November 21st, 2016

I always keep the Serenity Prayer in my mind for when times get difficult. The most familiar version goes, “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” The prayer, credited to the theologian Reinhold Niebuhr (1892-1971), has been adopted as the “official prayer” of 12-Step organizations, such as Alcoholics Anonymous and Al-Anon. Bill Wilson, the co-founder of AA, was impressed. In Alcoholics Come of Age, he wrote, “Never had we seen so much AA in so few words.”

I recommend the prayer to my patients and their families as a useful tool in their recovery, and I find improved outcomes in those who learn how to effectively incorporate its message. Being compact and pithy makes the prayer user-friendly but also, unsurprisingly, makes it incomplete. In particular, I believe that courage is a necessary element for successful change, but not in itself sufficient. Those who make the successful transition into recovery and the rewards that it brings, generally need to develop their own capacity for other strengths. Chief among these are perseverance and discipline.

This usually does not require the development of new abilities, but rather the redirection of already existing ones that have previously been used — by patients for the maintenance of their addiction and by family members for the support of the addicted relative. Most of my patients have spent years stubbornly attempting to control their substance use, despite substantial evidence that this is not a reliable solution. Frequently the adjustment to repeated failure was to stick with the same strategy and to “try harder.”

Change in behavior often follows a change in thinking. As Caroline Knapp put it in her powerful memoir, Drinking, A Love Story, she gradually began to realize that what she had thought was a solution to her problem was, in fact, a problem itself. The shift toward recovery is signaled by the appearance of a certain intensity of determination. In the 12-Step world, this is described as “being willing to go to any lengths” to protect one’s recovery, in contrast to a compromising strategy of trying to preserve some valued aspects of the addicted life.

Referring within itself to wisdom, the prayer itself has emerged as one of the wise sayings of our times – one that can be applied to many areas of life beyond recovery from addiction.

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