Rubber-band addiction recovery – No shame

January 15th, 2012

There’s a specific issue that keeps coming up with nearly every addiction client I work with who is in early recovery. Regardless of whether they’re trying to stop unhealthy alcohol or drug use, sex or gambling behavior, or anything else, this issue keeps returning. It doesn’t even seem to matter if this is their first attempt at addiction recovery or if they’ve already been here many times before.

The issue: Shame about a desire to return to old behaviors and stopping their recovery.

At the Matrix Institute on Addiction where I see some clients, they call this “The Wall” suggesting that it usually comes right after a relatively easy period of recovery in which clients are self-assured and confident that they’ve got their addiction beat. “The Wall” is supposed to be marked by anhedonia, depression, severe cravings, irritability, and more fun stuff like that. After the wall is the promised land of long-term recovery. By identifying the specific stages of recovery addicts are supposed to gain more understanding of their process and experience less shame. I love the Matrix method, but I see things a little differently.  The way I see it, “The Wall” is far from a single point in time, but is instead part of a larger pattern I like to call Rubber-band Recovery.

Rubber-band Recovery in Addiction

I’m sure everyone reading this has at some point played with a rubber band, stretching it and letting it snap back to its original state or pulling it between two fingers and playing it like a string (another name for this approach could be String Recovery, but that might get confused with theoretical physics and we don’t want that). When pulling the rubber-band one way, its internal structure pulls back, trying to get back to its natural state. The body can be thought to do the same when placed under chronic alcohol and drug use in addiction – it has a slew of internal processes that work hard to keep the body in its natural state, at homeostasis. Naturally, due to the pharmacological mechanisms of alcohol, cocaine, methamphetamine, marijuana, and many other drugs, these systems usually fail at setting everything back to normal especially during the use itself, which is why we get high. However, their work in a body that consumes drugs on a regular basis is obvious – reductions in the production of specific chemicals (like relevant neurotransmitters), changes in the structure of the brain itself (like producing less receptors or even removing some from the brain’s cells), and production of chemicals that combat the drugs’ actions.

All in all, the body and brain of a long-time, chronic, heavy user of alcohol and drugs are different from the body and brain they started with in important ways that specifically relate to their alcohol and drug use. They are like the stretched rubber band, similar but obviously not the same as it was in its relaxed state.

Individuals in early recovery from addiction essentially experience what happens when that taut, stretched, rubber band is let loose. Hurrying up to get back to its natural state, to homeostasis, it releases all that pent up energy and rushes through its original state, overcompensating and stretching a bit in the other direction. For the addict in early recovery, this is the process of withdrawal. As we’ve spoken about numerous times before when discussing withdrawal, a brain that has reduced its own production of dopamine because of large amounts of methamphetamine that flood its dopamine reserves will still be left with very low dopamine when the crystal meth stops coming in. Low dopamine will bring about many effects that look exactly like the opposite of a methamphetamine high – a large appetite, low energy, and reduced movement and motivation. For heroin addicts, the drug that’s caused them to feel no pain and become constipated will cause their bodies severe pain, diarrhea, and trembling when it’s removed from the equation. Some withdrawal is actually life threatening due to the extreme changes in body chemistry and structure that happen after long term use. In addition to all of the direct effects of the drugs and alcohol, those internal processes that have been working hard to counteract the effects of the drugs (they’re called “opponent processes” by some addiction researcher like Dr. Christopher Evans from UCLA) are still turned up to 10 and are going to take a little time to get back to their original state as well. All in all, that leaves addicts feeling pretty crappy to say the least during withdrawal, the worst part of early recovery from addiction.

But like that good old rubber-band addiction recovery than quickly turns around. Having overcome the worst part of withdrawal, addicts in early recovery often experience joy, confidence, energy, and clarity they probably haven’t felt in a long time. That along with the environmental influence of loved ones who are extremely happy to see an addict quit (especially the first time around) give those in very early recovery a feeling of great well being and happiness, like a nice pink-cloud they get to ride on for a bit. Remember, the rubber band is moving back in the direction it came from during active addiction and it’s likely that brain processes are doing a little overcompensating the other way now too, turning down those opponent processes and flooding the brain with the chemicals it’s been missing.

