Addictionland - Addiction Recover Blog
Arming yourself with information about the way myths and stigmas affect addicts and how people respond to them, can go a long way in supporting people to find recovery. Effective treatment for substance use disorders requires an understanding of the myths and stigmas of addiction. I'd like examine a few myths that surround addiction and foster a misunderstanding of how to best support people to find recovery.
<strong>1. Everyone needs to reach bottom before quitting.</strong>
Early in my career I worked with adolescents. One of the clients on my caseload was a 17 year-old girl who had a long history of prostitution, a significant legal history, and a span of alcohol and drug use that began when she was five. During treatment she spent time talking about her alcohol and drug history and how that affected the decisions in her life. She had various opportunities to quit using chemicals but she reasoned that she wasn’t ready. While she came to a place where she was able to give up her chemical use, she never escaped her history of prostitution. She was able to develop a motto that supported her to quit using alcohol and drugs: <em>your bottom is when you stop digging.</em>
My mom was a single mother. I don't necessarily think this was a bad thing. I was born in the 60's, and while it appeared my mom was pretty self-sufficient, where I lived in the working-class neighborhood of Brooklyn it was considered a faux pas to give birth to a child out of wedlock. My mom knew this and she found a guy who was willing to be listed as the father on my birth certificate. I didn't know this at the time, but my mom had been married two times before I was born. During her life she was married a total of nine times. Nope, that's not a misprint. Nine times.
My mom was also a consummate artist. She was also profoundly mentally ill. Her mental illness informed her art and her art informed her mental illness. Knowing my mom as well as I did it makes sense that she used art as a distraction. It also makes sense that she was married nine times. As her internal world was so chaotic I sense she was looking for outside stimuli to quell the madness she felt on the inside as well as receive some kind of validation that she was okay. During the time my mom was a professional artist her work appeared in over 200 shows. She worked in various mediums (plaster, ceramics, sculpture, pottery, pen and ink, etc) but her best work was done in either oil or acrylic. Today, artists would mount their work between two pieces of clear Lexan or Lucite. My mother's work was mounted between two large pieces of glass, held together by large machine bolts/screws. Felt washers were used on ether side of the washer and bolt and in-between the pieces of glass. The pieces of glass came shipped to our Brownstone pre-drilled. My mom tried various methods to mount her work, but she seemed to be fond of threading the holes in the glass with climbing rope and using a fisherman's knot connected to some bolts mounted on the ceiling. Not only was she a consummate artist, she prided herself on making sure her art was mounted in a way that could keep her work safe. People would come from across the globe to attend her shows and buy her work. I was proud of my mom and I never tired of people telling me that my mom was amazing.
As a kid I remember hoping that the constant adulation my mom received about her art would be sufficient to quell the near-constant distress she felt with her various mental health issues. As a kid I remember feeling powerless to help my mom. When my mother took her medication she was at ease in the world: her world made sense, and there was a sense of order in the Universe. When my mom took her medication I felt connected to her. When she kept to her medication schedule my friend's weren't scared of her. My mother was also trained as a mental health therapist. When she took her medication she had amazing clinical insight. When she didn't take her meds, the police were always there. I'm not sure exactly how many times I visited her in the hospital. The diagnosis was always the same:
- Paranoid Schizophrenia with depressed features
- Narcissistic Personality Disorder
- Borderline Personality Disorder
- Sociopathic personality Disturbance, or what is known today as Antisocial Personality Disorder
My grandmother was a social worker and my mom was a therapist. It's not surprising that I was drawn to working in the mental health field. After reviewing my mom's hospital records I'm not sure that the last three mental health diagnoses were accurate, however, I am absolutely convinced she suffered from Paranoid Schizophrenia. She had command hallucinations which convinced her I was the spawn of Satan and that the only way to save the world was to end my life. During her last hospital stay the entire team met with me and my grandparents and they disclosed my mother's plans to end my life. There were enough clues along the way but nothing extreme enough had happened which prompted the state or my grandparents to remove me from my mother's care. I came to live with my grandparents but was extremely sad as I felt like I was abandoning my mom.
