Addictionland - Addiction Recovery Blog

A random poll among newly sober clients, recovery counselors, and people who have achieved years of clean time would probably produce a varying consensus about the most pressing need for successful recovery.   Most respondents, however, would likely agree that relapse is often an indicator of stress.

The process of recovery, like the process of grief, is fluid and dynamic.  Exploring relapse before it happens is a good way to identify potential problems so you can be prepared for them.  Thorough preparation can help you minimize or even avoid issues may hinder your recovery.

Most people don’t think though the actions which eventually bring them to the point of relapse .  They simply had a desire to drink, and acted upon that without any thought for the consequences.  If they did indeed have any thoughts and feelings about the consequences of use, those thoughts and feeling were ignored or rationalized away.

In the recovery process, your recognition of that lack of forethought and insight should be a powerful lesson.  You can learn that anticipating the ultimate results of your behaviors will help you make much better choices.

When a person decides to get sober the idea of staying sober can be overwhelming.  The fear of relapse looms large.  A quick review of the literature suggests that the success rate is relatively small when compared to the number of people who attempt to find sobriety.  According to a 2003 study, the Caron Foundation documented that nearly 50-90% of people relapse within the first year after treatment or involvement in a 12-step program. Precursors to relapse can include anger, frustration, stress, or positive emotional states. The National Institute of Drug Abuse have determined that relapse rates from addiction can be compared to those suffering from other chronic illnesses such as Type I diabetes (30 - 50%), Hypertension (50-70%) and asthma (50 to 70%). Drug addiction should be treated like any other chronic illness, with relapse indicating the need for renewed intervention.

It is important to make the distinction between addiction and dependence.  Addiction is a change in behavior to accommodate or obtain the chemical, while dependence is indicated by measurable physical symptoms that arise when the chemical is not consumed. It is the general opinion of many addiction specialists that addiction is largely biochemical and that relapse is largely the result of cravings and proximity to alcohol/drugs or uncomfortable feelings.

Another skill which can be utilized to support recovery is the application of mandates and injunctions. A mandate is a set of thoughts that direct the addict to engage in using behavior when they have an urge to use.  An injunction is a set of criteria that provides the recovering person a way to think about their recovery so they don’t compartmentalize the skills and gifts they bring to their sobriety. In its simplest form it’s a part of a relapse prevention plan.

This approach is another way a clinician can help a client develop additional skills to maintain abstinence. Part of this includes an emergency sobriety card and an accountability contract. An emergency sobriety card provides a brief list of specific and concrete instructions that a person in recovery can refer to anytime when he or she needs help. It’s a small discreet tool that helps the addict find and build confidence in their ability to remain sober. The accountability contract is a set of permissions that an addict gives to his or her family and friends when its determined their recovery is in trouble.  The inclusion of family and friends as part of an addict’s recovery can provide support and help an addict get back on track.

Recovery need not be overwhelming and can be managed successfully. Matching a client to a recovery program is paramount, as we understand that recovery looks different for everyone.  In recovery from addiction, it is important to change your lifestyle to include abstinence from alcohol and drugs; involvement in healthy relationships; good nutrition, rest and exercise; and working to resolve one's personal problems.  Being mindful to incorporate the philosophy of mandates and injunctions will go a long way to build confidence in your recovery program.

You know the drill: you have spent countless hours in meetings, on the phone with your sponsor asking endless questions about your desire to use.  You have worked the steps and you’ve even consulted specialists.  In a moment of desperation you found help by attending treatment. You’re able to rack up six to twelve months, but eventually you find yourself in the throes of your addiction. None of this seems to work.  You find yourself questioning your commitment and ability to stay sober.  Maybe your sponsor was right when he said you lack willingness.

Not so fast….

What you are likely experiencing is Post Acute Withdrawal Syndrome or PAWS.

PAWS consist of a set of impairments that occur immediately and at times simultaneously after the withdrawal from alcohol or other substances.  These impairments affect three distinct areas of functioning and last six to eighteen months from the last use of alcohol or drugs as your brain tries to regain homeostasis.

Long-term sobriety requires personal engagement in your recovery.  Real engagement goes beyond just attending meetings or calling your sponsor.  Engaged recovery requires that you constantly learn new, concrete skills which support long-term sobriety. When I think of concrete skills that support recovery, several things come to mind:

Resilience - This generally refers to a person’s ability to cope with adversity, or the ability to bounce back from problems and setbacks. Research has shown resiliency to be a dynamic process.  Resilient individuals adapt to changing and unexpected events even under the duress of adversity. You can develop your own resilience by establishing good problem-solving skills, or by seeking help and building social support.  Fostering a belief that there are things you can do to manage your feelings and cope, and finding positive meaning in trauma, are other strategies for building your resilience.

Delayed gratification – Usually, people who can abstain from alcohol or drugs, or people who have managed to stay out of prison, have found ways to delay their gratification. People use chemicals to change the way they feel, so if you learn skills to act on your emotions in healthy ways, including offseting a need for immediate gratification, you can manage to fulfill your needs through avenues other than chemical use.