But alas, this little turn doesn’t last too long and back we go into the darker place of negativity, low energy, anhedonia, and more. But instead of calling this stage “The Wall,” I understand it as one of the inevitable turns in what is sure to be a back and forth, seesaw like trip of recovery ups and downs. Periods of confidence in our ability to overcome our demons are followed by others that make us feel week and irritable. The good news is that just like with a rubber-band, each successive cycle on this seesaw gets a little less intense, which means that confidence, elation, depression, and anger turn into comfort, contentment, and ease – our new homeostasis. After a ride like that most addicts really need a little rest and when we reach this stage (no matter what it looks like specifically for each person), long-term recovery feels like the norm instead of an effort. This is the real end goal of recovery – a state of being that feels normal and that doesn’t involve unhealthy alcohol or drug use, sexual acting out, or gambling.

At the end of the rubber-band game we get back to just a good old unstretched rubber-band, and it feels good. In the process, it makes little sense to feel guilty, or ashamed, at all the intermediate stages. They’re part of the game of recovery and they’re essentially impossible to avoid completely. Intense cravings come during specific parts because of internal, biological, and external, environmental influences. Being ashamed of that would be essentially the same as being ashamed of extreme hunger when you haven’t eaten in 5 hours and see a commercial for your favorite food – silly and useless. I can guarantee that the rubber band doesn’t feel ashamed about they way it behaves when snapping back…

Posted in:  Education Tags: addiction, alcohol drug, alcohol drug use, anhedonia, ashamed, band, biological, cravings, depression, drug use, early recovery, early recovery addiction, long term recovery, recovery, rubber, rubber band, UCLA, unhealthy, withdrawal

Recovery = Abstinence… Or not

December 25th, 2011

The Substance Abuse and Mental Health Services Administration (SAMHSA) just release a new definition of “recovery” from mental health and addiction:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

I’ll give you 10 seconds to find a key missing ingredient in this definition of recovery without peeking at our title. Hey! No Looking!!!

The definition calls recovery a process the provides improvements in well-being and that allows people to gain control of their life. It seems that abstinence is simply nowhere to be found in this new SAMHSA definition.

I have no doubt that some people will be upset about the decision not to include abstinence in the definition of recovery, but I won’t be one of them. I’ve been saying that we should be moving to a different definition, one that focuses on improvement in quality of life, as the basis for whether someone is in recovery or not. You see as far as I’m concerned it doesn’t matter whether a person is using any substances – all I care about is the impact of such use on their well being, their “quality of life.”

We’ve already written a few article on All About Addiction making this exact point (see here and here for some examples) and there have been some addiction researchers calling for the same when measuring success in addiction treatment research (see here and here).

Most addiction treatment research simply measures abstinence when individuals finish treatment (especially outpatient treatment) and then maybe 6 or 12 months later. But as the research I linked to earlier shows, there are a whole slew of people who are not abstinent a year after their release from addiction treatment but are without a doubt involved in recovery: Their substance use is either fully under control or is at least producing much less of a problem than it had before. As far as I’m concerned that is a success, and if the use begins being troublesome again, then it is possible that more treatment, and perhaps complete abstinence, is necessary.

This whole thought process can easily lead us right down the harm reduction, substitution therapy, and legalization argument rabbit hole, and I’m all for that discussion. I’m also sure that I will once again get some more hate-mail from readers who think I’m being irresponsible by suggesting that people who have at one point had trouble with substance abuse may be able to use anything (even substances that were not their drug of choice) ever again. They’ll accuse me of being responsible for those who decide to try such methods and fail while taking absolutely no responsibility for the countless who try their approach and relapse. Fortunately for me I’ve learned to ignore those emails.

Posted in:  Education Tags: 12 months, addiction, definition, definition recovery, recovery, SAMHSA, substance abuse and mental health services administration, treatment

Addiction stories: How I recovered from my addiction to crystal meth

October 15th, 2011

By the time I was done with my addiction to crystal meth, I had racked up 4 arrests, 9 felonies, a $750,000 bail, a year in jail, and an eight year suspended sentence to go along with my 5 year probation period. Though I think education is important to keep getting the message out about addiction and drug abuse, there is no doubt that addiction stories do a great job of getting the message across, so here goes.

My crystal meth addiction story

The kid my parents knew was going nowhere, and fast. That’s why I was surprised when they came to my rescue after 3 years of barely speaking to them. My lawyer recommended that I check into a rehab facility immediately; treating my drug abuse problem was our only line of legal defense.