Have you seen A Beautiful Mind ? It's an amazing film that does a wonderful job of illustrating mental illness, specifically paranoid schizophrenia and delusional episodes. While I have never met John Nash nor do I know anyone who knows him, I can relate to how his wife felt living with someone who was profoundly mentally ill. Unlike John Nash, my mom was never compelled to create a room full of chaos. She kept most of her delusions in well over 600 scrapbooks. My mom was obsessed with numbers, colors, shapes and abstract information. If she saw the number 5 on TV, she would collect five objects that represented that number. If the numbers on TV were a certain color, she would collect pieces of paper in that color: the word 'White' would become part of her delusion and she would collect a large number of objects that were white. As 'White' has five letters she would fixate on the number five. Much like someone with OCD engages in the compulsion to relieve the distress, my mom was compelled to focus on her delusions to feel safe. After I was sent to live with my grandparents I inherited all of my mom's scrapbooks. I tried looking through them to see if I could gain any insight as to how my mom lived her life and navigated her world. After paging through many of the scrapbooks my grandmother sat beside me, placed her hand on mine and encouraged me to stop. "Todd, even your mom doesn't understand why she does what she does". My grandmother was right. I was simply trying to find a way to be closer to my mom. I wanted to help her. I felt powerless.
Growing up with my mom and living with grandparents that survived a genocide certainly shaped how I view mental illness and the work with my patients.
I'm not a huge fan of labels. My experience is that when you label something not only do you need to overcome the affliction, you also need to overcome the label. I certainly understand why a label or a DSM code is applied in a mental health setting: they create a sense of commonality with other clinicians, they act as a gateway for billing practices, they offer a common language when writing reports or letters, and when clients do not behave in a clinical setting the clinician can blame the patient versus take responsibility for their inability to make any progress with their client. Unfortunately, labels also tend to marginalize clients, especially people who are poor or low-income. People with greater financial resources tend to have less social problems. Clients without the aid of financial support tend to be at the behest of agencies which are overloaded and they often are only willing to apply a label to make quick work of a new admit. As I've worked as a clinician in a variety of agencies and with clients on either side of the financial spectrum, I'm convinced this point-of-view is accurate. I'm also embarrassed to admit that early in my clinical career I was entirely too generous with the application of labels on a host of clients. I'm reminded of many assessments and letters and documents that were rife with the misapplication of whatever diagnostic assessment impressed me at the time. I'm grateful that I have grown as a clinician and have grown past the need to both marginalize and stigmatize clients seeking help.
I have suffered with depression for most of my life. Meds don't seem to work. I am sure that if meds worked I'd still be taking them. The only thing that seems to help is therapy and exercise. I think of mental illness as being on a spectrum, and I'm certain that if most people peeked at the DSM 5 they could probably identify with some of the characteristics of any of the diagnostic criteria. Chronic mental illness is a bit different. I think of chronic mental illness like a radio station: most people who are not mentally ill have the ability to tune into one station; my mother lacked this ability. Attendant to illness of Schizophrenia belies disorganized thoughts. I'm not sure my mom ever felt normal or had the ability to have coherent and cogent thoughts. Most literature suggests that symptoms of Schizophrenia manifests before the age of 19. While I never had the opportunity to meet any of her family, I have heard enough of her background to determine that my mom suffered from early-onset Schizophrenia. She likely heard voices and suffered with hallunications and delusions while she was in Kindergarten.
As hard as it was for me to accept my mom's mental illness, I am absolutely certain it was just as hard for her to accept that her brain did not function as a normal human being, whatever normal is. I saw a great bumper sticker that said normal is a setting on a washing machine. I think that is pretty spot-on. My mom represented two extremes of a great mind: a tormented human being in her own thought prison and a fantastically talented artist with the capacity to produce great, original work in various mediums which were lauded by art critics throughout the US and the rest of the world. The people who knew my mom suggested she was a great artist and a consummate therapist. I think they were right.
