Mindfulness in Recovery

Mindfulness in recoveryThe high-performing athlete concentrates on and practices physical and mental requirements to achieve success. The serious student blocks off time to pay attention to and study necessary subject matter to gain specialized knowledge. An accomplished musician shuts out distractions and focuses on the task at hand, allowing herself to become immersed in music. A master plumber is mindful of a plumbing problem and moves into a different state of mind to find a solution.

More and more people have discovered that life in general in improved by practicing what’s called mindfulness. Below is a brief description from Mindful.org:

Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.

Applied to addiction treatment and recovery, mindfulness is a therapeutic tool to ease anxiety, alleviate stress and remove blocks that prevent growth. Many of us live in constant distraction, dealing with situations throughout the day, hardly ever stopping to become mindful and pay attention to our emotions, thoughts and actions. Sometimes, when I stop to purposefully meditate and become mindful of what’s going on inside, I realize how tense I am, how I’m lingering in anger over something that happened days ago, how I feel anxious yet there’s no rational reason to be anxious. When you feel like a pinball in a pinball machine, it might be time to stop and become mindful. Meditation and mindfulness are especially helpful to the recovering addict early in recovery when everything is usually changing fast, confusing and tense.

There are certain skills that lead to a less stressful life, that help us deal with anger, that lessen anxiety, that help us connect better to others, etc. Just like the accomplished athlete, musician, student or plumber, living well requires knowledge, understanding, focus, paying attention to what’s going on in our brains, our bodies, and what happening with our emotions. There’s no universal way to meditate or practice mindfulness, but there’s lots of literature on the subject — as they say, Google it.

Science will gradually discover how meditation and mindfulness act on the brain to help with depression, anxiety and resentment, but people who’ve meditated and practiced mindfulness in one way or another for thousands of years just did it and it worked.

Pumping the Endorphins in Addiction Recovery

Pumping the endorphinsWhat are Endorphins? The excerpt below is from Wikipedia:

Endorphins (contracted from “endogenous morphine”[note 1]) are endogenous opioid neuropeptides in humans and other animals. They are produced by the central nervous system and the pituitary gland. The term implies a pharmacological activity (analogous to the activity of the corticosteroid category of biochemicals) as opposed to a specific chemical formulation. It consists of two parts: endo- and -orphin; these are short forms of the words endogenous and morphine, intended to mean “a morphine-like substance originating from within the body”.[2] The class of endorphin compounds includes α-endorphin, β-endorphin, γ-endorphin, σ-endorphin, α-neo-endorphin, and β-neo-endorphin. The principal function of endorphins is to inhibit the transmission of pain signals; they may also produce a feeling of euphoria very similar to that produced by other opioids.[3]

There’s medical evidence that exercise releases endorphins and can help ease depression. Exercise is routinely advised in addiction recovery. During addiction, the brain’s natural feel-good chemicals are altered, therefore, often in early recovery, depression, anxiety, low self-esteem and just a general “bad” feeling make it difficult to avoid relapse. Because addiction treatment is mainly about relapse prevention, we advise our clients to use every tool available to avoid relapse.

Unless there are physical restrictions which prevent a person from exercising, it’s important in recovery to develop a regular routine of physical activity — walking, running, Yoga, weight lifting, swimming, etc. Not only does physical activity release endorphins, it’s good for the heart, it builds and tones muscle and it can boost self-esteem. Just the regular act of doing something healthy gives a person a sense of accomplishment. Below is from Addiction.com:

In addition to the chemical changes happening in your brain when you exercise, working out can mitigate the negative effects of giving up your substance(s) or behavior(s), which include sleep troubles, anxiety and depression and weight gain. Simply by improving your overall health and well-being, regular exercise builds your body back up and gives you a healthy way to release difficult or pent-up emotions, including anger, sadness and frustration.

I can personally attest to the benefits of exercise. I always feel better after a good workout. (When there’s a question about the physical ability to exercise, always consult a physician.)

Healthy, Wise, Sober & Clean

I’ve heard over and over from people just starting out in recovery from addiction that it feels like life is over. It might seem obvious to most that abstinence is expected if a person’s going to recover from addiction, but for the one addicted the acceptance of this painful reality is difficult. When someone receives a serious medical diagnosis, it takes a while for the reality to set in. The same is true when someone gradually accepts that chemical dependence is a reality and abstinence is expected in recovery. To tell the person at this point that the end goal is to become healthy, wise, sober and clean is enough to make their eyes roll and stomach turn.

