4 requirements for successful Recovery

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Recovery isn’t about flipping a switch or waving a magic wand. There are certain elements that must either be in place or be developed before recovery can happen. As much as we want addicts to just simply stop using whatever substance to which they’re addicted, recovery just doesn’t work like that.

Therefore, someone is recovery requires four (4) things:

  1. A support system that’s educated on the relationship between anxiety and compulsion and how each maintains the addictive cycle. This education should include the pharmacology of the respective substance (or substances) of abuse, as someone addicted to cocaine requires different treatment tools than someone addicted to opiates.
  2. Recognition of the spiritual needs of the person in recovery. This does not mean pushing one religion or another onto someone; really, all it means is that each person should find a way to engage with something bigger than him or her self…

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Take Jack for example: An honest Recovery story

How do we honestly assess our failings and move forward with dignity?

To be clear, there is no easy way to take a hard look at ourselves and accept our failings and weaknesses. Looking at the “bad” things we’ve done and not internalizing the shame that can results from the reflection is not an easy proposition. But, in order to move towards a healthier place, it’s imperative that we not only look at our behavior, be we also need to reflect upon the circumstances in which we behaved.

Take “Jack,” a forty something Hispanic male who recently entered into recovery from an addiction to alcohol. When Jack entered treatment, he knew he wanted to be rid of his addiction, but the shadows from a divorce and from his subsequent alienation from his children hung over him and caused him to be a very shameful person. Jack is a talented and capable person; before his addiction took over his life, Jack earned a decent living as an auto mechanic. However, the more he slid into alcoholism, the less he was able to work. After the loss of his family, Jack pretty much gave up on holding a job all together. A DUI conviction forced Jack into treatment. Jack wore his shame like a suit or armor.

While I do approach treatment from a strengths perspective, I also recognize that if we do not assess our actions, we can are prone to repeat harmful and unhealthy behaviors. This is not to say that we should wallow in our past mistakes; we shouldn’t. However, we need to see that our actions tend to be the result of inaccurately processing our external circumstances. For Jack, he thought that having a beer after a hard day’s work was rewarding. He failed to value his family who begged him not to drink so much and as often as he did.

Jack was lucky in that he qualified for Vivitrol treatment. The Vivitrol helped with his cravings (may have been placebo effect, but who cares) and he was able to significantly scale back his drinking. As he did, he was able to see that he was mirroring behaviors he saw in his father. Jack felt that it was “ok” to drink in spite of his family’s concern because his father acted as he wished without regard for his own family. It wasn’t that Jack was a jerk; it was more that he thought he was acting in accordance with how a father was supposed to act.

As his thinking became clearer, Jack was able to mourn the loss of his marriage and find solace in the fact that his children were being cared for by someone who was strong enough to act on their best behalf. While he saw that his drinking led to significant loss, he also saw that he did not value his family or his work enough to make appropriate changes towards health. Once he corrected his erroneous thinking he began to act responsibly towards the people and activities that he really valued.

Jack’s been sober for almost five years now. He never mended fences with his ex, but he was able to salvage his relationship with his children. He found dignity in looking at his failings because he was able to recognize the context in which he failed was a result of his own upbringing. I think that this recognition neutralized his behavior; though Jack did feel guilty, he was no longer was ashamed of himself

Therefore, I think the way to look at our past failings is to understand them in context and then correct processing that led to the failures. Then once we understand the context and have corrected our thinking, we can then live with full knowledge that we have the power to change our behavior in context.

The 4 areas where Addiction Education must occur

Because Addiction is a complex condition, it can be contradictory for pressure for recovery to solely fall on the person struggling with the Addiction. The reality, though, is that the lack of understanding about Addiction and Recovery is part of the reason why relapse rates are so high. Really, when it comes to Addiction treatment, there are at least four (4) arenas in which there must be some level of education delivered:

  1. Clients must be holistically treated in ways that include education about healthy living and coping, as well as, education about their respective addictions and possible paths towards recovery
  2. Family and friends of addicts must be educated about addiction and recovery that includes content that addresses the substance or process at the center of the addiction
  3. Clinicians who don’t primarily deal with Addiction must become familiar with the mechanics of both Addiction and Recovery. As a matter of fact, there are few cases of any emotional disorders presenting without any type of substance abuse. Because of this high prevalence of co-morbidity, clinicians should also become educated about the pharmacologies of common substances of abuse (including alcohol)
  4. The general public must become educated about the realities of both Addiction and Recovery. Even as Addiction research provides more and more insight into the mulit-faceted and complex nature of Addiction, there still appears to be a single-pronged desire to hold onto a purely 12-step approach to addiction treatment, evidenced in recent movies like, “Cake,” and, “Thanks for Sharing,” which both emphasized the need to “work the steps.” While there is merit in the 12-steps, there is a lot more to creating the circumstance in which a person can overcome an addiction. As the general public becomes more educated, policymakers can then pass laws that would allow treatment resources to become more available

Although it can appear as though an addict has to work to get clean (and he or she does), the onus should not be placed solely on an addict’s shoulders. If treatment providers don’t educate families and friends, there is no way a “recovery-friendly” circumstance can emerge. If Clinicians aren’t better educated about addiction/recovery, then any work will fall short as the Addiction will interfere with treatment of say, Anxiety/Depression. And if we don’t do a better job of educating the general public, negative stereotypes will persist. These negative stereotypes allow shame and fear to run freely and present unnecessary obstacles.