When I was a kid I used to believe that my mom ruined my childhood. I blamed her for creating so much chaos in my life. I assumed she did this intentionally. I grew up in an environment of catastrophic violence. Whenever I had a hard time I'd point to my mom: I never developed the coping skills needed for a decent life, I developed PTSD because of my mom and her poor choices, I attracted women who weren't good for me as I had a poor role model. While this could be great fodder for a therapy visit, it's also a fantastic way to stay 'stuck'.
Here's what I know and believe to be true: my mom did the best she could with what she had. She was incapacitated and couldn't have functioned any other way. She was living with a disease that affected the way she behaved and thought about people and the world at large. While my mom was sufficiently impacted with mental illness, she had some sense that she couldn't care for me and let my grandparents raise me. In her mental fugue she had enough clarity to make a decision for my own well-being.
My mom also valued education (she possessed a few graduate degrees) and insisted I followed-through with my own education. She valued self-sufficiency and would remind me that I had the fortitude and capacity to survive. While I lived with her pain and confusion, this experience has remained a catalyst for my friends, sponsees, and clients: when people talk to me I'm not shaken by their disclosures. Being able to listen to the pain of another person without flinching is a very concrete experience that allows me to witness humanity. I'm also keenly aware that my mom had wanted to take her own life on several occasions. Had she done that I wouldn't be here. Because of my mom I had an amazing relationship with my grandparents that would have never been possible had my mom been born without any kind of mental illness.
I was able to meet with my mom before she died. I got to visit her in Hospice. She told me to never relent, come from a place of hope, strive, to grow, evolve, and make a noise big enough that the world would take notice. I suspect that was her final gift to me.
Was I affected by my mom's mental illness? Certainly. Do I have more work to do? Absolutely. While I can focus on what I didn't get and be upset that there are places in my life that feel incomplete, I am left with a striking revelation: there are gifts in the darkness.
However you choose to deal with your own distress, good luck on your path.
In a previous article I noted that I would talk about why I opted not to follow-through with my rabbinical studies. I was raised in a fairly orthodox Jewish household by grandparents that survived the Holocaust. I attended shul on a weekly basis, spent hours studying with various rabbis, and was fully invested in learning Hebrew, Aramaic, and Yiddish. I fasted before Shabbat, and was absolutely focused on being a Mensch and not dating a Goyim. I assumed that as my grandmother was a Shadchan she would find me a nice Jewish girl to marry. Jewish life seemed full and complete, and I certainly felt connected to the Jewish community in the Brooklyn neighborhood where I was raised.
Towards the end of my rabbinical studies I was asked to meet with the rabbis. I was impressed with my progress and assumed that something good would come out of the meeting. Rabbi "L" was one of my mentors and someone who listened to the first 5th step I completed without judgment. My grandmother spoke highly of him and I felt safe talking to him and trusted his judgment. Before he taught at my Rabbinical school, he was a professor of Engineering at a college in upstate NY. When I met with the Rabbis, Rabbi "L" said that the way I asked questions and the way I responded to questions the entire faculty was pretty convinced I was an atheist. This very kind man who I trusted without reservation told me something I knew one some level, but didn't want to admit. Rabbi "L" told me I needed to tell my grandparents as a form of making amends.
I needed to find a distraction, any distraction. I returned to temple, AA meetings, martial arts practice, and studying the languages of the Jews. I was embarrassed at how I lied to my grandparents and lived a life of deception. I'm Jewish and assumed my Jewish life would support my faith. While I was devout in my practice, something seemed to be missing. I came to understand that while I wanted to believe, I wasn't hardwired to believe in a supernatural deity. After a few months I approached my grandparents and made my grand confession. My grandmother smiled and told me that both she and grandfather had known for some time that I was an atheist. They thanked me for following through on their requests to attend Rabbinical school, participate in the Jewish culture, and study the language. My grandmother said that while I no longer needed to attend to the activities of the Jewish culture, she said that both she and grandfather required that I continue with AA meetings and martial arts practice. So as I wouldn't be complicit in any more deception I honored the wishes of my grandparents and admitted to them that I had also eaten pork when I wasn't at home. I felt a tremendous sense of relief and came to understand what the AA literature discussed when it mentions "freedom from bondage of self".
