Alcoholism and Holidays

Alcoholism and holidaysI could have titled this recovery and holidays rather that alcoholism and holidays, but I believe we all need to come to terms with the word “alcoholism”and “alcoholic”. Alcoholism is perceived as a harsh word that some prefer to soften with terms like Alcohol Use Disorder (AUD). Regardless what we call it, the reality’s the same. I’m okay really with using a different term as long as it doesn’t change the way people perceive the seriousness of the disease. Yes, alcoholism, or AUD, is a serious, debilitating. progressive and deadly brain disease. Recovering alcoholics have to make adjustments, and one adjustment in early recovery is how to deal with holidays and all the attendant festivities.

It seems like a downer when a newly recovering alcoholic comes up on a holiday like Christmas and invitations to parties arrive. What to do? Go and drink a soda that looks like a mixed drink? Tell the host that you aren’t drinking? Don’t go? Make a pledge to yourself or your spouse, partner or friend who might be going with you to leave if you get uncomfortable? Each individual has to make their own choices, of course, but it’s much better to get advice from someone in long term recovery who’s dealt with alcoholism and holidays a few times, or many times.

If the recovering alcoholic is going to AA, they suggest that newcomers get a sponsor, someone who’s been in recovery for awhile and knows the pitfalls. No one has to recover alone. There are many people who can and will support you in recovery — the recovering alcoholic has to seek them out and ask for advice and support. It’s difficult for most people to admit they have such a serious problem they have to ask for help, but there’s no shame in asking for help. If you don’t know anything about real estate, you find someone who does. If you want to learn a new language, you seek out people and methods to teach that language.

Alcoholism and holidays are tricky. There’s unnecessary stress during the holiday season — it doesn’t have to be that way. If a person in early recovery chooses to avoid parties with heavy drinking, then that’s probably a good choice. There will be other holidays, and when that person is strong in recovery and the desire to drink has gone away, a recovered alcoholic can do anything others can do, except drink alcohol without consequences.

Motivation in Addiction Treatment

Motivation in addiction recoveryThere are basically three types of motivation in addiction treatment. One is to avoid unpleasant consequences through compliance. These clients are usually pushed hard to get into treatment, and they’re the most likely to return to their drug of choice. Another form of motivation is calculation — a person has calculated the costs and benefits of drinking and using drugs and has concluded that stopping will be a better choice. The third form of motivation is existential — the person has committed to addiction treatment because life in addiction has become miserable, hopeless and precarious. These last two forms of motivation are stronger than the first with the last being the strongest.

Although addicts who’re forced into treatment by the courts, family, spouse, etc., can and do recover, they usually have to go through more trouble before the desire to change is deep and meaningful. I’ve seen clients who’re forced kicking and screaming into treatment turn around and realize they have a problem. Most of us working in the field for a lengthy period of time have come to realize that it’s almost impossible to tell who’ll recover and who won’t, but the odds are not favorable for the person who’s in treatment just because someone holds leverage over the person. You’ll often hear people say about addiction treatment and recovery that the person has to want to stop drinking or using some other drug in order to recover. A desire to stop is not necessary in the beginning. I’ve seen people forced into treatment with no intentions of stopping have an epiphany and recover long term, and I’ve seen people who desperately wanted to recover never stop for any long length of time and eventually die from their addiction. Nothing has hurt the addict more than for people to tell him/her that they aren’t trying hard enough, and that if they just put their mind to it, they could stop drinking alcohol or using cocaine or shooting up heroin.

The person who rationally looks at their addiction and decides the costs of using drugs outweigh any benefits are at least motivated, but if addiction recovery were as simple as calculation, most people would stop long before the late stages of addiction. Calculation can be strong enough to get a person into recovery, but there usually has to be something stronger keeping a person in recovery or they go back to the drug of choice after the bad memories fade and the calculation changes. Perhaps the person has bad fortune in recovery and loses their job in a bad economy — the person who’s only calculating the costs and benefits might say that recovery is not “paying off”.

