When I started working as a drug and alcohol counseling intern, the concept of Non-Maleficence expressed by the phrase primum non nocere or "first do no harm" seemed childishly obvious. Unfortunately harm is done in the recovery field and those who need us most are the ones most vulnerable.
This topic is too big for a single post so I'm going to start with something simple that in my experience has reduced much of the harm I've inflicted and increased my love for the work. Most if not all of those I work with struggle with a sense of shame and unworthiness. One of the biggest mistakes I've made is to validate that feeling of unworthiness when I thought I was helping. One way I avoid repeating this mistake is by changing the way I cope with the issue of honesty with clients. To the extent that I am able, I try and act on everything a client tells me as if it is 100% true. I may be a fool but I am not as naive as I sound.
There is an overwhelming opinion in popular culture that the term addict and the term liar are nearly synonymous. Nowhere is this opinion more prevalent than among people who identify as addicts, and the reason for this is that they are indoctrinated to believe it. Addicts certainly lie, but so do teachers, doctors, religious leaders and captains of industry. While people lie for many different reasons, in my professional life people seem to lie most often for one of two reasons; they lie because they are afraid I will reject them if I know the truth, or they lie because they desperately want what they are saying to be true.
It can be tempting to call a client out on a lie, to show them you're not stupid and they can't pull one over on you, but it is rarely necessary, usually traumatic for the client, and devastating to the therapeutic relationship. Also, the clinician who finds themself constantly looking for the lie is at risk of becoming cynical and jaded. The path to a trusting theraputic relationship is for the clinician to be trusting and non judgmental. Whenever possible,just let it go and it's almost always possible. Don't let yourself get pulled into the role of parent or truth police, it's a terrible job. When you must confront a client on a lie be understanding and remember people lie because they are afraid and desperate. Under the right circumstances we will all lie and it's up to us to create an environment where the truth is a safe option.
The author thanks you for taking the time to read Grey's Recovery. Feel free to give feedback on the ideas presented. Feedback on spelling, and grammar is not requested. Those who can't resist commenting on the author's spelling and grammar may be rewarded with a picture of the author's middle finger.
Ken, This is a great start and I am looking forward to the next blog.
ReplyDeleteThanks for the kind words Chuck! Don't get mad when you see your ideas repackaged as my own. ��
ReplyDeleteThank you for this. I work as a substance abuse counselor and I encourage the people I work with to notice if/when they lie or feel the need to lie in treatment and to get curious about why and that they can learn as much from that as from anything. I also assure them I'm holding a judgement free zone - no blame, no shame, just information to learn from their own experiences. Look forward to reading your blog.
ReplyDeleteThat's a wonderful idea. I don't often acknowledged the lies unless I have to. I just wait for the client to bring it up. But it never occurred to me to preemptively have the clients examine when they feel like lying. I suppose I do it in a passive sense but I'm all about putting my cards on the table rather than trying to trick clients into changing. I will have to experiment with this.
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DeleteI love this site so much. I am afraid I extract bits and put it into my wee NZ blog (credit to author of course!).
ReplyDeleteI have stopped drinking and it has been almost three week. There is still the small problem of kicking the pills though, but I am down to 20% of what I was taking as it isn't as much fun without the alcohol.
I am hoping that this is recovery and not cheating.
guilt isn't helping but nor would a free pass. how to deal with this one ay? x
Michelle
Oh and feel free to extract all you like. I'm not terribly concerned with credit as my ideas are not entirely my own.
DeleteHi Ken
DeleteThanks so much for your considered reply. Yes my mental health is improving dramatically. I look and feel so much better, I can sleep. The alcohol seemed to be the catalyst as it let me feel like I could do whatever I wanted and I was a failure so why not down whatever I could.
Unfortunately yes, the pills are opiates. I am saving about $160 a week in alcohol and over the counter meds. I can also get Pethidine but only limited supply 50mgs thank god. Writing this makes me feel like a loser but I have to face it - getting wasted is all about what lies beneath.
