions were influenced by people having them while drunk or otherwise impaired? This is another case where I am almost certainly biased, and should not overthink the relevance of my own experience, but unlike with the Cowenian teetotaling arguments, this is a case where my way of looking at others has genuinely shifted. Most of it is probably a sort of paranoia, focusing on minor things in the grand scheme, but it is an interesting change to live through because they are generally things I didn’t really think about at all before this.
At the very least I think EAs should be mindful to use these drugs in a way as detached from their work as possible if they do use them. To generally treat them as pure recreation or quite targeted healthcare.
So at the end of all these scattered thoughts, I want to try to give some concluding thoughts and takeaways, many of these will just be retreads of earlier sections, but it seems like it will provide better closure to reiterate them in an explicitly constructive way at the end.
I think maybe the biggest takeaway is – appreciate the people around you. This will sound like a cliché but I’m dead serious. Virtually every bit of progress I have undergone has been because of people close to me who provided invaluable help of some sort or another, often at great personal/emotional expense. Others I know who have struggled with this had the luxury of actively living with a significant other, and always stressed how important this was for their progress, my progress has often been slower and my low points lower. I started drinking and it got out of control in large part because of living alone, the most effective tactic I have ever had at my disposal for getting some good nights has been staying with someone else, and nearly all of my self-driven efforts have had modest impact at first and next to no impact eventually. Not everyone is as lucky as I was, some people do not have the connections and relationships necessary to get through this with help. Some addicts, as we have covered, are even living on the streets. It is very difficult for me to imagine how I could muster the strength to escape that situation if I was in it. Don’t be so sure that you could either.
Getting professional help might be a good idea, but the same things don’t work for everyone, so I would be careful. Rehab is very expensive and you can often get some of the same benefits from crashing with someone close to you for a while. If you wind up drinking even when crashing with this person, even if they know that you are an alcoholic and shouldn’t be drinking, then you might have to consider something more drastic. One on one therapy has never helped me much with any of my mental health problems and this one wasn’t an exception, but it can be helpful to some people. I have had a much better experience with group therapy, and you might as well. As medicines go, Naltrexone is pretty standard, and although it carries risks and side-effects it can be a very useful tool. I was personally very impressed with the immediate effects it has.
If things are getting bad for you, I would try a measure that seems a few notches more extreme than is strictly necessary, so that you buy enough time to reverse lost progress rather than just slowing your descent. Whatever the most extreme measure is that you can justify to yourself based on where you are.
Being an alcoholic in recovery is not just hard on your life because you will go places drunk and ruin relationships or lose your job or something, all of this is very possible but you will often wind up paying the cost of a small second rent, and losing the time of a part time job. Here’s a depressing factoid you might not know if you don’t spend alot of time in liquor stores – the big ones have shopping carts. And people fill them.
You’re not going to get a “you’re an alcoholic” card. It’s hard not to wait until you’re sure in order to start acting as though this is a problem requiring more serious action, but keep in mind that there is no special reason to believe that some intervention that gives a specific date to when you officially count as an “alcoholic” will ever come. Or if it does that it will come before you are very far indeed. This is worse if you live alone. Your alcoholism is likely to both get even worse, and to be even easier to hide. You need to be the one to decide that you are an alcoholic in this situation. I don’t know just how bad things could have gotten before I ever got that intervention or had people tell me I was an alcoholic if I had waited until then. I could be out on the streets first. I could be hospitalized first. I could lose friends, jobs, school first. I could be dead.
On a more positive final note: things are improving for me. I think I am past the worst of it. I had some really bad times, nearly a year where I was sober for about a week of cumulative days, with some days in which I drank three or four separate times in the day, or couldn’t work on my papers without being drunk, and at least one 24-hour period or so over which I stacked up a cumulative 40 standardized drinks. But the worst of it happened in a relatively short time span, and while I was still young. It is possible that my life is in expectation years shorter, but I think there is still time to avoid it being decades shorter. I have not fully recovered yet, but I probably won’t know when I have until long afterwards, and it’s not going to be clear how long to wait.
Since I have mentioned the relationship between my drinking and my Effective Altruism, I should maybe finally end with the confession that I am anotherburneraccountsorry, the author of “Advice for an alcoholic EA”. I regret to say that little came of this post. While people brought up potentially helpful advice and resources, I never got around to reviewing them in the way I had planned to, as the rest of my treatment picked up in terms of time commitment, and my other commitments outside of it did as well.