“Rock Bottom” means either prison or death

The idea that someone has to hit rock bottom before he or she will make a change is a misperception and leads to many people washing their hands of those who struggle with substance abuse challenges.  To begin, according to freedictionary.com, the definition of hitting rock bottom is to fall to the absolute worst possible situation.  So, by that definition, if someone isn’t in the worst possible situation, he or she will continue to use until they find themselves struggling in a living hell.  That is, only when a person has hit rock bottom will they try and make a change towards quitting the substance of abuse.

Letting someone fall until they hit the worst possible place he or she can hit seems cruel to me.  When we do allow someone to hit rock bottom, not only are we allowing suffering to grow, but we are also making recovery a harder and harder goal to achieve. The further someone falls in to the abyss of substance abuse, the harder he or she has to climb in order to free themselves from that pit of hell.  Seems obvious: The deeper someone gets trapped in a hole, the harder it is to get him out.  Hitting rock bottom makes recovery quite difficult.

People, in general, will choose a path that they see as easy over a path that they see as difficult.  Choosing the path of least resistance and discomfort is what keeps many people from quitting drugs and alcohol.  For example, quitting alcohol has a 10 to 14 day detox period that is painful and physically debilitating.  Once a person has detoxed, that person then has to deal with intense physical cravings that pull him or her to the bottle.  So, then, quitting alcohol doesn’t sound so good: Continuing to drink sounds a lot easier.  At least, it sounds easier on the surface.

The goal of any intervention, in my opinion, is to help the substance abuser see that continuing to use IS the difficult path.  Most people who abuse alcohol have a whole bunch of health, legal, and relationship problems as a result of their drinking.  It’s my role as a treatment provider to help people see the relationships between their drinking and their problems.  The more they can recognize the harm drinking causes, the more they look for ways to cut out harm.  Once someone learns that continuing to use causes all sorts of harm, there is more and more motivation to reduce his or her use and will accept some short-term harm (detox) for a greater amount of long-term gain.

So, then, rather than allow someone to free-fall towards rock bottom, maybe it’s better to approach the situation from a perspective of teaching that using is the harder path.  There is little doubt that abusing drugs and alcohol has really only two outcomes: Prison or death.   I’d rather help someone see than let that person end up hitting the two possible rock-bottom outcomes

I offer both free and customized substance use disorder continuing education

jblea1016.com

According to The Recovery Research Institute of Harvard University, “Several surveys have suggested that the majority of clinicians aren’t formally educated or trained in substance use disorder (SUD) treatment.” Because I believe it my mission in life to educate as many clinicians as I can about SUDs and their respective treatment, I want to remind people that I offer both periodic and custom developed continuing education workshops and seminars that pertain to SUDs treatment.

If you or your agency is interested, I could prepare a custom curriculum that would be best suited for your respective client population. I do offer pre-developed courses on the Three C’s of Addiction, Treatment for Opiate Addiction, and The Culture of Addiction. My costs are on a sliding scale basis; once we’ve determined the curriculum that best suits your needs, we can discuss the cost, based upon attendees and other factors.

Also, through my blog…

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Appreciation & Gratitude will beat the blues

I’ve been thinking a lot about ways to help get over a bout of general malaise.  There’s a ton of work out there about Depression treatment and there’s a whole slew of modalities that are recommended.  But, what about those moods that aren’t really a depressive episode?  We all have days where we just feel yucky and even if the yuckiness lasts a few days, there’s no other real reason to suspect a depressive episode.  What does the research say about those “down in the dump” moments?

Turns out, not much.  Clinicians tend to work with severe cases; that is, cases in which there is enough evidence of a disorder to warrant external assistance.  Someone who’s just got the proverbial blues may not believe that he or she needs that external assistance.  So, what are some ways to get over the malaise and get back on track?

Well, turns out, the more I think and read about ways that can help, I always return to the idea of appreciation and gratitude.  Life presents every single person with trials and challenges.  No one’s exempt from hard times.  To me, though, on average, people are quite fortunate, here in the U.S.   We may not all be one percenters, but for the most part, there’s good in our lives, even if it can be hard to see anything other that difficulty.