Volunteer work - My experience has shown me that volunteer work is a great way to feel better about yourself, develop a community of peers who share similar interests, and be of service to others.  If you want to raise your self-esteem, do things you’d be proud to tell other people.

Harm reduction is a way of helping the alcoholic manage their drinking.  For instance, if an alcoholic is prone to drinking and driving, maybe he should move close to a bus route or a subway line so that driving isn’t necessary.   Not drinking is, well, not drinking.  Harm reduction has its very strong proponents.

As for me, when working with someone, I’m always thinking not just about the harm I want to help them reduce, but about completely replacing harm with life.  No change that. Life: with a capital L.  This is much like the OCD client’s I have that are consumed with reducing risk in their life so they stop going out … it’s a wonder they even get out to see me.  The idea is to be free of the addiction.

When I think of the client who stops drinking at 26, gets a productive job, becomes supportive and loving spouse and father.  The ripple effects of all the people that this person touches in a positive way are literally infinite.  There is no comparison to that and if he had learned how to manage his drinking, and shrunk his life into a small flat near the bus line, working the system for what meager funds he could pull together to drink alone in his apartment until he died.  One is a giver of life and the other is a parasite on society and a downer even unto himself.

Are there times when I’ve engaged in harm reduction?   Yes.  Productively, I can see harm reduction as beneficial if it is seen as the pre-contemplative phase of recovery.  In other words, it is something that is useful once they have become a nuisance to themselves and society but before they are ready to throw in the towel.  In those cases I will help with harm reduction.  Having said that, it is something that I do with trepidation, because addiction is very unpredictable.  Just because an alcoholic moves near the subway line so that he won’t drive drunk, is not guarantee that the once drunk, he/she won’t rebel against the who system and drive anyway.  Or like one young man I worked with who fell alone in his apartment, bashing his head on the corning of his stereo and bleeding to death.  Ultimately, the concept of managing addiction or alcoholism is very arrogant.  Sadly, sometimes, as a professional, it is the only tool I have.  While I will use the tool if that is the only place the client will meet me, it is, in essence, a lousy tool.

Sobriety is such a blessing with so many rewards - rewards that are measured in reunited families, careers that never would have been, in spiritual enlightenment that is bigger than any of us – when I am backed into the corner of harm reduction, I feel so impoverished, a little like Dr Kevorkian.

Hi, I'm Dee.

I mentioned on a Facebook page that I've written a new book about the Twelve Steps from a Pagan perspective, and someone suggested that I make an excerpt available here.
If you would care to look at a preview, the first 20 or so pages are available here: http://www.lulu.com/product/file-download/the-pagan-in-recovery-the-twelve-steps-from-a-pagan-perspective/15925326?productTrackingContext=author_spotlight_104954579_

So what is this book about? Well, the title pretty much says it all, but let me explain a little. When I first entered the halls, I nearly ran out. While I know now that the Twelve Steps were written to be accessible to all, the truth is that in the rooms and in the texts, a very Christian attitude does exist. This is unavoidable because, especially in the United States, Christianity is the majority religion. Bill W. and Dr. Bob were also steeped in Christian tradition, and the program itself is a descendent of the Oxford Group - a Christian program.

So, as a Pagan, I was a little put off by a very Christian attitude. So often I'd hear "My higher power, who is Jesus Christ". The Lord's Prayer, a very Christian prayer is said at most meetings. AA's 12&12, and the Big Book mention Christian prayers and concepts quite often.

While, as a Pagan, I found this favor toward a specific religion and little mention of others a bit disturbing, I also knew that my very survival depended on recovery. My last outing found me waking (or regaining consciousness) in an intensive care ward at my local hospital. I didn't have much farther down to go. Quite simply, I needed to make this work - the alternative wasn't merely unpleasant - there was no longer an alternative.

As I worked the program, I came upon other Pagans - many who had left the program, many who were struggling. I spoke about the possibility of writing such a book, and the enthusiasm for this book was almost deafening. About a year later, this book was ready.

The Pagan in Recovery isn't a new program. Rather, it's a book that explains how ANY existing program can be used effectively by a Pagan. Let me know what you think; I'm interested in people's opinions. If you have questions about Paganism, or how a Pagan can utilize the steps, I'd love to talk about that too!

We are all addicts. This is true whether we've ever touched, heroin, alcohol, tobacco, cocaine or any other substances associated with addiction. The human ego spends its time clinging to comfortable, familiar and pleasant experience. It also flees from uncomfortable and unpleasant experience.

An extreme example of the latter is buried traumatic memories in the case of warfare or rape. While in some cases this is a healthy process, it mainly amounts to addiction.

A lot of spiritual literature emphasizes the art of nonattachment. You'll notice that Buddhism places a huge emphasis on this, and it's the same with a variety of other wellness traditions both spiritual and secular. In many of these cases, you may notice that meditation is recommended as a training vehicle for learning nonattachment.