In the person’s mind they try to imagine going to a restaurant without drinking wine — they imagine not stopping into a Sports Bar on the weekend, drinking beer and watching football — not smoking pot and listening to a great new musical release from their favorite artist — not getting chemically loose and in the mood before sex — no drug-induced inspiration when dealing with creative endeavors — on and on. Most of these images are old images that no longer fit the current reality. In most cases the drug has quit adding the original pleasure or expected result — the drug is mainly causing problems, but the mind tends to remember the pleasant, and repress the unpleasant. 

This is from the book Alcoholics Anonymous:

Most of us have been unwilling to admit we were real alcoholics.  No person likes to think he is bodily and mentally different from his fellows.  Therefore, it is not surprising that our drinking careers have been characterized by countless vain attempts to prove we could drink like other people.  The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker.  The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death.

This was written in 1939. The basic message applies today, to women, to young people, to old people, to all races and to other drug addictions. When the addicted person realizes and accepts the problem, the idea of life-long abstinence is almost always overwhelming. This is where the concept One Day At A Time came from. The person in recovery can stay clean and sober today, then commit again tomorrow. Before long, weeks, months and years have gone by. If the person’s using recovery in a holistic way, they’re exercising, eating well, improving their minds and nourishing their spirit. In doing so, life becomes good, and the person realizes they can do anything anyone else can do except drink or use some other drug of choice.

In most cases, the people I know in long term recovery don’t want to drink alcohol or use some other drug, because it’ll ruin the good life they’re living. In real recovery, when the person’s committed to holistic recovery, the struggle to stay away from the drug, and bemoaning the ability to “relax and have a good time”, transforms into a pull from a better life that creates the desire to seek more healthy, wise, sober & clean improvement. Instead of using energy to stay away from something bad, the person is pulled toward something good. This makes all the difference.

Alcohol Is More Than A Social Lubricant

alcohol is more than a social lubricantI definitely don’t want to come across as a prohibitionist, a nanny lecturing adults about the evil of alcohol. For those who drink socially and enjoy the experience, that’s fine by me. There should be no confusion between the treatment of alcoholism and drinking alcohol in general. If John Barleycorn is your social friend, a la votre! If John Barleycorn is slowly killing you, though, we can help. Most people think of alcohol as a social beverage, because they’ve never had a problem with alcohol and don’t understand people who “can’t hold their drink”  – however, alcohol is more than a social lubricant.

It’s been theorized that the stigma placed on alcoholism is partly because normal drinkers don’t want one of their only legal pleasures restricted. We all hear in the news about the harmful effects of sugar, cigarettes, fried chicken, etc. —  and even sex can cause diseases.  So, it’s understandable when there’s pushback when someone starts warning about alcoholism. What? I can’t even have a beer without worrying about addiction and liver disease? I also understand that for around 8-10% of the people who drink alcohol it becomes a problem. It helps to discuss alcoholism and get the facts out — this only clarifies the misconceptions and avoids confusion. Discussion of alcoholism has nothing to do with social drinking or enjoying a few beers watching football or just lounging around a pool relaxing. These are two separate things, so hopefully the stigma will vanish and we can deal with alcoholism responsibly.

You can easily look up the statistics on alcoholism. Alcoholism is a serious health problem and a drain on our economy. In order to fully understand that alcohol is more than a social lubricant, it helps to realize that chemically speaking alcohol is a drug. If we just discovered alcohol today, you’d have to have a prescription to buy it. Alcohol is simply the drug we chose as a society to sell legally without a prescription (not counting the years of Prohibition). Morphine was once sold over the counter, but all such drugs are now regulated so that prescriptions are necessary, except alcohol (marijuana in some states, now, although with greater restrictions).

Alcohol when used in excess over a long period of time does more damage to the body than narcotics you have to buy with a prescription. Just because the great majority of people can drink responsibility with no negative consequences doesn’t mean that alcohol is just a social beverage — to the alcoholic, alcohol is poison. It changes the structure of the brain and creates an insane obsession over time. I don’t really think that alcoholism throws a damper on the enjoyment people find in alcohol — it’s a separate subject about a health issue, sans moral judgment. My main concern is that with all the damage caused by alcoholism, the medical response and the social concern are totally inadequate, but that’s another subject for another day.


The Language of Addiction

language of addictionBy the language of addiction I mean how we talk about addiction in ordinary day to day discussion, how addiction professionals talk about addiction among themselves, how addiction professionals talk about addiction with clients/patients, how medical professionals who don’t specialize in addiction talk about it, etc. Often there’s miscommunication because of the stigma placed on addiction. The term itself is loaded and many professionals who work with addiction prefer to call it chemical dependence rather than addiction. These chemical dependence professionals also avoid the term drug addict or alcoholic — they feel the labels are too judgmental, demeaning and offensive.