Usually, when I experience yuckiness, it’s because my life isn’t going EXACTLY as I want it to go, WHEN I want it to go a certain way.  I have to step back and remind myself that things aren’t always how we want them to be at the exact time we want them to be that way.  Once I accept that reality, I then look at the moment in which I find myself and I make it a point to find at least one good thing going on in that moment.  Since it can be hard to find good in my own life during a dark mood, I look at someone else who may be experiencing a smile or a laugh or something else that’s sharing positive energy.  Seeing others laughing and enjoying a moment is actually infectious for me.  Really, I feel better and the doldrums tend to dissipate.

Once the dark mood has lifted a bit, I then turn my attention to the blessings of my own life.  Really, I am lucky to be alive in this time of change.  All people in all of time lived in moments of change, it’s the one constant of human existence: Change.  We all live and make history and I feel an immense privilege to be a part of that historical record.  I appreciate all that is good and strong and beautiful and I also appreciate the hard times for forging courage in my heart and for teaching me that time and again: Darkness will pass.

So, to get over a bout of the blues, maybe try to count your blessings. Literally: Take out a sheet of paper and grab a pen and list your blessings.  We all have a lot to appreciate in this life.  we just need to remind ourselves of that, again and again.  How would you feel if you lost the things/people/relationships on that list?

What is Addiction?

Really, addiction is a multi-layered disease per the American Society of Addiction Medicine’s definition, “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

The pathological pursuit involved in using substances is evidenced in the three “C”’s of addiction:

  1. Continued use despite adverse Consequences
  2. Lack of Control when using substances
  3. Compulsive seeking and using of substances

The key component, and in my opinion, the most difficult to understand aspect about addiction is Compulsion.  A good definition of compulsion is, “An uncontrollable impulse to perform an act, often repetitively, as an unconscious mechanism (sic) to avoid unacceptable ideas and desires which, by themselves, arouse anxiety” (2007, American Heritage Medical Dictionary).  I added the bolded font to emphasize that a compulsive behavior is an unconscious mechanism.

An unconscious mechanism is one that affects, “the part of the mental function in which thoughts, ideas, emotions, or memories are beyond awareness and rarely subject to ready recall” (2009, Mosby’s Medical Dictionary).  Therefore, if we work our way backwards from our three formal definitions, a person caught in the throngs of addiction is suffering with a brain disorder of which they are unaware that is impacting them upon every facet of their life.   Physical, financial, emotional, and spiritual health are all adversely impacted as a result of a behavior performed without awareness.   The brain of an addict is rutted towards using a substance and becomes ingrained and automatic.

If we look closer at the source of compulsion, anxiety, it becomes apparent that compulsion is protective.  It “feels better” to use than to experience the anxiety caused when not using.  Therefore, the automatic nature of using a substance must be disrupted before there is even a chance that the behavior can change.  That is, someone has to become aware of the compulsion to use, then has to feel the adverse consequences of using, and then has to see not using as a preferred path.  If we do not strip the veil off of the compulsion, we cannot elicit change.

Further, in substances that contain a physical component such as alcohol or opiates, the fear of withdrawal is sometimes so strong that just thinking about withdrawal causes such anxiety that even if the user is not physically ill, they need to use.  Really, addiction is complex and layered and I do not foresee a “magic bullet” from which a simple solution will emerge.   Recovery from an addiction requires patience, commitment, support, and emphasis of strengths rather than amplification of deficits.

Please, i beg you, support someone’s recovery

Whenever I’ve known someone to get into a car accident, I’ve seen enormous amounts of support: People head to the hospital in droves and offer any assistance they can. Seeing that much support tends to fill me with belief in our humanity. People care, it would seem, and will help the injured recover from there wounds and will do whatever is needed to ensure a speedy recovery. There’s little doubt that the outpouring of support is helpful and therapeutic, both for the injured and for the involved families. No one has to convince anyone that supporting an injured person’s recovery is a good thing.

However, when a person attempts recovery from an addiction, I don’t see the same outpouring of support. What I do tend to hear is the word: responsibility. I hear it in such contexts as, “well, it’s his responsibility to get clean if he wants to,” and, “it’s her responsibility to get help,” and so on. And while I agree that any type of recovery requires the responsibility of following an established treatment plan, I think it’s rare that anyone recovers from anything without help from someone. It’s just that it’s easy to help someone with a broken leg; whereas it may not be so easy to help someone who’s hurt us in some way as a result of his or her addiction.   However, I think the best way to help someone recover from an addiction is to forgive. As a matter of fact, I think it’s our collective responsibility.

Of course, we have the option of responding to any situation with anger. And I can understand why anyone who’s been hurt would be angry. But, as a long-term solution, anger just leads to fear, which then leads to hatred. Nothing good could come of hating. Rather, it’s better that we seek to understand the monster of addiction such that then we can then understand what a substance abuser may be facing. If we can gain understanding, then we can forgive and be a resource of comfort and safety so that healing can then begin and continue.