I had long known that I had an addiction problem when I first checked myself into rehab. Still, my reason for going in was my legal trouble. Within 3 months, I was using crystal meth again, but the difference was that this time, I felt bad about it. I had changed in those first three months. The daily discussions in the addiction treatment facility, my growing relationship with my parents, and a few sober months (more sobriety than I had in years) were doing their job. I relapsed as soon as I went back to work in my studio, which was a big trigger for me, but using wasn’t any fun this time.

I ended up being kicked out of that facility for providing a meth-positive urine test. My parents were irate. I felt ashamed though I began using daily immediately. My real lesson came when I dragged myself from my friend’s couch to an AA meeting one night. I walked by a homeless man who was clearly high when the realization hit me:

I was one step away from becoming like this man.

You see, when I was in the throes of my crystal meth addiction, I had money because I was selling drugs. I had a great car, a motorcycle, an apartment and my own recording studio. After my arrest though, all of that had been taken away. I just made matters worse by getting myself thrown out of what was serving as my home, leaving myself to sleep on a friend’s couch for the foreseeable future.

Something had to change.

I woke up the next morning, smoked some meth, and drove straight to an outpatient drug program offered by my health insurance. I missed the check-in time for that day, but I was told to come back the next morning, which I did. I talked to a counselor, explained my situation, and was given a list of sober-living homes to check out.

As I did this, I kept going to the program’s outpatient meetings, high on crystal meth, but ready to make a change. I was going to do anything I could so as not to end up homeless, or a lifetime prisoner. I had no idea how to stop doing the one thing that had been constant in my life since the age of 15, but I was determined to find out.

When I showed up at the sober-living facility that was to be the place where I got sober, I was so high I couldn’t face the intake staff. I wore sunglasses indoors at 6 PM. My bags were searched, I was shown to my room, and the rest of my life began.

I wasn’t happy to be sober, but I was happier doing what these people told me than I was fighting the cops, the legal system, and the drugs. I had quite a few missteps, but I took my punishments without a word, knowing they were nothing compared to the suffering I’d experience if I left that place.

Overall, I have one message to those struggling with getting clean:

If you want to get past the hump of knowing you have a problem but not knowing what to do about it, the choice has to be made clear. This can’t be a game of subtle changes. No one wants to stop using if the alternative doesn’t seem a whole lot better. For most of us, that means hitting a bottom so low that I can’t be ignored. You get to make the choice of what the bottom will be for you.

You don’t have to almost die, but you might; losing a job could be enough, but if you miss that sign, the next could be the streets; losing your spouse will sometimes do it, but if not, losing your shared custody will hurt even more.

At each one of these steps, you get to make a choice – Do I want things to get worse or not?

Ask yourself that question while looking at the price you’ve paid up to now. If you’re willing to go even lower for that next hit, I say go for it. If you think you want to stop but can’t seem to really grasp just how far you’ve gone, get a friend you trust, a non-using friend, and have them tell you how they see the path your life has taken.

It’s going to take a fight to get out, but if I beat my addiction, you can beat yours.

By now, I’ve received my Ph.D. from UCLA, one of the top universities in the world. I study addiction research, and publish this addiction blog along with a Psychology Today column and a number of academic journals. I also have my mind set on changing the way our society deals with drug abuse and addiction. Given everything I’ve accomplished by now, the choice should have seemed clear before my arrest – but it wasn’t. I hope that by sharing addiction stories, including mine, we can start that process.

Posted in:  Addiction Stories, Alcohol, Cocaine, Drugs, Drugs, Education, Marijuana, Meth, Sex, Sex Tags: addiction, addiction recovery, addiction stories, arrest, bail, choice, cocaine, crystal, crystal meth, crystal meth addiction, drug abuse, drug use, felony, homeless, ice, jail, marijuana, meth, meth addict, my addiction, outpatient, parole, prison, probation, problem, recovery, rehabs, sober, sober-living, Speed, stealing, substance abuse

The music must change! Obsesssion, compulsion, shame an guilt in addiction

March 28th, 2011

Guest co-author: Jeff Brandler from Changeispossible.org

The nature of addiction is one of obsession and compulsion. Regardless of the substance, behavior, or process, the addicted person will continue to obsess (countless and endless thoughts) and have compulsions (repetitive actions). They will repeat this obsession-compulsion ritual over and over.