The point is that a desire to stop is a good motivator, but not necessary to start the treatment process. Having a desire to stop, though, doesn’t guarantee recovery, especially if the person is quitting with the expectations that life will be trouble free without addiction. Addicts forced into treatment can and do recover, and addicts who initially decide to deal with addiction and recover can and do die from their addiction. What usually determines if a person recovers or not is their level of ongoing commitment to the long term process of recovery. The main form of motivation in addiction treatment that enhances long term recovery is internal commitment. When a person has truthfully admitted that addiction is a life-threatening problem and has committed to taking steps to achieve and maintain recovery, regardless of external circumstances or obstacles, then the motivation is real enough to sustain long term change and growth.

Virtuous Cycle in Addiction Recovery

recovery management

Upward and onward

In his book The Fifth Discipline, Peter Senge wrote about a virtuous cycle. Senge was writing about learning organizations, but the same principles apply to individuals and a virtuous cycle in addiction recovery. We’ve all heard about the vicious cycle — addiction is a prime example of a vicious cycle. A person becomes addicted to a drug, things get bad, the person tries to quit, the withdrawals are painful and life is just too hard without the drug, so the person says just one to take the edge off, then the cycle begins, over and over, with no apparent escape. This type of cycle is a downward spiral that ends in institutionalization, jail or death.

So, what is a virtuous cycle? A virtuous cycle would be when the addict actually breaks out of the cycle to create a new cycle that generates personal growth. The virtuous cycle is upward — it’s a good, reinforcing loop. The virtuous cycle is when a person applies recovery principles, things improve, the person reaches a plateau, then the person finds a new challenge, a new opportunity for personal growth which creates another cycle, over and over, upward and upward.

The path to the virtuous cycle is not easy, but it’s infinitely rewarding. In treatment, we attempt to guide clients to this virtuous cycle, to identify the old ideas that keep them trapped in the vicious cycle, to inspire actions necessary to get out of the vicious cycle and to teach recovery management tools necessary to start a virtuous cycle. The online Macmillan Dictionary defines a virtuous cycle this way:

a process in which a good action or event produces a good result that also causes the process to continue so that more good results happen

When the addicted person first tries to quit drinking alcohol or doing some other drug, they’re spending a lot of energy just staying away from the drug – if this is all the person does, no treatment, no counseling, no support, just white-knuckling it, then this will wear a person down mentally and emotionally, so that the person will most likely return to drug use. The virtuous cycle creates positive results — these improvements in the person’s life are inspirational. After improvement happens, the person’s drawn toward recovery rather than just trying to stay away from the drug(s) of choice. This makes all the difference in recovery.

When a person is pulled toward recovery because they want more growth and improvement, then great things can happen.

Outpatient Addiction Treatment

Group therapy

Treatment works

So, what is outpatient addiction treatment? First of all, the lingo is changing in the addiction treatment field. Although most professionals in the field still refer to addiction as addiction, there are some organizations referring to addiction as Substance Use Disorder or Alcohol Use Disorder. These changes in terminology are for diagnostic reasons mostly, and I still prefer to distinguish between alcohol/substance abuse and alcohol or other drug addiction. With temporary alcohol/drug abuse, a person might be mishandling a divorce or a close death by drinking too much or using some other drug to deal with pain and lonliness. This is usually temporary, and the person might need short-term counseling to find better ways to cope — however, if signs and symptoms show that the person is in the early or middle stages of addiction, progressing toward late stage, full blown addiction, then this is a serious medical problem that requires some form of treatment.

When a potential client comes to NewDay Counseling for a free consultation, we gather enough information to determine if the person is temporarily abusing alcohol or some other drug, or whether the person appears to have a more serious problem and could be in the early or middle stages of alcoholism or some other drug addiction. We also determine if the person has insurance or the ability to pay for treatment. For some reason many people tend to think addiction treatment should be free, but we’re a private organization and receive no government funds. There are organizations that receive state and/or federal funds, and we refer to these treatment options if the person can not pay for treatment or doesn’t have insurance. When people receive other medical treatment, they expect to pay for it or have it covered by insurance — addiction treatment is no different. Addiction might be the most under-treated medical condition in the healthcare realm, costing society billions of dollars a year. Addiction also needlessly causes pre-mature death.

When the issue of money becomes a barrier to treatment, even for someone who can easily pay, we always do a calculation of how much the person is now spending/wasting on alcohol and other drugs and the consequences of drinking and doing drugs — like DUI costs or making bad financial decisions or days not working or loss of a job because of a drug screen or failure to get a promotion due to lack of motivation or trips to the emergency room because of an accident while drunk — and when the calculations are finished the cost of treatment looks like a very smart investment. For an amount equal to most payments for furniture, a big screen TV or a nice stereo, a person can make payments on something, treatment, that can turn the individual’s life around and enable the person to become prosperous and happy in the future — yes, it’s a good investment.