I started working in the addiction field in the early 80s, and at that time “drug addict” and “alcoholic” were common terms. Yes, society used these terms in disparaging ways, but, then, society is going to use terms in disparaging ways as long as the stigma and old ideas about addiction exist. I don’t use the term “chemically dependent” often, but I might if I’m communicating to someone or a group of people who understand and use that term. Addiction is a perfectly good word from my perspective.

When I started in the addiction field in an inpatient facility, we called those who came for help “patients”, but now we call them “clients”. I think what matters most is not particular terms but the communication of ideas and facts, the connection on an emotional level and the understanding established on an intellectual level. It’s probably confusing to people, though, outside the addiction professional when they hear different terms used from one place to another. This is why the initial intake and assessment are important when someone seeks help. It’s important that the patient/client is not confused. It’s also important that we don’t soft peddle a serious condition by using vague terminology.

At NewDay, we seek to clarify the treatment experience upfront. We let the client know what to expect and we seek to get a feel for how the client understands the problem. We ask the client what they want out of treatment. It’s best to stay objective, to let a person know what the assessment/evaluation shows. If there are signs and symptoms of addiction/chemical dependence, then we let the person know what we see in the assessment/clinical evaluation. We make observations and recommendations not moral judgments and commandments.

When talking with someone who’s seeking help because alcohol or some other drug has become a problem, I always explain terms like “drug addict” or “alcoholic” or “substance abuse” or “chemical dependence”. I tell the person that if we use these terms, they’re not judgments and not meant to demean — we’re trying to establish the severity of the problem and the appropriate level of treatment.

Once trust is established, it’s like when a family has their own language and ways of communicating with one another when dealing with problems — if someone outside the family talked to the person in the same way, it might be offensive, but inside the family it’s understood. If I talk to a client to whom I’ve established trust, and I use the term “drug addict”, as in “it’s helpful for a recovering drug addict to establish a support system” the client understands what I mean by “drug addict”. If someone outside treatment who doesn’t have a close relationship with the person says “you’re a drug addict”, the person might react defensively. I also use the terms “drug addict” and “alcoholic” in treatment because if they go to Alcoholics Anonymous or Narcotics Anonymous for ongoing support after treatment, they’re definitely going to hear the terms — but, again, the terms are understood in such an environment and no one feels demeaned or insulted.

In treatment, the person who’s seeking help is better off understanding the language of addiction, and understanding that not everyone understands addiction in the same way. The important thing is no matter if we say chemical dependence or addiction, understanding and accepting the reality of the condition is far more important. If a doctor diagnoses someone as a diabetic, what’s important is that the patient understands the reality of being a diabetic and accepts the treatment for diabetes. It’s the same with addiction — getting hung up on terminology is distracting and dangerous.

Opiate Addiction and Recovery Management

OPiate addiction and recovery managementThose who become addicted to opiates through prescribed medication for a legitimate medical condition like pain relief have a hard time accepting they have the same opiate addiction as someone who became addicted after using opiates they bought from a dealer to get high. There’s a difference in the original motivation to use opiates, but there’s no difference in the subsequent addiction to opiates. This resistance to be seen as an “opiate addict” is understandable given that there’s still a stigma attached to drug addiction. In treatment we remove the stigma and teach clients that addiction is a medical condition regardless how one becomes addicted. Opiate addiction and recovery management are basically the same for all who become addicted.

The differences are covered in the treatment plan. Each client in treatment has to deal with their individual emotional, social and psychological difficulties. The problems with which they present might have been caused by their addiction or they might have preceded their addiction. It’s a mistake, however, for a client to think that if they deal with their emotional problems they’ll be “cured” and won’t have to develop a long term recovery management plan. Those who come to treatment because they became addicted to prescribed opiates often think that if they’re detoxed, get it out of their system, then there’s nothing else to do except be more careful.