One thing that I asked, and which seemed to come up briefly in the comments as well, was that it might be a good idea to set up some kind of recovery group for EAs struggling with substance abuse. While there are other EA mental health initiatives, ones more like group meetings seem less common, but I think I would feel especially eager and able to be helpful and be helped by people who have some of the same background references and concerns and beliefs, at least it would help when airing out certain topics. Something as simple as some informal recovery meetups, in person in major hubs and/or remote ones for EA more broadly could potentially be helpful to many people.
If there is something I could concretely do to help setup or participate in a group like this, I would be happy to. If anyone else wants to do something like this, I would support them in it. At the same time, as I mentioned in this post, there is a risk of becoming too inward facing or getting too reliant on this one group for even major life events that aren’t as directly relevant to it, so I don’t want to remotely discourage people from attending different groups, even if one like this does get set up.
On the other hand… one of the most inspiring things I ran into during my period as an alcoholic was just a couple videos by Victoria Lynn Carroll on her experience with alcoholism, someone I mostly knew about through a single funny sketch on rationalist twitter handles, and whose level of involvement with EA or rationalism is unclear to me. I wouldn’t have run into these if it wasn’t for my involvement with the EA and rationalist communities, and it’s not clear they would have meant as much to me without that context. Another was just watching the 2022 Secular Solstice recording during an especially tough time for me – I still have The Mary Ellen Carter on repeat when I need to feel some hope and motivation 2 – and it didn’t even touch on addiction.
Despite my sense that separating intimate mental health experiences from EA to a degree can be important for being a richer and more grounded person, it is undeniable to me that I feel a strong need to connect my hardest experiences to aspects of my community and values that provide me with day to day meaning, and that did before I had this problem. It is unsurprising to me that so many religious addicts wind up involving religion very heavily in their recovery. People who compare Effective Altruism to religion are usually making some subtle dig, meant to prove something they lack the arguments to argue for directly, and so hope to imply with more superficial connections… but there is at least some less superficial connection as well, and I think one of more important ones to recognize is the way EA can serve as an anchor point for identity and meaning for people in the community who are suffering from an acute crisis of both. When it comes to cheap or free ways to help people through this anchor point, like informal recovery groups, we shouldn’t pass up the opportunity.
Effective Altruists in particular often have a completely different objection, which is that the money could help someone else even more. I don’t like this objection, explaining in detail my problem with it will probably take me too far afield, though I might write a future post on it, but basically I think it conflates “could” and “would” in a way that defines into existence a normally non-existent causal connection between decisions to give to the homeless and decisions to donate to effective charities. One could make specific decisions that would force a causal connection into existence, but there is no reason to, and there’s a bit of a regress if you follow this “could” through the relevant chain of dominance arguments, so the ultimate reason for giving to the homeless you pass on the streets isn’t “irrationality” or even “warm fuzzies” but that it is just a good thing to do. An objection to EA thinking I have seen Larry Temkin raise is that it can lead someone to moral dilemmas where they have “one thought too many”. I tend to find this style of objection unimpressive, but if we look at it from a more practical and less fundamental lens, I do think various confusions and scope-based biases lead EAs who have an extra thought when they pass someone begging on the streets to have the wrong extra thought, and they should probably act the same way as they would if they were decent people but not EAs in this situation. ↩︎
I can’t resist some defense of what mattered to me in this song in particular. The commentary by Scott Alexander on the song, saying it is about doing the impossible, and comparing it to necromancy, captures something perhaps missing for someone for whom it is difficult to tell what a random sea shanty about sailors rescuing their lost ship could mean to me. Much recovery discourse feels like it is well-trodden, there is a sense that if you are a strong virtuous person, you can just recover eventually. This is mildly infuriating, in a way it is true, but it doesn’t capture the feeling of hopelessness, that really this is the end, that it is unimaginable after trying all of these different strategies, how something could change. For other supposedly impossible things in life, there is less a sense that this is just about finding the inner strength to fix something you can certainly fix, for many matters the very idea of “maturity” comes bound up with the expectation of fatalism. That it’s over, solving it is impossible, even trying is immature. The greatest motivation I think I could find in my position was specifically through defiance of this finality. It is this rejection, specifically, that is so important in the Mary Ellen Carter, not the vague idea of hope or resilience. It is the immature defiance, it is shutting up and doing the impossible, it is the necromancy. ↩︎