Figure 1 shows the abstinence process, including the IAA cycle, Turning Point and Ongoing Processes. Influencing Factors are included to give a complete picture.
The IAA cycle
IAA is short for the Indulgence, Ambivalence and Attempt stages. In Indulgence Stage, alcohol-dependent individuals and their families recognised that the sufferers had virtually no control over their consumption at all. Physical and mental impairment was fundamental. As they attempted to overcome withdrawal discomforts, they became, paradoxically, more alcohol-dependent. Interviewee 26 said,
"When I had physical problems and saw the doctor, they never got better. But I felt good when I had a drink. I started relying on alcohol and started wanting to drink all the time. Drinking would help me feel better."
When there is no control over alcohol, and physical condition is deteriorating, alcoholics and/or their families perceive the issues underpinning their motives for quitting. They may have joined AA or simply stopped drinking by then and/or accepted treatment in hospital. At this stage, the 32 interviewees moved, at their own pace, into the Ambivalence stage.
In Ambivalence Stage, they want to quit, but, still more, they want to drink. Alcohol-dependent persons struggle to make up their minds to give up drinking. They are afraid. It is usually difficult to resist the craving. Interviewee 25 said,
"I'm afraid of life without alcohol. I've been around alcohol for so long it's become a part of my life. Oh! If I had to give it up all at once, I'm really afraid of that kind of bleak existence."
They feel that they still have some control, using their will, and believe that drinking isn't a problem for them, yet. Interviewee 24 said,
"Other people keep pointing out my problem and I can't accept that. I'll admit I have a drinking problem, but I think I can control it."
When first joining AA, some sufferers reject the "Western religious ritual" of admitting that they are alcoholics, and often cannot publicly admit it either. Only two interviewees lingered between the Indulgence and Ambivalence stages (IA cycle, Figure 1) and could not move into the next stage. They would fall back to the Indulgence stage, especially when faced with physical or psychological stress. The other 30 interviewees so feared and felt physical and psychological pain that they eventually determined to overcome their drinking. Once they eventually were able to abstain, they had moved into the Attempt stage.
In the Attempt stage come recognition of deteriorating physical condition and family relationships, and resolve to change behaviour.
In effect, sufferers chose some way(s) to quit, by themselves, and/or seeking treatment in hospital and/or joining AA again. Interviewee 12 said,
"If somebody were drinking over here, I'd just take a different route. I wouldn't pass by anywhere where everyone knows me. We drank together. We know each other. If there's alcohol on this street, this is a street I won't walk down."
However, they often struggle with the craving. They have to go through the frustrating experience of alcohol dependence, over and again, to keep motivated. Escape is possible if they have support from their families and the AA, and, in many cases, a steady job and normal lifestyle. Twenty-one interviewees had successfully given up drinking for a period, but they were unable to overcome the three Influencing Factors and eventually relapsed (IAA cycle, Figure 1). Interviewee 9 said,
"After I sobered up, it was all the same. I still didn't feel good. I still wanted to hurry to get back to drinking again. It was a cycle; recurring over and over again."
Nine interviewees (AA subjects) who clearly realised the chaos and desperation of their situation fell back into the Indulgence stage. They said, "my life is at its lowest ebb", and the feeling was of "having fallen to a personal nadir" (hopelessness, feeling of uselessness or impotence). They then moved from the IAA cycle to the Turning Point. Twenty-one of the 32 interviewees remained in the IAA cycle, and the two of the twenty-one interviewees are still in the Indulgence and Ambivalence stages (IA cycle).
The Turning Point is crucial for alcohol-dependent persons, who now show both destructive and reconstructive tendencies. It has three characteristics: the Personal Nadir, self-belief and acceptance, and embracing the idea of change and self-rescue.
All of the nine AA interviewees suffered extreme physical and psychological pain, and worse than before in the Indulgence stage. These people were again totally controlled by alcohol. Their family situations were extremely chaotic, interviewee 26 said everybody sinks to a Personal Nadir, but this experience is not the same for everybody. If they have not reached that lifetime's Personal Nadir, no drying-out treatment can succeed. She recalled her own Personal Nadir:
"When drinking, I suffered physically and everything was controlled by alcohol. My personal relationships were destroyed, and I could not see where I had gone wrong, so I felt that it was the other person's fault, or my environment, I felt God was not being fair to me, and so I drank. In the end, I was in a state of mental collapse, and I didn't know what to do. I was floating on the verge of death."
In their despair, alcohol-dependent persons may intend suicide through drinking, but mostly, they are also afraid of dying. They "try to commit suicide by alcohol, but just cannot make it." Interviewee 24 recalled,
"I drank until it was really agonising, even when I wanted to give up drinking. My wife said, 'It's up to you if you want to drink yourself to death.' In my drinking days, I really did want to drink to finish my life."
With regard to self-belief and acceptance, alcoholics must admit to themselves that they are drunkards--desperate, often hopeless--and have chaotic lives. They have to realize their condition and search for help, continually, through support groups (for example AA). Interviewee 26 said, "Alcohol is crafty; it's stubborn. It won't quit just because you quit. It sneaks up and catches you."
At this point, they have ideas of change and self-rescue. But the nine AA interviewees realised that they were not able to complete or endure the abstinence process alone; they were still vulnerable in their state of mind, and needed help from support groups. Alcoholics are often motivated; they "want to live" and "want to win," and abstinence is the only hope. Interviewee 26 emphasised that, "I didn't drink myself to death in the end, so I've got to keep on living as best I can."
If alcohol-dependent persons can exhibit resolve, their lives will be turned around. They can take the key step into the Ongoing Process, finding ways to continue abstinence and get support.
There are three aspects to this: strength from others' support, self-prompting, and self-help and helping others and all are essential for the success of any attempt to remain abstinent. It is an indefinite process. Support comes from self-help groups and families. In the self-help groups, sufferers exchange experiences, communication and hopes. Recovering alcoholics pool resources. They go to AA meetings every day, and offer and receive respect and concern. When they have emotional problems, they turn to counsellors, pray, or read the Anningjing (Serenity Prayer).
In addition, family members who stand by in the background, and who give encouragement or accompany sufferers to self-help group meetings, are also a motivating force. Interviewee 23 said,
"During that time when I just beginning to go to AA, my sisters took turns to take me there...... one came on Monday, Wednesday, and Friday, the other on Tuesday, Thursday, and Saturday. After work, they came to my company and took me to the meetings...... At that time I had to also muster a great deal of courage, I wanted my family members to see me dry out."
Interviewees were asked to carry out a "recovery plan" to win praise and develop more positive attitudes. They had to constantly be on their guard against the Influencing Factors, and avoid "taking a glass." Interviewee 24 said that alcohol is like a monster that always waits for a chance to attack you.
"This group has strategies like, 'No matter what, don't take a glass of alcohol,' because if I take it, I'll just completely lose control."
Self-help and helping others not only mean the alcohol-dependent can get support, but also, through sharing of individual experience with new members, can help other people. At the same time, they can learn from the experiences of new members, maintain their own sobriety and ensure that they do not fall back into the IAA cycle. Interviewee 24 said, "Helping people is the best way to stay vigilant myself." Alcoholics can get their lives on track and, eventually, regain their freedom if they consistently resist drinking. Interviewee 22 said,
When I was in abstinence periods, the craving would always be there. I don't know when, but, eventually, I became a completely free man. Now, I don't avoid convenience stores or street vendors that sell alcohol.
In this process, alcohol-dependent persons have stayed dry, and changed their mindset. They can handle their emotional problems and interpersonal conflicts, and show gratitude. They have found balance in life, without alcohol, and stay sober.