There’s not enough space in a blog post to go into the difference between physical dependence on a drug and drug addiction, but suffice it to say that addiction adds to physical dependence the element of mental obsession. Addiction alters the brain and, in a sense, rewires the brain in the region that has to do with pleasure-reward. Most people who use opiates/opioids for pain relief don’t become addicted, even if their body adapts to the medicine and they develop a physical dependence — they don’t crave the drugs when the pain is relieved, and they don’t usually take more than is needed to deal with pain. They might experience some withdrawal symptoms when they quit, but they don’t crave the opiates after there’s no good medical reason to use the medication. (read the link) 

When a person is addicted, though. it takes a long time for an opiate addict to get past the mental obsession that is a huge part of addiction. When the brain is wired to crave a drug as if it were a necessity, that obsession doesn’t leave immediately. There are social, environmental, emotional and psychological triggers that set off this craving, and until recovery is solid the recovering addict is in danger of relapse. The addict is in danger of relapse even after years of abstinence, although if the person is working a recovery management program the danger becomes less and less.

It’s only when a recovering addict stops doing anything to manage their susceptibility to active addiction that the person sets up almost certain relapse. It’s easy to forget what addiction was like if you go about your life as if it never happened. Over time the mind can play tricks and the addict tells herself that it’ll be different now that she knows what can happen if she uses opiates too often — the addict will experiment with a tablet here and there – when nothing terrible happens the person thinks it’s under control. What happens after that is active addiction returns and the mental obsession coupled with physical dependence once again controls the person and leads to bad consequences.

It’s not as important what motivates a person to start using opiates as it is that a person accepts their addiction and realizes that a recovery management program is necessary to avoid returning to addiction.


Choosing Sobriety Over Alcohol

Choosing sobriety over alcoholI recently read about a group of young professionals from Brisbane who started a movement in 2010 to help change ideas about drinking alcohol. The movement is Hello Sunday Morning (HSM). This is a recent blog. I chose this blog because it relates to the holiday season. Celebrating life is a powerful concept, and the holidays are a good time to focus on that concept.

HSM is not a form of addiction treatment. The people who have joined HSM might be early stage alcoholics or they might simply be tired of cultural expectations to drink alcohol. For most of my life when someone said they have given up alcohol, the first reaction is that something is wrong with their health. What a crazy reaction. The guys who started HSM felt the same way — they experimented with six months of sobriety and learned about themselves clear headed and sharp. Their movement has grown to be the largest such group online.

I often tell people in treatment who have a difficult time seeing themselves as alcoholic or a drug addict to just drop those labels and make a decision to give sobriety a chance — see how thinks go after 3, 6, 9, 12 months. I tell them that if they want to go back to drinking after giving sobriety a chance, the liquor stores and bars will still be open — they aren’t going anywhere.

It’s amazing how many people come back and report that life has greatly improved since they’ve been sober. I think it’s great that many young people are choosing sobriety, whether it’s to be healthy, productive, or to take a better looking selfie at a moment’s notice, whatever the reason, it’s a valid choice. Alcohol is not friendly to the mind and body if it’s consumed above moderation. Moderation is defined by most experts as just a drink or two a day — many young people who go out drinking at clubs fall into the binge category.

Alcohol can negatively affect school, job performance, health, mental acuity in general, and it can be tough on relationships if the partner doesn’t like the constant drinking, partying lifestyle. Choosing sobriety regardless of societal pressure shows individuality, self-awareness and independence. Drinking just to be like others is not a good reason to drink.

In addiction treatment, we see people who’ve reached a more serious stage and our focus is on medical stabilization and dealing with the bio-psycho-social ramifications of addiction. Movements like HSM deal with general attitudes about drinking and the choice to not drink. Wow, sobriety as a voluntary life-style choice, even if you aren’t an alcoholic – what a concept!

Holidays and Addiction Recovery

It can be tough on people in addiction recovery around Christmas and New Year. Holidays and addiction recovery cause friction in early recovery The parties and spirit of celebration too often center around alcohol spirits. The holiday season doesn’t have to be difficult for those in recovery — there are different ways to celebrate. It probably sounds corny to most sophisticated party goers, but the holiday season can be a time for reflection and the expression of good will.

People in early recovery who could have a hard time during the holidays, if they think about all the parties they’re missing or worrying about being around family members who’re drinking egg-nog or sneaking out in the back yard to smoke a joint, could think about others instead. It’s the season of giving. The holiday season should help us get out of our self-centeredness and think of others. There are people who literally have nothing, no home, no gifts, no money, no family, not anything. Helping some of these unfortunate people is a good way to get out of self pity.

Also, Alcoholics Anonymous and Narcotics Anonymous groups usually have holiday get-togethers where people in recovery celebrate sobriety and help one another appreciate the good things recovery brings. There are lots of ways to celebrate the holidays rather than drinking alcohol of taking some drug for an artificial high. Real joy doesn’t come from a bottle or a pipe or from popping pills — joy comes from human interaction, from fellowship, restoration and healing and helping those less fortunate.