Once we’ve determined that a person has an alcohol or other drug problem that is serious enough to warrant treatment, we have to decide if the person needs to go inpatient or is appropriate for outpatient. Outpatient treatment is less expensive and, of course, less restrictive. In outpatient a person can continue to work and be with the family if there is a family. Our Medical Director makes the final decision between inpatient and outpatient. If a person is in danger of going into withdrawals, and it’s too risky to try detox medication on an outpatient basis, we’ll recommend the person go to an inpatient detox, then the inpatient facility will determine how long the person stays inpatient. It could be that the person stays inpatient for a week or so then is transferred back to us at NewDay Counseling to complete addiction treatment in outpatient.

If the person is going to receive addiction treatment with us in an outpatient program, we perform what’s called a Bio/Psycho/Social assessment which asks pertinent questions about the person’s drug use/drinking history, family history, medical history, emotional state, employment situation and history, etc. After gathering all this information, a treatment plan is developed. The treatment plan establishes treatment goals, objectives, and interventions to accomplish the objectives.

The person begins group therapy which is four evenings a week, Monday, Tuesday, Thursday and Friday, from 5:30pm to 8:30p. One hour of group is educational, regarding some topic pertinent to addiction or recovery from addiction, then the other two hours are process group therapy. Very real, powerful and therapeutic relationships are developed in group therapy if the person opens up and allows others to know him/her. When a group of people are working together toward common goals it’s a much more effective than going it alone or simply talking to a therapist once a week for an hour, especially when what you’re dealing with is something as powerful as addiction. The client receives at least one individual session a week, more if necessary, then family involvement as indicated.

The person in addiction treatment and their counselor work on treatment plan goals, and the counselors meet once a week, at least, with the Clinical Director and Medical Director to discuss clients’ progress and what adjustments are necessary. Referral sources, such as physicians, attorneys, employers, EAPs, if they are on the signed release of information form, receive updates regarding the clients’ treatment — the client has to agree to this update information, otherwise, the client’s treatment is confidential. Unless a client gives us permission to tell someone he/she is in treatment, we can’t tell anyone unless there’s a court order signed by a judge legally requesting the information, but even then it has to be a court order signed by the judge, not just a subpoena.

Near the end of treatment, the counselor and the client begin developing a discharge plan. I prefer to call this a Recovery Management Plan. This plan is very important and should address the long term goals of treatment. Addiction is a chronic brain disease and it takes a long time to clear up, gain insight, stabilize and develop the coping skills necessary to make changes. Then treatment becomes maintenance. We recommend that the client find a support group like Alcoholics Anonymous, Narcotics Anonymous, Rational Recovery, a recovery church group, or whatever, just support from others going through the same recovery from addiction and maintenance of recovery. After a period of time in a support group like AA, the person can begin helping newcomers coming into the group, and this is when recovery goes to a higher level.

Once an individual begins feeling good emotionally, mentally, physically and spiritually, making positive changes, developing purpose and meaning in life, and then helping others do the same, recovery becomes not a “staying away” from alcohol or other drugs, but a moving forward to a better life that improves as time goes on. Recovery can seem like something is pulling the person forward — this is recovery, and it has to be managed and maintained.

More on Recovery Management

Recovery management

Spirituality in Recovery

I would like clarify my ideas and write something more on Recovery Management. In a practical sense, Recovery Management is about checking off items on a recovery plan list — nutrition, exercise, support group, relationships, work, etc, right on down the list of areas of concern in recovery — however, recovery is not so cut and dried.

Most addicts die premature deaths from their addiction. It’s the exception to the rule when an alcoholic recovers. It’s the exception to the rule when a heroin addict transforms her life. It’s not that recovery is reserved for the lucky few. I believe any addict can recover, so why do so many not recover? The answer is multifaceted. Addiction is more than situational drug misuse — addiction consumes the addict. Taking the drugs out of an addict’s body is the easy part — long term recovery is hard, although worth the effort, of course. Getting to the place where the addict realizes what he/she has to do to recover and becoming willing to do the hard work to recover is the missing link.

