Friday, November 25, 2016

I'm not here to make friends

I'm not here to make friends 


When I worked for an inpatient facility I heard it at least once a week. Sometimes it was an individuals justification for isolating or sometimes for a harsh word, perhaps a cover for shyness, not wanting to show weakness. Often it was a declaration meant to show me the counselor how dedicated the individual was to recovery, a vow that the individual was willing to forgo most if not all of the softer parts of rehab and dive head first into the hard work that lay ahead. These folks were never without their journals and worksheets, they carried their Big Books clutched in their hands and read them at every break. "I'm not here to make friends!" They would say though they might have said another common mantra of the newly sober "I'm not like these other people." I would often lay awake at night worrying about these folks.

Two reasons I see this as a red flag 


Let me say that again 

RECOVERY CANNOT BE FOUND IN A WORKSHEET! This goes for any worksheet. The free ones you find online, the expensive ones you purchase on your own and photocopy without permission, the ones that use a 4th grad vocabulary and the eloquent ones, recovery cannot be found in any of them. For that matter it can't be found in the Big Book either, it's not in a PowerPoint, a self help book, a video or in your favorite therapeutic card trick. In my opinion the vast majority of curriculum in rehab has very little value for the person in recover. These trappings are really more for we the professionals than those that come to us for help. They exist to make us look like we know 
 we are doing. They allow us to say "take two and call me in the morning" and fill the long hours with"programming" which the organization charges a sizable fee. Research indicates that educational lectures, videos and PowerPoints have almost no value for the person in recovery but many continue to lecture and play videos and continue to call it treatment. The videos give us time to catch up on our notes, the lectures are easy and one cannot invent the wheel on a daily basis so who can blame us? Because we put so much importance in these activities clients often mistake them for recovery. The "Not Here for Friends" folks most of all. So we take energy and focus which could be used more effectively and waste it on a hamster wheel.


The most damaging thing about addiction is how much it isolates. Humans are social creatures and we don't just want to interact with each other we need to. The Rat Park experiment if it can be applied to humans indicates that isolation and an inability to alleviate it by making new connections may be the key difference between someone who abuses substances when in a tough situation but stops when out of that situation and someone who gets trapped in a cycle of substance abuse becoming addicted . As chemical dependency counselors it is important to spot the clients who use our assignments as an excuse to isolate and encourage them to socialize. 

This does not necessarily mean clients should become friends with other clients though inpatient and IOP settings are a great place for clients to practice reconnecting. Your clients will likely come from very diverse backgrounds but all have a shared experience of struggling with substance use and of going through treatment. These things alone can be the basis for a profound connection. Many facilities are concerned with clients forming romantic relationships and discourage contact between clients outside of treatment. While I agree romantic relationships can distract from recovery the friendships that form can be a great support. The romantic relationships seem to form no matter what we do and I have to question if it's really any of our business if adults outside our facilities start to couple.

So we find ourselves with addiction that isolates, which may have been caused by isolation, we pull these people away and isolate them from friends family and work to treat them and to keep the lights on we professionals need to fill their day with programming so we can bill for our services. What's the solution? Obviously I don't know but here are some ideas.

Fewer lessons, more discussion. Keep the clients talking to each other not just to you. If you see that a client isn't joining the discussion prompt them and train you more outgoing group members to draw them out.
Focus on developing social skills. Role play uncomfortable social situations, talk about the clients anxiety over social situations and how to overcome them.
Make your homework social. Tell your clients to go to a meeting or some other sober gathering. Have them talk to 3 or more people. Have them journal about the feelings this inspires.
Make your programming fun. Provide the opportunity for your clients to take social risks and be silly in the safe supportive environment of your program. Play music, dance, tell jokes, or sing.

We may even wish to challenge the practice of isolating the clients from the outside world. Living in the world, rejoining the human experience is the goal of recovery.

Saturday, November 5, 2016

I will not relapse over Donald Trump

I will not relapse over Donald Trump 

I haven't posted any original work in Grey's Recovery for months. There are several reasons for this and I'll briefly mention a few. One reason is that I now work for a mental health organization rather than a treatment center focused almost exclusively on chemical dependency. My title is Substance Abuse Specialist and I still run a group (two groups now) focusing on chemical dependency as well as providing individual counseling but much of my work includes clients who have significant mental illness and/or difficulty meeting basic needs and often I find that while these folks do have Substance Abuse issues they are not the number one priority. A second reason is I'm trying to get into grad school. Writing essays, chasing down people to write recommendations, and studying for the GRE take up much of my free time. Thirdly and the last reason I will present is my anxiety disorder is acting up. Coping skills I have learned in recovery are very effective in coping with anxiety so I have managed to stay functional in spite of the thunderstorm raging in my chest that periodically shocks me with bolts of agony. While my new job and the idea of going back to school at 47 are enough on their own to produce the occasional sleepless night by far the biggest trigger has been the unyielding fear that Donald Trump may soon be president of the United States. I'm almost 9 years away from my last drink but the relentless fear has brought back a longing for numbness for a short gentle oblivion that up until now was a distant fading memory. But I am not the man I was 9 years ago and I win or lose I will not relapse over Donald Trump.

Forget for a second that while the race has tightened Hillary Clinton is still favored to win. Forget also that a President Donald Trump will probably not bring about the apocalypse I fear, though he will most certainly damaged many of the causes I hold dear. I have completed numerous ABC exercises, identified my irrational beliefs and disputed them. I have also chanted the serenity prayer as a mantra that even as a nonbeliever I sometimes find comfort in. These things have helped but they have not been enough to end the silent torture my brain seems determined to inflict upon me. But win or lose I will not relapse over Donald Trump.

While it hasn't worked to address the anxiety itself which has gone off the rails and may not return any time soon that doesn't make me powerless here is what I can do.

 Accept that I am going to be anxious. This is probably the most difficult choice to make but expecting anything else is simply magical thinking. I am going to be anxious and with that anxiety will come a low frustration tolerance, poor sleep, and an ever present physical pain. But I've been here before, this is the devil I know. I have survived it drunk and sober and I will survive it now. I occasionally meditate on the anxiety, not to reduce it but to get to know it. I test its limits and sit with the pain. I step back and observe my mind running away with itself and remember that wherever my mind runs my body remains here. I occasionally take an ibuprofen to address the head and muscle aches but I resist the siren call of the dog's Xanax and of course the liquor store because I know the cost of the relief that will give. Numbing this will only delay the inevitable. I will have to face the anxiety either now or later, and if I send it away with chemicals it will return later with its friends. Worse still a chemical solution may compromise the tolerance I have built up over 9 years and validate the nagging thoughts that tell me I really can't stand this. But I can. Win or lose I will not relapse over Donald Trump.

My rewards for this path are considerable. For every 2 days I cope with the anxiety I get a day or two of feeling invincible, powerful, like nothing can keep me down. My nights have not been completely sleepless, I've even had a few nights where I've slept through the night. On the worst nights I still manage to get 3 to 6 hours of sound sleep. Not ideal but enough to function on. My anxiety is acting as a focus to practice mindfulness. In spite of my poor sleep I've had amazing clarity of mind and my compassion for people struggling with mental illness and addiction as well as my gratitude for those who support me my recovery is growing. My anxiety is killing me, it's helping me grow.

Only a few more days to go.

If anything from my experience helps you I hope you use it, even if you replace the name "Donald Trump" with a far more qualified candidate.