I realized what had been missing from my life. I understood that being consistent meant that I would need to live my own truth.
After I told my grandparents, I told the rest of the students in my class at Rabbinical school. I talked to my martial arts teacher and anyone in my life who was close to me. Some people told me they suspected that I was a non-believer while others told me I was having a crisis of faith. When I asked these folks what manifested in their life to demonstrate they believed in God and they told me, I let them know those sorts of experiences never happened to me. My friends in Rabbinical school pointed to me surviving my addiction as proof of God. I couldn't accept this as proof as I understood that giving some deity absolute credit for saving me dismissed the role that the medical community had in saving my life. I spent 31 years of my life as a mental health counselor treating veterans with PTSD and addictive disorders. My graduate work in forensic psychology and clinical psychopharmacology relied on peer-reviewed methods. I've returned to graduate school and I'm currently studying theoretical physics and algebraic geometry. I am a guy that needs proof, and my former career and current graduate work is filled with what I see as proof.
Let's define what I mean when I say proof:
It's probably not a leap to suggest that a belief in God would be able to meet any of this criteria. I don't expect an answer from any deity. I know a lot of fine people who have God at the center of their life. Every single sponsor I've had in the program of Alcoholics Anonymous had a belief in a higher power, and when you asked them to define this higher power they would always credit God with helping them get and stay sober. Nearly all of the women I have dated believed in God. This wasn't an issue for me as both groups of people never had a need to foist God on me nor did they have a need for me to believe. I certainly don't have a problem with people believing in God as long as they don't use their faith to enact law and enforce policy.
My grandparents had a quiet faith. I never heard them talk about God more than three times the entire time I knew them, and the only reason they said anything about God is because I asked their opinion. My grandmother said that talking about God was useless and that people needed to live their faith My grandparents often felt that the people who talked the loudest about their faith weren't doing anything other than trying to convince themselves they believed.
The program of AA suggests that people need a higher power to remain sober. Some people in the program work towards finding spirituality. I like this definition of spirituality from Wikipedia which includes "a sense of connection to something bigger than ourselves, and it typically involves a search for meaning in life. As such, it is a universal human experience - something that touches us all". In my case the "something bigger" involves feeding people that are homeless, donating clinical hours to veterans suffering with PTSD, working with people to help them stay sober, and completing graduate work in physics and math. All of these practices help me feel connected to people and none of these practices require that I believe in God. I often see the connection I had with my grandmother as my 'higher power'. My grandparents, especially my grandmother, is my moral compass. If I'm stuck or feel disconnected I can simply think about any number of conversations I had with my grandmother about a particular issue and I'm able to get clarity. My grandparents helped me get and stay sober.
Six of the 12 steps directly reference God, so it's not a leap to suggest the program is focused on God and it would be difficult to argue with people when they suggest AA is a religious program. I'm reminded of a recent court case filed by a prisoner who suggested that mandatory attendance in AA violated his constitutional rights. The court sided with the prisoner. The probation and parole officers involved in the case counter-sued and lost. The Ninth Circuit Court of Appeals upheld the opinion of the lower court and suggested that the dividing line between church and state is so clear that mandating AA attendance violates the First Amendment and the establishment clause of the US constitution. The court also suggested that a prisoner cannot be forced to attend 12-step meetings as a condition of his release and that probation and parole officers as well as prisons can be held liable for damages by mandating attendance at 12-step meetings. The Court's opinion suggested "while we in no way denigrate the good work of AA and NA, attendance in their programs may not be coerced by the state".
Reading this article you could suggest that I am wholly critical of Alcohol Anonymous. I think that would be an unfair assessment. I love AA and credit the program for saving my life and to a large degree, keeping me sober. Just as you cannot talk about Ovarian cancer without talking about women, you cannot talk about AA without considering how some people take exception with what might be seen as a religious overtone in the program of AA.
