"People do not simply stop using substances. They learn how to live differently. And spirituality, in many forms, helps make that possible."

J. Andrew McCullough, 2026 Dissertation

He could stop; give up the booze and drugs, all of them, any day, for a day. That was never the problem.

He could stop long enough for his eyes to come back into focus and for people to believe him when he said, "This time is different." Early on, he had stretches of sobriety: thirty days; ninety once. Six months was long enough for friends and family to believe it was real.

He knew how to do Day One. What he could not do was learn to live with himself sober. Bored. Discontent. Lonely. Constantly nagged by that critical inner voice that alternated with a second voice that assured him: "Just a little bit; you can handle it."

The first relapse was quiet. A Tuesday. No fighting, no collapse. Just an evening alone in his apartment, the air feeling tighter than it should. Bored. Discontent. He tried what they had told him. Distract. Walk. Breathe. It didn't touch it. He had a list of numbers; people willing to listen, to help.

But he did not call. He could not bring himself to call anyone on the list. Instead, with no more than muscle memory, on mental autopilot, he called his dealer. It was the easier call. In the dark of a cold night, he found comfort in being numb. And then immediately, he hated himself for it.

The next time he achieved more than a day sober, he committed to making it work.

He spoke more in meetings; told the truth faster; said things about his loneliness, about the constant sense that something was off, like his life was built for someone else. Inside, it felt like holding his breath. He told himself he was fine. He believed it, right up until he wasn't.

By the third time, something had worn thin. Not gone. Just thinner. He wanted it. He was tired of the chaos of the drug life. He wanted the life others described, but it was getting harder to imagine. The steady one. The connected one. Sober or using, he couldn't see himself fully in either world.

The relapses came closer together after that. Less time in between. Less distance to fall.

He died on a Thursday.

A work friend confided in me that his brother died from addiction. He struggled to understand how a good but emotionally tortured man, who shared his fundamental values, was unable to grasp recovery. My research and this book emerged from that conversation.

I wanted to know why, too.

Professionally, my understanding of addiction has always been clean and clinical: diagnosis, treatment, interventions, and outcomes. I lean into the language the field uses to explain itself, justify funding, evaluate programs, and publish research.

Treatment works, and I believe in its value.

But in conversations that stretched beyond the first 50-minute session into the real honesty that unfolds over weeks and months, I realized there was a depth to getting sober and staying sober that clinical language cannot capture. Life can be messy, and connection does what clinicians often cannot.

Why do some people exposed to the same substances under similar circumstances develop devastating addictions while others do not? Why do some people recover through 12-Step programs, others through faith communities, others through secular philosophy, and still others through something less definable than time and a decision to live differently? Why does the same intervention, the same program, the same medication, and the same community produce dramatically different outcomes for different people?

Beneath all those questions, one kept nagging at me: Why do the people who have stayed sober for decades almost always reach for spiritual language when they try to explain how?

That is the question this book tries to answer.

I have spent more than twenty years in the behavioral health field, treating mental health and substance use disorders in outpatient and residential programs. I have sat across from people at every stage of addiction and recovery, from the first appointment to the thirtieth year of sobriety. I have led clinical teams and taught doctoral students.

In my work, I talk, I listen, and I observe. The most important of those observations is this: people who achieve the deepest and most durable recoveries are rarely those who simply stop using. They are people who find meaning in their experiences; forgive their shortcomings; cut loose guilt and shame. They rebuild an understanding of themselves, their relationships, and their place in the world, and for most, their relationship to something larger than themselves.

To study this phenomenon, I decided to listen to the people who had lived it. Statistics simply cannot capture fully human questions. What I sought to better understand required giving people room to describe their experience in their own words without forcing those words into pre-existing categories.

I recruited twenty-four adults in sustained recovery, each with at least one year of sobriety, though most had far longer. Participants had been in recovery from one to forty-five years, with most exceeding two decades. They were Black, white, and Native American; men and women; Christian, Muslim, secular, and philosophical. There was no one favored substance. Their paths to recovery varied. Almost nothing about their stories was the same.

I asked them to tell me how they got sober and what they do to stay sober. I asked about spirituality: what it meant to them, how they accessed it, and how it had changed over time. I asked what made the difference.

And then I listened to their stories. I expected to create a specific toolkit that could be passed on to help others achieve sustained recovery. That toolkit did not emerge. I found something greater.

One consistent theme emerged: spirituality, used to understand self and to connect with others.

In forms so varied that the word barely contains them all: prayer and meditation; moral inventory and service to others; sitting by the river in the early morning and reading philosophy; attending AA meetings and working the Steps; going to church and not going to church; connecting with animals; reading Scripture; practicing gratitude; helping the newcomer in the parking lot after the meeting; taking desperate calls at eleven at night; arranging the folding chairs and making the coffee. All of it, somehow, spirituality.