I believe that it’s my responsibility as a treatment provider to provide clients with as much information such that they can find their own respective paths to recovery. It is my responsibility to meet clients where they are, not where I think they should be and it is my responsibility to engage clients from a place of compassion and not judgment; after all, no one has ever appointed me to be the judge of all that’s right and wrong.

So then, next time you approach someone in your life who struggles with an addiction to drugs and/or alcohol, try to see him or her the same way you’d see someone with an injury. It may lead to better situations for both you and him or her.

A brief intervention

If someone were shooting a video of his feet while he walked, the video would have captured his stride and cadence and pace and any viewer would have recognized the steps of an elderly man. The viewer would notice the delicate way that each foot scooted across the floor and felt compassion for the physical deterioration that comes with a long life. However, the video would not have been of an elderly man. The labored and measured steps belonged to a man in his mid-forties who was coming off of a week-long relapse and who was losing his life to alcohol.

“Please, get dressed and let me take you to the E.R.,” I said to him. His sister called me and expressed deep worry that her brother was not well. He wouldn’t answer his phone and the thought that he was dead entrenched itself in her mind. I drove to his apartment and hoped that I wouldn’t find him dead. When I arrived, I found his door open and walked in. He wasn’t dead; he was lying on the ground with his arm covering his eyes. There was blood caked to his face and significant bruises covered various parts of his body. To me, it was clear that he needed immediate medical attention and it was either that I take him in, or I call an ambulance. Either way, he was getting his battered body to the doctor.

“No,” he said. “The doctors and nurses will give me the lecture and I don’t want to hear it.”

“What lecture?” I said, though I knew full well what he was going to say.

“They’ll tell me how I have to stop drinking or I’m going to die.”

I shook my head a bit. While my mission in life is to change the way the world sees suffering souls, I also recognize that sometimes anger cannot be helped. Medical staffs in E.R.’s tend to be overwhelmed by people doing little more than going to the hospital as a way to hustle drugs. Plus, the fact is that for someone with Hepatitis and liver cirrhosis, death is imminent if he or she continues drinking alcohol. So, the lecture isn’t really a lecture, but an attempt at trying to reach the part of humanity that drives the desire to live.

“Look,” I said. “We’re all going to die. Look at yourself: You can barely walk and it’s clear that you either fell or got beat up somehow. You need to see a doc; please, as a favor to me, let me take you in.” He turned towards his couch and winced as his body made its way into a sitting position. It was difficult to watch; it the moments that passed while he made his way across his living room, my heart filled with hate for the evil enemy I fight: Addiction. But I know that hatred clouds judgment, so I stifled my own feelings and said, “Please, come with me to the hospital?”

He sunk into his couch and closed his eyes. I thought he may have passed out because his breathing deepened in the way all our breath does when we fall asleep. However, he must not have fallen asleep; rather, he must have found something in his thoughts for which he wanted to live because he opened his eyes and nodded…

A model of the Addiction Process

addictionModel

I’ve taught the diagram above in several different contexts. It illustrates the process of either developing or full-blown Addiction. The six steps are consistent with what I consider as the foundational “Three C’s of Addiction”: Control, Consequence, and Compulsion.

The process begins with a trigger. A trigger can be anything from a fight with a spouse to the beginning stage of withdrawal. Triggers are as specific to a person as is a fingerprint and can only be described by the person caught within the Addiction process.

Once triggered, the second step occurs: Anxiety. According to the American Psychological Association, anxiety is characterized by, “recurring intrusive thoughts or concerns…and physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat” (APA Website). Really within the Addiction process, once anxiety sets in, it lets loose a chain in motion that’s only resolved through either the ingestive or process behavior at this source of the Addiction.

The compulsive behavior can be anything from using a substance to gambling, to a combination of compulsive behaviors. If the behavior involved food, substances, or alcohol, it is considered “ingestive” because a person ingests the item. Gambling, sex, and/or shopping are examples of compulsive behaviors that are process-oriented. Compulsion is an uncontrollable impulse to perform an act, often repetitively, as an unconscious mechanism. Therefore, a compulsive behavior is one done without conscious regard that relieves the anxiety. Once the target of the behavior is exhausted, i.e., there’s no more substances or money, the behavior ends.

Here’s the kicker: there’s adverse impact that occurs after the compulsive behavior that then triggers conscious shame that then acts as a trigger, which then starts the process all over again. This process goes on and on until it’s either disrupted or the person caught within the process becomes numb to everything except the target of the Addiction.

The Addiction process incorporates the Three C’s, as once the anxiety sets in, the person loses control, behaves compulsively without awareness or regard to consequences. It’s only when the compulsive behavior ends that the person returns to his or her conscious mind.

I hope the diagram and my brief explanation does help in understanding what is a frustrating and insidious disease.