What I'm saying here is that meditation is the art of addiction recovery in the most fundamental sense of the term. Meditation is the long term antidote to the "Great Addiction" - the desperate grasping of the ego.

When you can calmly observe your moment to moment experience as a detached observer, then you can gradually dissolve all the problems of the addicted mind at their roots. The more present you can be with your thoughts and experiences without addiction, the more efficiently you "digest" them. This means emotional healing and recovery from not only addictions, but from all types of tension that the Great Addiction creates.

"Whether such a person can quit upon a nonspiritual basis depends upon the extent to which he has already lost the power to choose whether he will drink or not."

Alcoholics Anonymous, page 34, More About Alcoholism

Of the many internal rearrangements I experienced as a result of the steps of Alcoholics Anonymous, the most profound was in how I understood the disease.  This shift was a direct result of being able to align the experience and pain of my repeated relapses with the explanation of the disease in the first 63 pages of the Alcoholics Anonymous text book (with the help of a terrific teacher).  Ideas and concepts I had held for decades about the nature of alcoholism were rendered embarassingly inaccurate.  Many of the AA sayings  I had chanted effortlessly for years (just don't pick up the first drink!) suddenly felt like codependent sloganeering.

Had you asked me several years ago what the difference was between a drinking problem and alcoholism, I would have likely responded "not much."  Try to explain it to me?  I'd have politely nodded but dismissed you as someone with way too much time on their hands.  I simply was not there-- I had double digit sobriety, a good life and the assurance that by keeping my memory green about where alcohol had taken me, I'd never drink again.  I've since learned that alcoholism is cunning and baffling; it can also masquerade as sobriety.  In retrospect, I was unaware that the very proclamations I valued as manifestations of my sobriety were really untreated alcoholism.  And it was biding its time, trying to find another way in.

But back to the point of the post-- what's the difference?  I see it this way:  the person with a drinking problem should stop, and usually can.  The person with alcoholism must stop and cannot.

"Yet we can't well content ourselves with the view that all these recovery failures were entirely the fault of the newcomers themselves. Perhaps a great many didn't receive the kind and amount of sponsorship they so sorely needed. We didn't communicate when we might have done so. So we AA's failed them. Perhaps more often than we think, we still make no contact at depth with those suffering the dilemma of no faith."

Bill Wilson, AA Grapevine, April 1961 "The Dilemma of No Faith"

Cross posted at Thump.

I stole this Nikos Kazantzakis quote from the Facebook page of a Thump fan, Robi Carlson, because I love language that challenges conceptions of spiritual power.

"The Great Spirit does not toil within the bounds of human time, place, or casualty. The Great Spirit is superior to these human questionings. It teems with many rich and wandering drives which to our shallow minds seem contradictory; but in the essence of divinity they fraternize and struggle together, faithful comrades-in-arms. The primordial Spirit branches out, overflows, struggles, fails, succeeds, trains itself. It is the Rose of the Winds."

In order to be willing to believe in a power greater than myself, I needed to set aside all of my ideas and concepts about "God."  I wiped the slate clean, even of the word "God." My conception of a higher power could not be tethered to human expression, not because I was special or intelligent, but because all language and expression carried some baggage, and I needed to be free of that.  It was the only thing that would work.  I needed to experience a power greater than myself, not define it.

Cross-posted at Thump.

On the first Monday of each month, my beginners meeting reads from Living Sober.  I'm not sure who wrote this tragic little book, but the fact that Living Sober is conference-approved AA literature is one of the great mysteries of the AA fellowship.  Put nicely, there's just very little in Living Sober that you can line up with the philosophy of Alcoholics Anonymous.  In fact, much of it runs completely counter to the Big Book.  I like to think of it as  an operators' manual for the willpower.

And last night, we found ourselves reading one of my favorites, the chapter "Using the 24 Hour Plan."  This little treatise suggests that anyone can stop drinking for 24 hours, and that sobriety is really just stringing those 24-hour successes together.   One could argue that since AA has largely become a pep rally for abstinence, "Using the 24 Hour Plan" could be our new "How It Works."

I've got nothing against keeping it simple in the early phases of sobriety.  Getting past the physical urge to drink or use drugs is arguably the hardest thing we do, and unless we're locked up somewhere, it does require willpower.  Getting clear of that craving-- that maddening itch that needs scratching-- can be helped by breaking it down into digestable time segments.  I get it.

The problem, as I see it, is that many never get past One Day At A Time.  They grind it out, the physical obsession quiets, and they feel better.  They equate that physical restoration with recovery.  The condescending term used in AA for this feeling is a "pink cloud."  "Be careful," nods the sage oldtimer, "you're on a pink cloud."  This diagnosis is rarely followed with precise direction as to what the newcomer might do to guard against the looming relapse, unless you consider "keep coming back" to be meaningful advice.