Imagine a radio station that plays the same song over and over. Imagine that song being a steady diet of thoughts, and feelings of guilt, shame, remorse and self-loathing (GSRSL). Imagine an endless supply of obsessive thinking and compulsive replays of the thing(s) that the addict did to start the song playing.

People get involved in all kinds of self-defeating/self destructive behaviors. There are numerous reasons for this. The top ones that I see are: addictive disorders, mood disorders, self-sabotaging behavioral and personality traits. The GSRSL is a constant loop. It never stops. The problem with it never stopping is that it creates more GSRSL. The more GSRSL, the greater the need for the behavior. The more behavior that happens, the more GSRSL that you need and so on and so on. Does your head feel like it wants to explode?

Obsession and Compulsion – An example

Let’s say I had a fight with my spouse. I decide to smoke a joint in order to relax, escape, or unwind. Afterwards, I feel a lot of GSRSL. I have guilty thoughts, feel embarrassed and shameful. I have remorse for what I did, and beat myself up unmercifully. So what do I do in order to stop this behavior? You got it, smoke another joint, or maybe have a drink, only to feel more GSRSL. In doing so I then have the trifecta GSRSL of before, during and after-The music must definitely change!!!!

Or, imagine an alcoholic who receive a 3^rd DWI citation after finally getting his license back following a 2 year suspension for his previous offenses. That’s some serious GSRSL. I have the most recent driving incident plus the 2 years where I lost my license swirling around my head like a blender. Talk about a bad song!!!! Please change the music!!!!

How does a person change this music?

It’s easy to change a radio station, but something that is so ingrained, so obsessive & compulsive is going to be much harder to change. Part of stopping this music is recognizing: 1) this is going to be hard to do 2) that I have been doing this for a while, and 3) it’s going to take some time to stop it. The key word that describes this is permission – I have to give myself permission to take the time that it’s going to take to make this major change. I’m also going to need to use a variety of approaches to change these thoughts and feelings (i.e. thought stopping, disputing irrational beliefs, identifying affirmations, (and using them regularly), and finding gratitude despite the pain).

Using this total package will be a first step towards change. It begins a long process of turning down the GSRSL music . I may need to also speak to a therapist to examine why I do these behaviors and what they are “wired” to. If in fact there is something biologically based, there may be a need for medication to “tune” these thoughts/feelings into healthier ones. Yes the music can change– It can go from “Comfortably Numb” to “Peaceful Easy Feeling”. The process of change is possible, but it’s going to take time and hard work.

Posted in:  Education, For addicts, Tips Tags: affirmation, Alcohol, change, cocaine, compulsion, dwi, gsrsl, guilt, music, obsession, obsession compulsion, permission, recovery, remorse, shame, weed

The cost of quitting alcohol and drug addiction – treatment tips for addicts

March 20th, 2011

Many users are discouraged by the cost of drug and alcohol addiction treatment programs. The treatment programs that advertise, which are normally the only ones most people hear about (you know them: Passages, Promises, Betty Ford and more) may offer services that are worthwhile, but they may not and consumers have no way to evaluate this as they’re asked to spend tens-of-thousands of dollars per month (as much as $80,000 in some cases). Unfortunately, inpatient treatment is the only form of treatment most people have ever heard of and even though research does show that individuals can get a greater benefit from inpatient treatment, it usually makes a significant difference only for the most difficult addicts to treat, and I mean difficult – injecting drug users, those with numerous previous attempts, multiple time felons, and such. Still, when families contact me, it seems that they overwhelmingly believe that residential is the only way – But they’re wrong.

Many health insurance companies will help cover certain outpatient treatment programs (Like Matrix; Kaiser Permanente has their own) that can  help put the vast majority of those who are seeking addiction treatment on the right track. Many outpatient programs offer great bang-for-your-buck, delivering intensive treatment protocols that are evidence based and can help most addicts get better at a far reduced cost of only a few thousand dollars a month. Anything is better than doing nothing, and taking the first step is always the hardest move. Fact is, many insurance companies will not pay for inpatient or residential addiction treatment until outpatient options have been tried and failed. If clients feel they need the added security of a safe, drug free, residence they can combine outpatient treatment with a good sober living facility (but DO NOT pursue this option for patients with serious mental health issues until you’ve seriously consulted with professionals).