Spirituality did not emerge as a single practice or as a single event. It was described as something larger than the diminished self that addiction had built. And what I found, when I looked at what that orientation produced, was a pattern so consistent across all the variation in background and tradition and vocabulary that it could not be a coincidence.

It was the scaffolding that allowed for the development of the ME and the WE of recovery.

The ME is the inner work: the rebuilding of identity, the practice of honest self-examination, the cultivation of a new relationship to the self through whatever forms of spiritual practice the person found meaningful. The WE is the relational work: the community, the accountability, the experience of being genuinely known and remaining accepted, the service to others that gives the suffering years a retrospective purpose.

The people in this book are composites. The four characters, Wayne, Denise, Ray, and Gloria, are built from the voices of real participants in the research, woven together to protect privacy while honoring their stories. Where they speak, they are speaking in language drawn from the actual words of actual people. Where their lives are described, the lives are genuinely lived, shaped into single narratives for this book.

The research voices that appear throughout are set off in the text as direct quotations from participants. These voices are real. They are the words of twenty-four people who shared their experiences in the hope of creating a better understanding of addiction and recovery. I am grateful to them in a way that I do not know how to adequately express.

What I bring to this book is not neutrality. I am not a neutral observer of this subject, and I would not want to be. I bring the particular perspective of someone who has been in the rooms, has read the research, and has spent twenty years trying to understand the gap between them.

This book is my attempt to close that gap. Or at least to illuminate it.

One of my participants, a man with more than two decades of sobriety who had worked in peer recovery for years, described a moment that I have thought about many times since the first time I read it.

Late in his active addiction, sitting alone in his car, he had an epiphany. He vividly remembered everything about that moment. The dashboard clock read 2:14. Bluish smoke filled the air, and the car smelled of cigarettes and something sweeter underneath. Outside, the parking lot light made a small orange circle that did not quite reach his windshield, and the engine had gone cold without him noticing when it happened. He was no longer afraid of dying. He was afraid, he said, of living like this forever.

And in that moment, he did something he had not done in years. He reached out. Not to a treatment program. Not to a hotline. He called another person in recovery and said, simply: I can't do this alone.

That phone call led to a meeting. The meeting led to conversations. The conversations led to small daily practices: listening, reflection, service, and gratitude. And those practices, sustained over the two decades that followed, led to the man who described a life he had not imagined was available to him when he was sitting in that car.

That is the story this book is about. Not just his story. All their stories. The twenty-four people who agreed to describe, in their own words, how they got here and what they do to stay.

The way through exists. These are some of the people who found it, and this is what they found.

J. Andrew McCullough, PhD, LPC    Little Rock, Arkansas    2026

Wayne remembers the exact temperature of the parking lot concrete. It was a Tuesday in November, he knows this because the Razorbacks had lost the Saturday before, and he had spent the four days in between making sure he didn't have to feel it. The asphalt radiated cold through his jacket. He had no idea how long he had been sitting there. His truck was maybe thirty feet away. The keys were in his pocket. He had checked three times.

He was fifty-one years old. He had a daughter he hadn't spoken to in two years and a brother who had stopped taking his calls. He had a job as a construction foreman with the same crew for eighteen years, but he had burned through most of the goodwill that bought. His marriage had ended quietly, the way marriages sometimes do after the shouting stops and there's just nothing left to say. He owned a house, but it felt less like a home every month and more like a place to store the evidence of a life that had not gone the way he had planned.

He wasn't drunk. That was the strange thing. He had had a few beers that afternoon, enough to take the edge off, not enough to explain why he was sitting on a parking lot in the dark outside a gas station, unable to make himself stand up and walk to his truck. He had been in that in-between state for years now. Not destroyed. Not okay. Just moving through the days on autopilot, chasing just enough relief to get to the next one.

What he felt, sitting on that cold concrete, was not despair exactly. It was something quieter and more frightening than despair. It was the sense that he had run out of ideas. Every strategy he had tried: cutting back, swapping bourbon for beer, quitting for a month to prove he could, keeping it to weekends, had eventually failed. He was not stupid. He knew what the problem was. He had known for years. What he didn't know was what to do about it, because the one thing that reliably made him feel better was also the thing that was quietly dismantling his life.

He stood slowly. The cold had settled into his knees in the way cold does when you have been still for too long in it. Then he got up, drove home, and poured a drink.

The bottle was already on the counter. He did not remember leaving it there, but he always left it there.

This is not the end of Wayne's story. It is the middle. But to understand where he ended up, and why, we have to start here, on the concrete, in the cold. We have to start with the paradox.

