Dear Dr. Romance:

I am an addict. long term. I've had some time in NA running what I thought, and what others even so much reinforced, that when I began to feel like I needed to "leave the nest" a little  (at about five years sobriety), I copped all kinds of flack from other members, and I had a really  hard time getting anything in my life to "work". But after having arrived at NA in '99 smashed  into tiny pieces from a years-long bout with heroin addiction, the  program helped me put those pieces back together. and pretty well I  might add. but after a while I felt like I was still a bit "sick"  and I could not figure out why.

I began to become very frightened. a long and slow progression into  hell followed, and I couldn't seem to find any answers with my AA  colleagues. "Go help somebody, you selfish jerk", was the usual  party line.

Well, I relapsed; again and again since then. It's been about two  years "out" now. today, I'm pretty shot out, I know I have to stop, but I haven't been able to. so on Saturday, I am going to check out a methadone maintenance  program for a while. god knows I don't want to be on that stuff forever, but it feels like  my nervous system is so raked, that there's no way I could hold on any other way. but I'll  still be left with me. and that's the part that I know is going be the most difficult.

I found your book (actually, my father did.), The Real 13th Step, and it sounds like me talking, when I was still sober and feeling kinda okay.

The point is, i need some therapy, because no matter what i do, i'm  still always left with the real problem, me, and all the guilt, shame, lack of true confidence, you name it! And there is no torture worse than knowing you are a bright, bright  star, but not allowed to shine.

thank you for your patience with my long letter.

Dear Reader;

I'm sorry you've had such a difficult journey.  Clearly internal pain is a big component of addiction, especially to hard drugs. It's often a way to self-medicate the pain of Post-Traumatic Stress Disorder, the residual memories of a painful event, or events.  Methadone maintenance is a helpful way to transition from heroin addiction to sobriety, but it doesn't eliminate the emotional problems underlying the compulsion.  Cleaning up from drug addiction is a layered process.  One must get past the physical addiction: the body's dependence on and cravings for the drug.  That's what usually happens in detox.

Then, there's the habit problem: the brain patterns established while using the drug.  Habits are powerful; we need them so we don't have to decide each move we make every day.  However, there are healthy habits and destructive habits.  Addiction, of course, involves a lot of destructive habits. One must learn to replace the destructive habits with healthy ones.  That's one focus of twelve-step programs, like Narcotics Anonymous and Alcoholics Anonymous.  The program helps you replace destructive patterns with the twelve steps, which are much more constructive. The twelfth step requires giving back to others, which replaces the destructive self-involved habits of addiction. 

One must also replace destructive social environments (like hanging out with druggie friends) with more constructive associations. Twelve-step programs provide this through having many group meetings you can attend every week, which gives you social contact and support in addition to the twelve-step learning process.  In the meetings, you are also exposed to the experiences and stories of other addicts who've successfully become clean.  Because relapse is so pernicious in recovery, twelve-step programs emphasize that you are never cured; relapse is always a possibility, so they say "keep coming back; it works."

What the twelve step programs are not really about is healing the inner pain. That requires deep therapy, which is what The Real 13th Step: Developing Confidence, Self-reliance and Independence Beyond the Twelve-Step Programs, teaches.

  13th Step ebook

You can use the exercises in it with your therapist, or as an adjunct to your twelve-step group, with your sponsor.  I wrote it when because so many twelve-step members came to me looking for the same things you are seeking. To make your relationships, your work, and your life function properly you need skills and healing beyond getting clean and sober.  The Real 13th Step supports and enhances twelve-step work while giving you the extra deep recovery insight you need.   

I encourage you to find a therapist, and to get back into studying the twelve steps.  "Guidelines for Finding and Using Therapy Wisely" will help you find a therapist who is knowledgeable.

For low-cost counseling, email me at

Author's Bio: 

Tina B. Tessina, Ph.D. is a licensed psychotherapist in S. California since 1978 with over 30 years experience in counseling individuals and couples and author of 13 books in 17 languages, including It Ends With You: Grow Up and Out of Dysfunction; The Unofficial Guide to Dating Again; Money, Sex and Kids: Stop Fighting About the Three Things That Can Ruin Your Marriage, The Commuter Marriage, and her newest, Love Styles: How to Celebrate Your Differences. She writes the “Dr. Romance” blog, and the “Happiness Tips from Tina” email newsletter.