Even if a person is not a Christian and doesn’t connect to Christmas or isn’t of some other faith like the Jewish faith celebrating Hanukkah, anyone can connect to the spirit of joy, good will, giving and love. Although it would be good if we could maintain this attitude and mindset year round, it’s unrealistic to expect we can do so without getting bogged down in the drudgery at times — so the holiday season is a good time to rejuvenate our spirits and recharge ourselves — it can be a joyful time or a time of depression, it’s up to us. Holidays and addiction recovery don’t have to be at odds, not if the time is used to celebrate life and recovery.


New Year’s Addiction Resolution

decideMost people think of resolutions at the beginning of the New Year. Our name – NewDay Counseling – is based on the concept of a new start, new life, new beginning, a new day. Addiction treatment is not something to put off, because it’s too easy to keep putting it off. The idea of a new day is that this day is the “new day” and it’s time to act. This is the day to make a decision. As the old saying goes, tomorrow never comes. All we have is today, right now.

It’s easy to say that we can deal with a problem like addiction without professional help, to minimize the consequences and rationalize why now is not a good time for treatment. Well, there’s Christmas shopping, parties to attend, and, besides, with the New Year  coming up that’ll be good time to make a new start — later, tomorrow, next week, next month, next year.

The problem with putting off addiction treatment is that it’s never a good time, because it’s something scary and unpleasant. Who wants to jump right into something that’s unpleasant? In reality, the only way to get into treatment is to just do it. Everything an addict puts before treatment and recovery is usually, eventually, lost. Addicts lose the family they claim to be number one, or they lose their job that’s so important they can’t take off from work to get addiction treatment– on and on.

The New Year’s addiction resolution doesn’t have to come later — it can start now. This day. Most of our clients in treatment talk about the relief of finally making the decision to deal with addiction and to take actions to achieve recovery. In order to get into recovery and stay in recovery, it requires commitment and action. When someone says right now is not a good time to take 8 weeks out of their life to attend treatment, I take them to a blank chalk board and put a little dot on it. I say “This board is your life going forward, and this dot is the eight weeks you’ll be treatment. It’s such a very small amount of time compared to the rest of a person’s life, but it can make such a huge difference.

Another thing people often say near the end of treatment is how fast the time went by — we have clients who say they aren’t ready to leave at the end of 8 weeks. We never know if something can be done or how it will turn out until we take the action. Happy Holidays! I wish everyone suffering from addiction finds their way to recovery — what a great present that will be — today is the day to begin.

Opioid Deaths Continue to Rise

fentanyl-on-rise  This Washington Post article received national attention. Opioid deaths continue to rise — in 2015 the number of opioid caused deaths were greater than gun homicides. All drug overdose deaths reached approximately 50,000. Around 7200 American soldiers have died in the Middle East since 2002 — over 50,000 Americans died from drug overdose in 2015.

Heroin overdoses have exceeded 12000 deaths in a year. I heard over the weekend that addiction treatment is the fundamental answer, yet most addicts can’t access treatment, and if they can it’s usually low quality treatment. Young people attending college have not gravitated toward addiction treatment as a career. Many think that addiction treatment is subsumed under their psychology degree, or counselor’s license, but addiction treatment is a specialty that requires specialized training and knowledge. Drug misuse that doesn’t reach the severity of addiction can be dealt with in one on one counseling sessions dealing with risk reduction and cognitive behavioral changes, but opiate addiction, for instance, requires a comprehensive medical approach along with group therapy and individual counseling.

I’m sure there are individuals who can get off opiates through their church, their physician, talking with a therapist, or going directly to Narcotics Anonymous, but when setting standards we need to be realistic. Most opiate addicts will not get through the withdrawals — even if they tough it out and do get past the withdrawals, statistics show they’ll return to opiate use in a very short time.

According to scientists who’ve studied opiate addiction’s effects on the brain, opiate addiction rewires the brain, so to speak (for technical knowledge read the book linked) or causes dysfunction in the brain at the reward center, the mesolimbic pathway. It takes a long time for the brain to adjust after coming off opiates. If we’re going to treat opiate addiction effectively, we need standards that are comprehensive. There must also be access to treatment. I don’t how we can fund treatment to assure everyone receives quality treatment, but it’s the only way to effectively deal with the problem. Physicians can quit giving out so many pain-killers, and scientists can invent pain medication that’s not addictive, but even then there’ll be underground drug operations which understand the profit in addiction. Opium has been a problem for a long, long time with spikes and dips in the severity of use — there’s a spike right now.