There is a question that haunts everyone who has ever loved someone with an alcohol or drug problem, and if you have ever struggled with one yourself, it is a question you may have directed at yourself in those moments of despair: Why?

Why, when you can see what this is doing to you, your body, your relationships, your career, your sense of who you are? Why not just quit? Why does the craving not simply stop when the losses pile high enough? Why does every promise, every fresh start, every desperate attempt at willpower eventually give way?

These questions have been asked since the first human being discovered that certain plants and fermented liquids could alter the way the world felt. They have been asked by priests and physicians, philosophers and policy makers. They have produced centuries of answers: moral failure, weak will, sin, disease, trauma, and brain chemistry; each one capturing something real, and each one, alone, proving insufficient.

The question "Why can't they stop?" should be: "What are they looking for?"

Because here is what the research keeps finding, in study after study, in the accounts of thousands of people who have lived through addiction and come out the other side: the craving is not simply for the substance. It is for something the substance briefly provides. Relief from pain, yes. But also: connection, meaning, transcendence, peace.

Carl Jung understood this in 1961, when he wrote to Bill Wilson, co-founder of Alcoholics Anonymous, about a mutual friend whose drinking Jung had once tried to treat. The craving for alcohol, Jung told Wilson, was "on a low level" the equivalent of a spiritual thirst: a hunger for wholeness; a search for what medieval mystics called union with God, for what the secular mind might call meaning, or connection, or simply the feeling that life is not arbitrary or necessarily lonely.

The substance answers that hunger, briefly, badly, and at enormous cost. But it answers it.

Jung's insight, which Wilson incorporated into the foundation of AA, was this: the only thing that can answer that hunger more reliably than the substance is a genuine spiritual experience. Not a doctrine. Not a denomination. Not an argument. An experience. Something that reaches the same place in the human psyche that the substance reaches and fills it with something that lasts.

Described in Latin by Jung: Spiritus contra spiritum. Spirit against spirit.

This is the paradox at the heart of addiction, and it is also the doorway to recovery.

In 2023, approximately 48.5 million Americans aged twelve or older met clinical criteria for a substance-use disorder. That number includes 28.9 million people with an alcohol-use disorder and 27.2 million with a drug-use disorder. These are not statistics about people on the margins of society. They are statistics about our neighbors, our coworkers, our siblings, our children.

They are, quite possibly, statistics about you.

Substance-use disorder is, by any measure, one of the great public health crises of our time. It fills emergency rooms, jails, and courtrooms. It ends marriages and careers and lives. It costs the United States more than $600 billion each year in healthcare, lost productivity, and criminal justice expenses. And despite decades of research, expanding treatment infrastructure, and genuine scientific progress, the numbers are not improving.

The reward system of the brain is ancient. It evolved to keep us alive by making survival behaviors feel good. Eating feels good. Social connections feel good. The brain releases dopamine, a neurotransmitter associated with pleasure and motivation, in response to these experiences, reinforcing the behavior and motivating us to repeat it. This system is not a bug. It is one of the most elegant features of the human brain.

Psychoactive substances hijack it.

Alcohol, opioids, cocaine, methamphetamine, and most other drugs of abuse produce dopamine releases anywhere from two to ten times more intense than those produced by natural rewards. The brain, designed to learn quickly from rewarding experiences, responds accordingly: it begins to reorganize around the substance. Neural pathways associated with craving and compulsion strengthen. Pathways associated with impulse control and long-term decision-making weaken. The prefrontal cortex, responsible for judgment and the ability to weigh future consequences against present desires, loses ground to the more primitive circuitry of the reward system.

What this means, in practical terms, is that addiction is not primarily a problem of willpower. It is a problem of architecture. The brain has been restructured to prioritize the substance above almost everything else, including things the person genuinely values and loves.

This is why the question "Why don't they just stop?" is so inadequate. For someone in the middle stages of addiction, stopping is not a matter of choosing differently. It is a matter of rewiring a brain that has been systematically altered over months or years.

But here is where the story gets more complicated, and more interesting. Neuroscience explains the mechanics. It does not explain why some people, exposed to the same substances in similar circumstances, develop devastating addictions while others do not. It does not explain why, across all the different paths to recovery, one theme appears again and again: the spiritual one.

For more than twenty years, I have sat with people in recovery and asked them to tell me, in their own words, how they got here. Not all of them used the word "spirituality." Not all of them believed in God. Some were actively hostile to religion, having grown up in environments where it had been used against them. But all of them described something that functioned like a spiritual experience: a moment of profound shift, a sense of connection to something larger than themselves, a reorientation of meaning and identity that the substance could not provide and that their own willpower, deployed alone, had consistently failed to produce.

Wayne got up off the concrete. He drove home. He poured the drink. The bottle was already on the counter, and he always left it there.

But that is not where his story ends.