For many years Alcohol and drugs were my higher power. While getting drunk and loaded were the most important things in my life, I came to realize I was asleep on my life. I lived my life in fear and decisions were made for me. This wasn't okay then and it's certainly not okay now. As an extension of my evolving spirituality I have come to realize then when I focus on what isn't working in my life my world feels really small, and when I focus on possibility I enliven my life, expand my outlook, and attract more good stuff my way.
I'm an atheist as when I honestly examined the historical, philosophical, and scientific evidence for and against the existence of a deity and came to a conclusion that for me, no such supernatural deity exists. When I came out as an atheist I wasn't sure how the people in my life would react and I wasn't certain I would be welcome in Alcoholics Anonymous. Both of these fears were unfounded. When I approached steps two and three with my last sponsor he simply asked me if I had a higher power that worked for me, and when I said that I did, he simply responded "I guess we're done with those steps".
Much like Rabbi "L", my sponsor and grandparents, I found almost universal acceptance when people find out I do not believe in God. With the exception of several people who were absolutely convinced I would relapse unless I found God, most people are interested in my story. They want to know how I'm able to stay sober without God in my life and I continue to receive feedback that people love the stories I tell about my grandparents, the lessons they taught me, and the skills I learned from them that have enabled me to remain sober.
If you're like me and have found that you don't believe in God, or you lost your faith and you're wondering if it's possible to stay sober, I want to invite you to realize that yes, absolutely. It's possible to create your own definition of a higher power. It's possible to stay sober as an Atheist, and it's possible to find your way if you have a secular approach to recovery.
Whatever you do, good luck on your path.
Success isn't owned, it's leased,,,,,and rent is due every single day - JJ Watt, Defensive End, Houston Texans
I've been spending a fair amount of time thinking about commitment and how that manifests in my life. When I got sober I made a commitment to my grandmother that I would stay sober. Initially this commitment was made out of obligation. I was annoyed that I was asked to modify my behavior. I was young and suggested my grandparents were being unreasonable. It didn't make any sense that someone would ask me to quit as I reasoned that my use affected no one but me. When I stepped back from my self-righteous anger, I remembered that my grandparents survived a genocide. I realized I could continue to meet my own needs or understand that not only did my grandparents spend a lot of time and money dealing with the wreckage of my use, but they also spent a lot of time worrying about me. I realized my behavior was no longer okay. I came to understand compassion meant that I needed to place their needs before mine. When my grandparents gave me feedback they were never hostile nor did they attempt to make me feel bad - they simply told me how they felt without shaming me. As I have matured I understood my grandparents were pretty evolved human beings, and I was both lucky and exceedingly fortunate to be raised by such lovely and generous people.
During the last day of my use I ingested large amounts of alcohol and copious amounts of stimulants. This combo landed me in the hospital and resulted in significant physical problems. I awoke surrounded by a team of doctors and nurses consulting about my condition. The attending physician began to tell me that I nearly ended my life, but I readily dismissed his comments and was able to counter every intellectual argument he offered - in the fog of withdrawal I somehow assumed that even tho I nearly died, I was intellectually superior. My grandmother came into the room, and with a disarming sense of compassion, she disabled my defenses by simply telling me she was worried I wouldn't make it. I broke down and told my grandparents I would do whatever they asked. Both my grandmother and my grandfather told me I needed to attend AA meetings, enroll in a martial arts school, and attend to rabbinical studies. I have continued with martial arts and AA meetings, but have since ended my rabbinical studies, something I will address in a later article. What I initially assumed was a way to manipulate me (the requests of my grandparents) I came to understand was merely compassion. - my grandparents wanted me to be okay; their energy came from their concern.
I have been wearing my grandmother's wedding ring since my 16th birthday and have never taken it off. I wear her ring every day as a reminder of the commitment they had for one another, and as a reminder of the commitment I made to them that I would stay sober. I have honored that commitment as I just celebrated 36 years of sobriety.