I don't think I would be a candidate for Methadone as NZ - here is an example of our NZ methadone culture:
Extract from The Press NZ "Liquid Handcuffs"
"A heavy-handed culture at the Christchurch Methadone Programme (CMP) is condemning addicts to a world of suicide, accidental overdose, crime and prostitution, according to a damning review.
Methadone, or opioid substitution treatment, helps wean addicts off hardcore drugs, but inflexible barriers and a "risk averse culture" has left consumers terrified, angry and, in some cases, dead.
An external review of the Canterbury District Health Board (CDHB)-run programme, which was leaked to The Press, highlights at least four breaches of the Health and Disability Code of Consumer Rights.
"The review team heard not just of suicide and accidental death, but stories of loss of employment, deterioration of mental health, compromised physical health, financial insecurity with increased criminal behaviour and work in the sex industry," it said.
Stringent regulations at the Christchurch programme force consumers to provide at least three clean urine samples before being accepted - a practice not used anywhere else in New Zealand and "quite out of keeping" with national guidelines.
To remain on the programme, consumers must attend monthly medical appointments at Hillmorton Hospital which the review said was "time consuming and unnecessary", citing other programmes that only required two appointments a year.
Consumers told the review team they felt "utterly controlled" by CMP and some couldn't sleep the night before an appointment through fear they would be kicked off to face a withdrawal accepted to be worse then heroin."
As you can see the conservative hard-line approach is adopted here in NZ - I have kept my behaviour completely hidden and have little choice but to do this alone. Well I am not alone because I started my diary online and find others who are very supportive albeit they are across the other side of the world. Your are the first person who is employed in the field of recovery I have spoken to.
thank you
Michelle
side note : Pethidine 50mg x 30 per 45 days
DeleteMy goodness you are anything but a loser. Your story is a gift of courage to everyone who has ever struggled with substance dependence. Provided you can get a fairly steady supply and the supply is safe (not counterfeit pills with gods knows what in them) you can use any opiates to taper. That is there is nothing magical about methadone or Suboxone other than they are convenient, but in NZ it seems they are not. I admit I am surprised. I'm not used to learning other countries have less enlightened views about recovery than my own. So many have gone in a better direction than the U.S. I have a very high opinion of NZ having known a few exchange students in my youth.
ReplyDeleteNaltrexone may still be an option for you but discuss it carefully with your doctor first. It's my understanding that it will plunge you into withdrawal symptoms if you are still talking opiates when you start. But if you can get into a treatment program that can keep you safe long enough to get the opiates out of your system naltrexone has a well documented track record of helping manage cravings for both alcohol and opiates.
It is my understanding that SMART Recovery has made it to your country though I don't know to what degree so maybe you can find support there. If not SMART online meetings have a good reputation. If not SMART perhaps a good therapist?
Just be very careful as your opiate tolerance drops very quickly so as you lower your dose of pills the risk of overdose may become quite high. So if you feel yourself slipping slip as slowly as possible.
Here's the thing about those of us who struggle or have struggled with substance dependency. We are no less human than those who have not had that struggle. If I could wave a wand and remove the stigma of substance use from the world and make all drugs legal in their safest most controllable form what would it matter if you took 2 or even 10 pills a day? Opiates don't harm the body like alcohol and you are likely long past feeling any sort of high or impairment from the pills. The only difference between you and anyone else is that if you don't have your pills you will feel sick. Otherwise you can take your pills and go about your day, working, loving, creating, and caring just as well if not better than any other human on the planet. It wouldn't surprise me if your experience has made you a little better at those human activities I just listed. Drugs have not reduced you, drug policy has. You feel like a loser because you have been told that people who use drugs are losers by a thousand different sources. There are medications that could treat your dependency very easily but due to stigma and ignorance they are kept away from you. Yet you are three weeks off alcohol and have reduced your pills use to 1/5 of your former use. You have done this with minimal support. You are not a loser, you are a goddamn miracle wrapped in flesh. An inspiration to us all and that is no less true if you use tomorrow or not. My struggle was with alcohol but I work with people with similar to you daily and that is not my sacrifice, it is my privilege.