If you’re thinking about quitting, simply making your way to a 12-step meeting in your area can end up opening a whole new world of possibilities, but if that doesn’t work know that there are many more options. If you’re wondering about specific options for yourself or someone you love, feel free to contact me and I’ll do my best to help guide you. If you’re looking for a more anonymous, automatic way of doing some of this searching, make sure to check out our Rehab-Finder, it should help guide you in the right direction. We’re currently going through a real verification process to do some of the quality-assurance legwork for you!

Posted in:  For addicts, For others, Tips, Treatment Tags: 12 step, cost, dollars month, drug, expensive, help, help guide, inpatient treatment, insurance companies, Kaiser, matrix, outpatient, outpatient substance abuse treatment, outpatient treatment, recovery, residential drug treatment, residential treatment, treatment

The forest and trees of addiction

March 8th, 2011

It’s unfortunate that some people look at substance abuse problems from their vantage point only – Everyone seems like them whether normal users, light abusers, abstainers, or hard-core alcoholics (recovered, recovering, or not).

The world is full of individuals arranged in loosely associated groups. Unless one can acknowledge that real, important, and consequential differences exist, all you’re seeing is a tiny little bit of the beauty.

Posted in:  Opinions Tags: addiction, differences, drug abuse, recovery, substance abuse

Calling bullshit on addiction treatment bullies

March 6th, 2011

About three years ago, I was attending a national conference on public health (American Public Health Association) and presenting my posters on the relationship between drug use and violence, and sexually transmitted infections and injecting drugs. As I walked the aisles I ran into a woman who runs a Florida addiction “treatment” facility. We talked for a bit about my work, her facility, and then we shared some of our personal stories. Mine included meth addiction, jail, recovery, and now graduate school studying addictions. Everything was great until I mentioned that I now drink alcohol socially… “We’ll save a seat for you” she told me as she handed me her business card. Idiot.

Recovery bullies and addiction treatment

As soon as my version of recovery from addiction didn’t match her expectations, it was an immediate failure. Forget the 6 years I’d spent free from crystal meth use, the excellent graduate school career that was producing real results I was there to present. Forget the fact that my family, my bosses, and my girlfriend at the time thought I was doing amazingly well – As far as this woman was concerned it was her way, or her way. Well I call bullshit on that thinking once and for all.

Unfortunately for her, the research evidence, as well as the actual human evidence that I’ve seen, shows that recovery from addiction comes in many colors and flavors, like pretty much everything else in life. We’ve covered research on all about addiction before showing that the best evidence to date actually calls into question the idea that relapse is the necessary disaster so many paint it as. The fact that the majority of those who meet criteria for drug dependence at some point in their life actually recover on their won is also there, and although this does nothing to reduce the impact of addiction on all those who have an incredibly difficult time quitting, it’s there and can’t be ignored. Drug dependence is almost certainly not a one size problem and the solution is probably far from a one-size-fits-all, no matter how much you like your own solution.

So there’s cognitive behavioral therapy, peer support solutions (like SMART Recovery, Rational Recovery, Life Ring, 12 Step groups like Alcoholics Anonymous, and more), medication-supported recovery (like Suboxone, Methadone, Vivitrol and more), Motivational interviewing and other Motivational Enhancement techniques, as well as a whole host of psychotheraputic approaches that are more eclectic. No research we have to date indicates that any of these approaches is necessarily more effective than others, which means that they are all essentially equally effective. We’ve already talked about some combinations that work very well together, like PHP programs for physicians, but there is absolutely nothing to indicate that the 12-steps (for examples) are somehow superior to CBT, or Rational Recovery, when it comes to treating addiction.

If you get better, you’re a success in my book

When it comes down to it, whether this Florida 12-stepper likes it or not, I am still a social drinker and I still don’t believe that this nullifies any of my other achievements or my successful recovery. More importantly, it doesn’t nullify the success of millions of others, no matter how poorly it fits with some people’s notions. When a life gets overrun by drug use or another addiction, a successful outcome to me means recapturing a functional life that is no longer dictated by the pursuit of that addictive behavior. Anything more or less is a personal preference sort of thing. The problem with these idiots who will absolutely ignore success because it doesn’t conform to their expectations is that they drive people out of treatment and away from success and that is not okay. I’ll continue to call them out for their narrow mindedness and hopefully eventually, their voice will be far from the dominant one.

Posted in:  Education Tags: 12 step, addiction, Alcohol, alcoholics anonymous, CBT, crystal meth, drug, drug dependence, drug use, Drugs, graduate school, MI, motivational, motivational interviewing, public health, recovery, relapse