Addiction treatment, unfortunately, is hit and miss. The quality of care in addiction treatment is not consistent. Because addiction treatment access is limited, and because insurance coverage for addiction treatment is limited, and because there is still a social stigma placed on addiction, and because most bright young kids in college never think about making a career in addiction treatment, the results of addiction treatment are worse than they should be. There’s no reason that addiction treatment centers can’t offer consistent, quality care across the nation, but without the proper understanding and knowledge of what’s needed, healthcare professionals and insurance companies will not make the effort. There’s even misunderstanding of addiction among healthcare professionals — many think it’s simply a moral failing and lack of will power.

So, when a person suffering from addiction does seek treatment, there’s no guarantee they’ll receive quality treatment and education. Even when a person receives quality treatment, if the community in which they return after treatment still stigmatizes addiction and lacks the resources to help the recovering addict maintain a Recovery Management Plan, it’s very hard for the recovering person who’s still adjusting to sobriety. Depending on where the person lives, it can be very difficult to recover. If a person lives, say, in a section of a large city where many people use drugs and drink constantly, the temptation is ever-present. If there are no close AA or NA meetings, and if the people of the community have little interest in or knowledge of addiction recovery, then the recovering person is isolated. If this person has no family support, you can see the problem.

Still, such people do recover. Recovery takes an inner psychic change, a deep yearning for change, a spiritual transformation. Not a religious transformation — a spiritual transformation. What I mean by spiritual is simply that deepest part of what makes us human. It’s the part of us that has to do with survival, growth, love, courage, naked honesty, humility, the will to live and thrive. So, while Recovery Management is a practical plan to enhance recovery, recovery begins through that deep psychic change that wants something different and is willing to do what it takes to recover despite the odds — it’s a sincere reaching out to find the support, knowledge, help and spiritual strength that’s needed. Good treatment can help a person get to this point, but there still has to be, at some point, maybe not in the beginning, but at some point, something deep inside the person that wants a better life.

Balance in Addiction Recovery

well-balanced recovery

Addiction Recovery

Most people, especially younger people, who are in treatment contemplating what recovery and abstinence will be like foresee boredom and a constant struggle to avoid temptation. They fear the loss of friends and any kind of social life. What does a person do if they can’t go out to clubs and have fun with friends? What about when friends get together to watch the Super Bowl? What about New Year’s night? How can I not drink beer? How can a person enjoy music if they’re straight?

All these questions are frightening to someone who wants to recover but doesn’t want to live a life of mind-numbing boredom. It would be disingenuous to say that there isn’t an adjustment period in the beginning of addiction recovery in which it’s difficult to live without alcohol or some other drug of choice — however, if the person in recovery has a plan for recovery and manages the plan, they’ll know that this beginning phase will pass and they’ll find many things to do.

Usually, the person in treatment imagines how things were at some point in their life when alcohol or some other drug worked for them and they had fun. The person in early recovery is likely not taking into account how their drinking or other drug use was not fun before coming into treatment and caused many awful consequences. If they imagine these problems progressing, as they will if the person continues to drink alcohol or use other drugs, then the person can also imagine a different life in recovery.

Most people who make it to treatment have had significant problems with alcohol or other drugs such as cocaine, heroin, meth, etc. If the person was drinking or doing drugs and having a blast, they would most likely not come to treatment. The average addict wakes up feeling awful and attempts to drink enough alcohol or use enough drugs to feel normal — they are past feeling euphoria when using drugs — they are simply trying to get to normal or not suffer from doing without their drug of choice.

This is hardly a good, well-balanced life — it’s definitely not having a good time. In recovery a person can make new friends or come to an understanding with old friends who respect their recovery. People in treatment should soon realize that’s it’s a sad statement to say they don’t have what it takes naturally to have fun or do interesting things without putting some mood-altering substance in their body. They do have what it takes to have a good time, and, in reality, in recovery, they can have a truly good time, not an artificial high that doesn’t last, causes terrible consequences and eventually turns into constant pain.

Balance in addiction recovery means different things to different people, but basically a person who is managing their recovery will address all areas of their life — nutrition, intellect, emotions, relationships, exercise, occupation, etc. When this happens the person discovers their true potential. Recovery is about growth as a person and becomes a discovery process. Alcoholism and drug addiction restrict a person’s life and eventually destroy the person, while recovery expands possibilities and becomes creative. Facing life with a clear head and an untroubled heart leads to avenues the person never imagined were available. I see it all the time — a person in recovery finds a beautiful life-mate, they go to college and get a degree, they heal important relationships, or they get promotions at work, or they change their lives in some way they never knew was possible. Recovery, managed well, is about actualizing potential — it’s about growth and pursuit of happiness. If a person in recovery is bored and dissatisfied it’s likely because they aren’t managing the recovery very well. It could be they need some kind of medical attention, but it’s up to the person to find solutions and allow others to help in recovery — there’s always a better solution than returning to a life of addiction.

Recovery Management

Managing addiction recovery

Long term recovery

I’m as guilty as anyone writing about the problem more than the solution. It’s no wonder that many in society have a negative perception of addiction — they hear about the problem and consequences of addiction and substance abuse, yet hardly ever hear about or read about recovery. I’ve worked in this field long enough to see recovery happen over and over. People ask if working in this field is depressing, and if it leads to burn out. The answer is no, not if you don’t take it personally and follow up on those who recover. Addiction is a disease of relapse, so, even if a person relapses several times, if that person is sincerely trying, then recovery can happen — the relapses become learning experiences and reinforcement of recovery principles. Recovery management is a concept that addresses the chronic nature of addiction.

I started working in inpatient in a town that is a real recovery-based community — even the local university has an addiction support system to deal with students who are recovering from a problem with alcohol or other drugs. The treatment facility also had a half-way house component, so I witnessed long-term recovery many times over. In practically all the incidences in which recovery happened, the person used all the support resources available to manage recovery. Many  people in recovery return to school to finish their education, exercise, eat better, work on relationship problems, gain stable employment, learn to manage money, take care of their appearance, develop their interests that were before neglected, etc. A person recovering from addiction doesn’t have to go inpatient and a half-way house, this is just where I first witnessed the process of recovery. Recovery can managed through outpatient and ongoing community and family support, or a person can go into Alcoholics Anonymous and learn to manage recovery with the help of others. There are many pathways to recovery.

Recovery is recovery of the whole person. Addiction tears down the whole person, mentally, emotionally, physically and spiritually, so in recovery all these areas should be part of recovery. Attending Alcoholics Anonymous or some other support group is critical for long term success for most people in recovery. I won’t say everyone has to go to a 12 step groups or a support group, but I will say that I’ve seen the most success when do attend AA, NA, church groups dedicated to recovery or some other type of group support. Here is a link to a website that writes about recovery.

Recovery and Environment

addiction and recoveryWhen I worked in an inpatient addiction treatment facility in the 80s, when patients were admitted they were isolated from outside influences, especially alcohol and other drugs. The idea at the time was to remove all external distractions so the patient could immerse themselves in treatment. This wasn’t necessarily a bad idea for the beginning of treatment, but most patients were isolated for about 30 days with no outside contact, and counselors tended to forget about the environment to which the patient would return at discharge. Well, the counselors didn’t quite forget, because a discharge plan was developed to recommend aftercare actions, like attending AA or NA, but there wasn’t enough preparation for the patient to adjust to the environment. There also wasn’t a good understanding of how the environment affects recovery. We all made the mistake of placing too much importance within the person for achieving their own recovery. Just because a month of isolation and immersion in recovery produces marked change in an individual, this doesn’t mean that the change will last once the person returns to their environment. If alcohol and other drugs are present, and if there is no understanding among the people closest to the recovering individual, then recovery can be sabotaged.

It’s true that the individual has to take actions or nothing happens, but it’s also true that if family members, employers and friends don’t have a good understanding of addiction and recovery, they can have a very negative affect on an individual’s recovery. If alcohol and other drugs are always present in the recovering person’s environment, then it will be hard to resist using them again. Treatment providers gradually understood the importance of bringing the employer, family, family physician, friends and anyone else critical to the recovering person into the recovery process. We know now that recovery is a long term process that requires a plan, support from the family and community, and ongoing learning regarding what’s necessary for recovery from addiction. No one is obligated to support anyone else in recovery, but most people will are eager to support someone they care about if they’re informed about the condition and what it takes to manage recovery.