Forgive me for getting a little preachy. I was feeling a little down this morning and your story has given me hope. Don't give up.
Hi Ken
ReplyDeleteThanks so much for your message, it feels good to read. So I have read it a lot :)
SMART has only made it to NZ in the unfortunate form of rational.org.nz centered entirely around Cognitive BT. It's not that I don't agree with the principles surrounding CBT, it is the medical professionals (or so called) here in NZ that treat everything with the CBT Wheel.
I did try to start recovery of some kind by working at the problems in my life about 3-4 years ago (before the substance abuse got completely out of control). I was given about 4 names by my Dr of people who do what was considered here as a "new" treatment centered around changing your thinking (CBT).
After waiting a month I finally was lucky enough to pay $180 for a "trial" session and told that if I didn't buy into the method of letting the good thoughts in and the bad flow out then I wasn't a great candidate. If I did agree to the CBT "wheel" then the next appointment would be $260 and I would need about 6 months worth of sessions each fortnight.
I honestly thought the whole thing was bullshit and I would have preferred to fly to Australia, sit on a mat and do Vipassana again. I figured it would be cheaper and probably more productive to go to the blue mountains and get bitten to death by mosquitoes (https://www.dhamma.org/en/schedules/schbhumi)
Considering all the options, drinking and taking pills seems an intelligent decision.
New Zealand does have the hard-line approach to self-harm or any kind. There is more awareness to victims of domestic violence due to our incredibly high rate of infant/child death rate. The govt is trying to figure out why we have one of, if not, the highest rates of 0-19 y/o deaths.
"Children and teenagers are 50 per cent more likely to die of abuse in New Zealand than across the Tasman. We don't know why – the countries share such similarities – but, per capita, for every two Australians aged 0-19 who die due to negligence, maltreatment or abuse, three Kiwi kids die. While the data is limited, we can't ignore the fact New Zealand remains one of the most dangerous places in the OECD for young people"
What a depressing post - sorry! but important as most people see NZ as a nation of wonderful wildlife scenic beauty - which it has, however, with such an ENORMOUS division between wealth and poverty, a strong minority population of Maori who are a tough as hell, we have our problems. (I am white and my kids are Maori). Tough love and sweep it under the rug is the reality, it is a lovely place to retire - but for young people it is as boring as watching paint dry. Nobody wants to say it - just google NZ and boring and you will see we are top on the list. I do love my country but it has limitations and problems - many many more than we like to publicly face. Many people have contacted me on my silly little blog, and wouldn't you know it, not one from NZ. (they all read the page but no way would they every make contact) The support I can hope to find is from offshore.
So once again I thank you and please forgive ME for going on :)
Michelle
If it's any help try to remember that most people recover from substance dependency without going to treatment. Anywhere from more than half to a vast majority. So what you are attempting is not only possible, it's been done successfully time and time again. The key seems to be believing you can do it and time. Stay out of jail and most importantly stay alive and if you don't give up you will make it.
DeleteAs far as CBT and SMART Recovery it's supported by a good research base but the whole point of SMART is to provide a choice not to force on ideology over another. If your yoga mat has helped you in the past it will likely help again. We are amazing adaptable creatures and given enough time we find a way.
Hi Ken - I know it is 3 months later, but I have just joined Smart for the US and UK online sessions and the live chat. Thank you so much for recommending it to me. I did try AA but it was hard to go to the meetings as they were at night here and I have littles.
ReplyDeleteSupport at 101 days is super important so I stay sober and safe. I am giving in to CBT and realise the reason I couldn't before is because I was (am, whatever) an alcoholic / addict. When you are drinking it is impossible to heal the mind!
thanks so much again,
Michelle