Focusing on commitment requires that I change my behavior. I understand that while my intentions might be in the right place, my behavior is the only thing that tells the truth. During my active addiction it became apparent that my behavior progressed in concert with my addiction. I was certain that my use didn't impact anyone, let alone me. The truth is that I was committed to meeting my own needs and committed to ignoring the needs of my grandparents and the world at large. I pretended I was committed to changing my life. I'd give lip service to the importance of staying sober, but when I was alone I was committed to getting high. While I believed I was maintaining a bulletproof facade, on some level I knew I was lying.
After being sober for some time I learned two things: that everything I do either supports me to remain chemical free , or leads me to a place where I'll engage in some kind of distraction (working too much, playing video games, eating too much sugar, chemical use) and doing what my grandmother used to say: you are behaving in a way that doesn't look good on you.
Here are a few tips for developing a stronger sense of commitment:...
Next week I will celebrate 36 years of sobriety. As I approach the eve of my anniversary I am reminded of the model of recovery that has made this milestone possible. When I got sober my grandparents (both of whom survived Auschwitz) asked me to develop a mission statement that would guide my sobriety which I would like to share with you: staying sober is the single most important thing in my life, and if anything jeopardizes my recovery, it's eliminated. This kind of commitment and absolute focus has supported me to remain sober through hardship and loss, through sadness and despair. Absolutely nothing else is as important as staying sober.
I am grateful I found a homegroup where I feel comfortable and feel like my contributions are valued. In the last two years I've seen an increase in membership and a significant amount of relapse. While relapse can be part of recovery, it certainly doesn't have to be a part of your story. A casual review of the people who have relapsed in the last year demonstrates a startling pattern: every single person that relapsed gave a detailed version of their relapse, and without question they placed more importance on other aspects of their life versus the need to stay sober.
I have mentioned the following concepts in another article I wrote for this site, but I believe it's worthy of restating them here: I attach a tremendous amount of emotional pain to the thought of using and a tremendous amount of pleasure to the thought of remaining chemical free. Not only do I stay sober because I made a commitment to my grandmother (pleasure) I do not use chemicals because it creates more problems than it solves (pain). I was able to quit as the people I knew who used drugs and alcohol had different goals than I did. I wanted more from my life than I was currently getting. I no longer saw drug use as fun, and everything I wanted in my life conflicted with using alcohol and drugs. I did not want to be asleep on my life. Anything I wanted in my life and the relationships I created are vastly more important than any chemical I would use or alcohol I would drink.
Oftentimes I hear people suggest they don't like the program because all they hear is pain. I don't see pain when I attend meetings, rather, I see possibility. I am reminded of Ivan Denisovich, the protagonist in the novel, One Day in the Life of Ivan Denisovich, a story about a prisoner in a stalinist labor camp in the 1950s. The story offers a stark parallel to an AA member trying to stay sober. Ivan does whatever he needs to do to make it through the day so he can eat. He endures hardship and trouble as he understands the reward for existing one more day. He exists because he knows that staying alive and pursuing freedom is its own reward. The protagonist in this story also draws a parallel to Viktor Frankl, a survivor of the Holocaust and the author of Man's Search for Meaning. Frankl' noted that we must endure, and that suffering will, with a proper attitude, bring light. He recounted that the will to survive (a man's attitude) and not the conditions of a particular camp, generally determined if this same man survived. Frankl' believed that possibility is the natural outgrowth of pain....
It's been suggested that you can improve the quality of your life by cultivating compassion. Compassion has been described as 1) a feeling of deep sympathy for another person, 2) to suffer together, or 3) concern for the misfortune of others.
Not only is compassion praised as a desired human quality, studies suggest that engaging compassion can increase the hormone DHEA and reduce cortisol, the hormone responsible for managing stress. It's also been suggested that people who live with a high degree of compassion tend to be happier and be actively engaged in service and volunteer work.
When people live a compassionate life they tend to be admired by friends and family. This sense of compassion tends to spill over into their relationships.
I'd like to suggest five ways to engage compassion: