“If you don’t know someone who’s had a problem with addiction, you will.” –Dana Boente
Working in the addictions field is not easy. It is not predictable either. Some of the people who start treatment and sound like they are making healthy choices in their lives, end up relapsing, while others who struggle to start suddenly have a turnaround. Recovery is a journey and every person dealing with addiction and recovery need to forge their own road to determine what works for them. As I work with clients I discuss their window of choice and help clients to figure out what stretches it.
I define addiction as both a choice and disease. As I envision it, there is a window of time when a person has a choice, but once it reaches the threshold, it flips into a compulsion. At that threshold, the disease of addiction takes over and there is no longer a choice in the matter. During active addiction, the window of choice is minuscule. There is not much time from when the person feels the urge to the time they start using. Recovery is about stretching the window of choice.
So, what stretches the window of choice? Whenever a person does something that brings them peace and joy they stretch the window. When they feel connected with someone or when they are able to shift their perspective of a situation they gain more power to choose. Every time a decision to not use is made and honored the window gets bigger. I encourage my clients to make a list of things they can do to stretch the window of choice. They may listen to music, take a walk, journal or draw. It may take a lot of slow work to stretch the window of choice out enough to abstain or the window can seemingly stretch in the moment that the person hits rock bottom and decides that they need to change.
Recovery is about continuing to stretch out the window and adding more time of choice before hitting the threshold. Stress shrinks the window of choice. When someone has a setback or faces the pain of confronting the repercussions of addiction it causes the window of choice to get smaller, which leaves them closer to the threshold of relapse. Understanding this balance is critical. The window can shrink slowly or it can vanish the instant a certain person, place or thing appears. The key to recovery is understanding the window of choice and continually monitoring the growth or reduction of the window. When the window begins shrinking, self-care is critical to stop it. I encourage the clients to revisit the list they created and encourage them to choose at least one thing to try from their list. If you or a loved one are struggling with addiction, become curious about the window of choice and have a discussion about how to support its growth. It could be the key to change!
“If you don’t change your beliefs, your life will be like this forever. Is that good news?” –W. Somerset Maugham
We all have our own way of being in this world. Some people are optimistic and ‘happy go lucky,’ while others are pessimistic and constantly waiting for the next stroke of bad luck to hit. We all fall somewhere on that continuum and that is our baseline experience of the world. It is our default internal programming that keeps us stable in life. When we are on our baseline, life feels ‘normal’ or routine. When events happen, they sometimes throw us off our baseline. We can tell when things are off. We either have a feeling of being down, below our baseline, or things are going well and we are above our baseline. Resiliency is often discussed as being able to get back to ‘normal,’ or baseline after an event occurs.
While getting back to baseline is comfortable, this doesn’t always serve us. I often use an example of someone who has been living in poverty their whole life and they suddenly win the lottery or inherit a fortune. Many times, these people spend the money in excess and find themselves right back at their poverty baseline. It doesn’t have to be that way though. If they are able to raise their baseline and see themselves as a wealthy individual who respects the money they have, they can budget and invest to remain wealthy.
In order to raise our baseline, we need to see ourselves differently. This comes from doing the work of self-compassion and forgiveness. It comes from questioning our beliefs about who we are and what we want in our lives. Working in the addictions field, I frequently see people who start doing well once they get clean. For a period of time, things seem to be improving and changing. Then suddenly something happens which causes them to relapse. While they tell me that they have bad luck, what I often see is self-sabotaging behaviors. Their baseline beliefs about who they are have not caught up with the changes that are happening in their lives. They often feel unworthy of good things happening, or feel that they need to be punished for choices they made. While intellectually they want the good, their underlying beliefs are stuck on seeing themselves as ‘broken’ or ‘dirty’ because of what they did. Their baseline beliefs are still low, so their behaviors bring them right back to baseline.
In order to grow, our baseline beliefs about ourselves need to change. When we go through a difficult period, many people emerge stronger than before. This is referred to as post-traumatic growth. The baseline of how they see themselves shifts during the low point and they have more confidence and awareness once they get through. When we go through joyful times our baseline can raise as well. Knowing that we are deserving of the good and worthy of the blessings allows our baseline to float up and become our new normal. The key to growth is recognizing our baseline and questioning the beliefs that hold the baseline down. What are your baseline beliefs?
“My best friend is the one who brings out the best in me.” –Henry Ford
There is a big difference between the disease of addiction and other health related diseases. When someone battling cancer has a relapse they are often surrounded with love and support, but when someone suffering from addiction has a relapse, most people cut them off and avoid them. The love given to someone dealing with cancer is withheld from some going through addiction. It is not easy to be around someone struggling with addiction, but does shame and isolation work to get them to stop using? I was at a conference last week and Brené Brown asked a very powerful question. “Does shame and isolation make people more or less dangerous?” Think about the implications of that question. We have realized for decades that shaming hurts people, yet it is one of the most frequently used techniques to control behavior. What we all long for is connection. It is the support piece that is often missing and what we, as humans, crave.
We are wired for connection. It is part of our genetic makeup. From the time we are born until the time we die, we look for connection with others to share this experience of life. Somehow in our society we seem to have adopted a belief that we need to pull ourselves up by our bootstraps and go on alone. While it is true that we are the only one who can choose our behavior, having someone to talk to and share experiences helps to shift our perspective. Successful recovery includes forming a positive social support network. We all need at least one close friend to be open and honest with in our lives. We need that one person we can talk to when we have entered a ‘shame storm.’ It is someone who can help remind us that we can do better next time and help us to see that all is not lost. Social support is a critical piece of successful recovery and successful living.
If you know someone who is suffering from addiction, take notice if people around them are using shame or isolation to try to change their behavior. Reach out and provide a connection. It may save their life.
“Life is not linear; you have ups and downs. It’s how you deal with the troughs that defines you.” –Michael Lee-Chin
After years of counseling people in addiction and their families, the question I hear most often from loved ones is ‘why don’t they just stop using?’ Addiction is complex and although it seems like the answer is easy, it is anything but simple for the person dealing with addiction to stop. While there are no cures for addiction, research has shown that counseling, inpatient treatment and support groups are beneficial for many people. One of the ways I have found to explain addiction and recovery to my clients and their families is to envision a ‘Chutes and Ladders’ game board. The work of recovery is like going up the ladder. Along the way though, there are many opportunities to go right back down the chute of relapse. In order to keep them moving up the ladder, I discuss the importance of having a vision or goal they are working towards. Climbing the ladder day after day is hard work. It would be much easier to take a break or go down the slide, but knowing why they are doing the work of recovery is critical. One of the things I reinforce to my clients is that they can’t be doing the work of recovery for anyone except themselves. Many clients tell me that they are getting clean for their children or significant other. While I agree that their loved ones are important, the more important thing is to recognize that they are doing the work to be the best mother, father or partner they can be. It really is for them to be the best they can be and give their best to their loved ones.
So why do some clients seem to climb the ladder relatively quickly and easily, while others struggle and fall down the chutes of relapse time and time again? One of the things I discuss with my clients is how there are sticking points along the way. Many clients seem to do well for a time and then begin to backslide or self-sabotage. I believe that these sticking points are places where limiting beliefs reside. Many clients begin doing well and then the voice of doubt or fear arises. The voice reminds them that they don’t deserve to be happy because of all the pain they caused or because of what they did to their child or any other variation of doubt and fear. The louder this voice becomes, the closer to the downward slide they get. When the voice is all they hear, it only takes a little push to go right down. Challenging the voice of doubt and fear, forgiving themselves and learning to love themselves despite the past, dissolves the sticking points and allows the client to continue the climb of recovery. Helping a loved one in recovery is never easy. Reminding the person that they are worthy and deserving of love is one of the best ways to help them move through the sticking points and continue the lifelong journey of recovery.
“People who have never had an addiction don’t understand how hard it can be.” –Payne Stewart
Working in a methadone clinic over the past several years has given me a unique perspective on addiction. I have been privileged to hear heartbreaking stories of addiction and witnessed firsthand the devastating effects it has on the entire family. Loving someone struggling with addiction is perhaps one of the hardest things there is to do. The person that you once loved seems to be replaced by a foreign entity. It is hard to know who you are talking to. The addiction masquerades as the loved one and it is unbearable to discover that the person you once knew is unreachable. So, what do you do if you love someone who is suffering from addiction?
First, know that the person in addiction is not the person you love. I always think of us as having different parts that take over in different situations. There are loving and gentle parts, as well as angry and demanding parts. There is a different part of me in control when I’m at work then when I’m at home with my children. When someone is struggling with addiction, it is the addict part that has taken control and seals off the other parts. Sometimes we can get glimpses of the real person, but during active addiction it is difficult to know if you are talking to the addict part or breaking through to your loved one. Be cautious and discerning when talking to your loved one. Remember that the lies and manipulative behaviors are the addict part which has taken control and are not behaviors the person you love would do.
Second, know that the person you love did not intend to become addicted. There is not a single client that I have worked with that told me they wanted to become addicted to heroin. Of course, they made an initial choice to try it, but once the addiction took hold, they lost all power to choose. This is why addiction is considered a disease. The urge and compulsion to use is so strong that the choice to stop is blocked. Know that if addiction were just a matter of willpower, there would be far fewer people suffering. It takes support and understanding to break through addiction. It is complex and there are no easy answers or solutions.
Third, understand that the person in addiction is suffering, too. Addiction creates a downward spiral. There is usually a point when the person in addiction decides that they want to stop. They tell themselves that they are going to stop, but the compulsion becomes so strong that they can’t control it. After they use they feel guilty about it and the pain becomes stronger. The stronger the pain, the stronger the compulsion to use. The spiral continues until they hit the proverbial ‘rock bottom’ and seek help or treatment of some kind.
Fourth, don’t give up. Loving someone struggling with addiction is painful. There is no denying that, but when the person hits their ‘rock bottom’ they need love and support in order to heal. Set extremely firm boundaries. Enabling and making excuses for the person in addiction does not help them. They need to experience the consequences of their behavior choices. This is extremely difficult to accept because death is a very real possible consequence. Setting boundaries does not mean withholding love and support from them. Trust has to be earned back. It is a slow process, but don’t give up on them! Get family counseling to help the entire family heal and open the lines of communication back up.
Finally, take care of yourself. Loving someone with an addiction is consuming and feels helpless. You cannot stop or control a loved one’s addiction. The person in addiction is the only one who has that power. The more worn down you become, the less helpful it is for everyone. Find your own hobbies, attend Al-Anon meetings, spend time in nature or laugh with friends. It is not selfish to take care of your own needs. By practicing your own self-care, you are able to help the family heal and move through the recovery process. Your family deserves the best you can give, which only comes when you take care of yourself.
The journey of addiction is never easy. It is a dark chapter for many families, but it doesn’t have to be the whole book. You, as a family, get to write the rest of the story. It can have a happy ending.
“Man never made any material as resilient as the human spirit.” – Bernard Williams
As I sit with my clients week after week I hear how frustrated they are with their inability to change. They often say they want to stop using and when they are thinking rationally they tell themselves that they are never going to use again, but then the compulsion takes over and they lose the choice, only to find themselves using again. It is frustrating and disappointing each time they use and the hope that they had of stopping gets harder to find. I have often pondered whether the addiction they describe so clearly is a disease or if it truly is a choice. There is a big debate in the field and there are strong proponents on each side who argue their case.
For a long time addiction was touted as a moral issue. People suffering from addiction were judged as not being strong enough to simply say ‘no’ and thus were treated poorly. More recently though, addiction has become defined through the medical disease model. The American Society of Addiction Medicine has defined addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” (http://www.asam.org/quality-practice/definition-of-addiction) They clearly discuss the physical changes in the body that occur throughout the progression of addiction and discuss the way the brain’s circuitry and neurochemistry are physically changed. There are debates going on throughout the addiction field as to whether addiction is a choice or a disease. What I have come to believe is that it is not either/or, but instead both/and. Addiction is complex and to simply say it is a choice denies the fact that there are physical changes within the body which limit the person’s ability to access the rational part of the brain where choices are made. At the same time to say it is purely a disease denies the fact that people can and do stop using by choice.
So, how can these two sides find some agreement? I believe it starts by looking at addiction through the mind, body AND spirit. In the mind we have the choice, in the body we have the physical disease, but the third aspect, the spiritual aspect is not usually addressed. To me, the spiritual is the authentic and genuine aspect of each of us that is under the ego. It is who we truly are. It is the spark of life itself that is breathing us and beating our heart. When we are able to help clients tap into the authentic part that is their true self, they are able to access both the power to choose and the power to heal a disease. Ultimately, whether it is a disease or a choice truly doesn’t matter. What does matter is helping people overcome their addiction. Helping each person reconnect with who they truly are is what I believe to be the first step towards recovery. It is helping them to see that under the addiction they are whole and well. Despite what they may or may not have done, they can begin to love themselves and the power of developing the spirit, the authentic part of them, is where true healing begins and addiction ends.
“It is strange to be known so universally and yet to be so lonely.” -Albert Einstein
In all counseling theories there is discussion of the importance of connection and healthy relationships with other people. Attachment theory focuses deeply on the innate need humans have for connection and how not having a safe attachment figure leads to various difficulties and even mental illnesses. One of the things that I hear over and over again from many of my clients is how alone and isolated they feel. In this world of billions of people how is it that so many people feel so alone? In his book and Ted Talk, Johann Hari discusses how he believes that a lack of connection is a root cause of addiction. He uses as evidence the famous Rat Park study. In the early research of addiction they put a rat in a cage and presented two bottles of water, one laced with heroin or cocaine and the other one plain. In those experiments all of the rats kept going back to the drug water and eventually overdosed and died. Then an experimenter in the late 1970’s thought about the fact that rats are social creatures and he wanted to see what happens when rats are placed in a social environment. They called it Rat Park and provided a large cage filled with about 20 rats. They had all kinds of things for the rats to play with and explore. When the rats of Rat Park were presented with the same two bottles of water none of them overdosed, none of them died. When I share this study with my clients many of them discuss how they always felt like the ‘black sheep’ of the family or they talk about how they never felt like they truly fit in or belonged with their family or friends. Through their addiction they hurt others, which then lead to even more isolation and stigma. In effect, they describe what living in the cage of isolation feels like. What is going on that so many people, not just people dealing with drug addiction, feel alone even when they are surrounded by people that care about them? I believe that it comes down to how we see ourselves and what we say about ourselves when we look in the mirror. I had one client say to me that he felt that he should have a warning label when he is around others because he believed that if others got too close to him, he would eventually hurt them in some way. For him, he felt it was better to stay isolated then to hurt others, but what he didn’t see was how his choice to stay isolated was also hurting those who cared about him. While we all have an internal critic, for some that voice is so loud and so persistent it is becomes hard for them to believe that they are worthy of love and connection. It is the fear that others will see their unworthiness that creates a separation which cuts them off from connection. That internal programing of self-doubt, insecurity and fear is like a self-inflicted cage. So how do we develop the courage to step out of the cage and into life? I’ll talk more about that next week.
“I am determined to be cheerful and happy in whatever situation I may find myself. For I have learned that the greater part of our misery or unhappiness is determined not by our circumstance but by our disposition.” -Martha Washington
If nothing else, working with people addicted to heroin has given me the opportunity to hear first-hand some of the most difficult life circumstances imaginable. There is not a day that goes by that I don’t listen to their life stories and wonder how I would have handled the situations they found themselves in. They have experienced trauma, abuse, isolation, abandonment, betrayal, homelessness, illness and much more, yet have found ways to cope with these circumstances. They have all survived physically, but many seem to struggle emotionally. Working on their recovery and starting to imagine what life can be like without the very substance that got them through, is sometimes a daunting task. To talk about what would make them happy is often not received well, as they argue that they can’t be happy because of the circumstances they are living in. When I offer an alternative that they can choose to be happy despite their circumstances, I am often met with resistance and told that I just don’t understand how bad their situation is, which justifies to them why they can’t be happy.
Realizing that we have the power to choose our emotional state despite our circumstances is a big jump for many people and it took me a long time to truly believe this for myself. We are taught early on that we need things to be happy and we need approval to be happy and we need to be good to be happy. We have been taught that happiness is contingent on getting what we want and we will be happy when we get the house, car, promotion, bills paid off… fill in the blank. We have learned to future-ize our happiness and honestly when we get what we said we wanted we may be happy for a moment until we have the next goal to work towards. Life becomes a big game of getting things, avoiding things and forcing events to happen just as we planned in order to make us happy. We can only be happy when the outer things are in alignment with what we say we want. When things are out of alignment we are frustrated, angry or depressed. The big question I ask my clients is ‘Is it true that you need that to make you happy?’ While most people’s initial reaction is a resounding ‘YES!,’ we talk about it some more and dig deeper into what the truth is. While it is true they may prefer to have different circumstances we discuss how the circumstances themselves do not create their emotion. It is their thinking about the circumstances that creates the emotion. We are free in this moment to choose our thoughts. We can choose to think about things that have made us happy, to be grateful for what we have been able to experience, to give thanks for the life we currently have. We give thanks to the body that is breathing without a machine, to the legs that walk without devices to the hands that are able to grasp objects, to the mind that is able to think, for the family members who have supported them, for the shelter that provides protection, for the food that nourishes them. Once they truly begin to feel happy and grateful for what they have, there is a moment where they do realize that it is within their power to choose to be happy right now, despite their circumstances. If they can do it for a minute in the office, what is stopping them from doing it at home? Once they truly get that the outer circumstances don’t have the power to determine their happiness, they are free to be happy despite their circumstances. This is a liberating realization!
“There are so many fragile things, after all. People break so easily, and so do dreams and hearts.” Neil Gaiman
This week I was meeting with a client who was discussing how there seems to be a constant conflict of voices within. There are some voices which seem to be positive and others which seem to cheer for behaviors that are not in alignment with what his goals are. The client was talking about abstaining, but noted that there is a strong voice that rises up and says, ‘just one last time’ or ‘no one needs to know’ or ‘it was a rough week, you deserve it!’ We discussed the differences between these two voices and then I asked him to name the one that wants him to abstain. He called it his true self. When I asked him to put a name to the voice of doubt and he called it his devil. I noted that devil is an accurate name for it because devil spelled backwards is LIVED! We discussed how these voices are calling him to live his life backwards. Wanting him to continue to use is not in alignment with who he truly is. I then discussed how his dream of living a life of sobriety and finding healthy ways to deal with pain instead of numbing is fragile at this point. It needs some protecting. I used an analogy of how the dream of him staying clean is like an eggshell. It is very fragile, as are all dreams in the beginning. When the voice of doubt comes up it easily breaks the shell. We discussed how the ‘devil’ within isn’t truly trying to crush our dreams, it is only trying to keep us in what is known and familiar. Although it is risky to continue to use, for this client it was more familiar and known then having to give up friends and the only form of social interaction he knew. The devil voices rationalize that it is better to stay in the known then to venture out into the unknown where there could be bigger dangers and risks. We then talked about how a fragile egg, with bubble wrap and a protective barrier around it can be dropped from a significant height and remain intact. I asked him what his bubble wrap could be to protect his dream of staying clean. We each have a dream. For some of us it is just a fleeting thought that we would like to open our own business, or write a book, or travel to India or any thought that charges us with excitement. We also have all the reasons why it isn’t the right time, we don’t have the education, we don’t have the money or we aren’t worthy of that dream. If you have a dream, what is your bubble wrap to protect that dream? The first line of defense is to protect the dream from your own devil. Remind yourself that if you were given a dream by your authentic self, your authentic self will be able to lead you towards it. You are more than your devil. Are you ready to turn your DEVIL around and live the life that is meant to be LIVED through you?
“Longing is like the rosy dawn. After the dawn out comes the sun. Longing is followed by the vision of God.” Ramakrishna
This week a co-worker and I were having a discussion about addiction. I talked about how many of our clients have had experiences with overdosing and have even lost friends. They say they don’t want to die, but yet they continue to use fully knowing what could happen next time. I wondered aloud with her why this seemingly obvious consequence isn’t enough for them to choose a different behavior. We discussed how they seem to struggle with seeing themselves living any other kind of lifestyle in the future. She responded that she feels it stems from a lack of self-worth. Do they feel they are worthy of living the life they would love to be living? Many times the person looking back at them in the mirror tells them they are not. I believe that change can only come in two ways. Either we are so discontented with the life we are living that we are pushed to make a change, this is often known in the field of addiction as hitting rock bottom, or we become so clear on the life that we would love to be living that the longing pulls us towards it. So do we want to be pushed by discontent or pulled by longing? It would seem that longing would be the easier path, but getting clear on what we would love to do and knowing that we are worthy of living the life we would love are two big obstacles. This week I will discuss some strategies for getting clear on the longing and next week I will discuss feeling worthy of it.
I have been amazed at the responses that I get when I ask my clients what they would LOVE to be doing in five years. Many of them paint pictures that look very similar to the lives they are living now, with some modest upgrades. When I ask them if they would love their life doing what they just described many of them laugh and say it would be better, but they have no idea what they would LOVE. I then ask them to create a vision for their life in five years. What does their body feel like? Is it able to move with ease? Is their mind sharp? Are they at a healthy weight? Are they abstaining from the use of all substances? What do their relationships look like? Are they supported? Do they feel a sense of connection with family and friends? How do they spend their time? Are they employed in a job they love? Are they volunteering their time helping others? Are they engaged in their hobbies or interests? What does their financial situation look like? Are all of their bills paid with ease? How much do they make in a year? These are just a few questions to get started on becoming clear on the life they would LOVE to be living. There is no longing for the life of their dreams if they aren’t able to see it with perfect clarity. I encourage everyone to play in the realm of imagination and place themselves in the life they would love to be living. If it is crystal clear you will get a sense of longing for it. Creating a sense of longing is the first step to making lasting changes.