Answer Addiction

Tag: Features

  • Ring of Shame: How Getting Ringworm Triggered My Alcoholism

    Ring of Shame: How Getting Ringworm Triggered My Alcoholism

    Even medical people are treating you like a second-class citizen. Is this really about ringworm or is this reminding you of what it’s like to be a person with addiction?

    So one day I see this pink round patch on my forearm. It itches. I immediately start Googling eczema and psoriasis. Nope, looks nothing like that. But it does have that distinctive red ring so I look up pictures of ringworm and voila, there it is, my new friend.

    When I was smoking meth and shooting cocaine, I never got sick. I never got staph or scabies despite lying around with a bunch of gutter punks. But at six years sober, out of nowhere, I get ringworm. I don’t deal with children. Colonel Puff Puff, my cat, doesn’t have it. What the fuck is going on?

    Despite its grotesque and misleading name, it has nothing to do with worms. Ringworm is a type of skin fungus akin to athlete’s foot and jock itch. Trying to make light of the situation, I tweeted: “I was super depressed and smoking again but suddenly I got ringworm and that cheered me right up.” I was hit with a bunch of questions like “Is that the one that makes you skinny?”

    No dear, that’s a tapeworm, but thanks for the concern.

    I’d heard ringworm was very contagious so I went straight to urgent care where they confirmed it was indeed ringworm. I was prescribed a cream that burned like the fires of damnation and told to “keep it covered” at night to protect the Colonel. (When the Colonel last got ringworm, it cost $2,500 for multiple lyme dips, shavings, and numerous vet visits to get rid of it. It’s a persistent motherfucker.)

    I went to the pharmacy, pulled up my sleeve, and told the pharmacist I had ringworm. 

    “I don’t know how I got it,” I said, annoyed.

    The pharmacist pulled up the leg of her capri pants and said, “I got it working here! I was really stressed out because I was getting married and my mom had a stroke and boom.”

    We both laughed and then I took my supplies home, hopeful things would soon return to normal.

    Once I informed my friends of my condition, nobody would touch me. Friends and neighbors wouldn’t come into my apartment nor let me into theirs. 

    “We love you and your ringworm,” they’d chant from the other side of the door. I was beginning to feel very leper-like even though it was one fucking red ring. My sponsor told me I could still go to meetings but I didn’t want to take the chance of giving it to anybody…(except maybe a few specific people).

    Two nights after following the urgent care doc’s protocol, the ringworm seemed to be getting worse. I saw a new circle sprouting up and there was a clear red rectangular demarcation from the band-aid. Kill me.

    Panicked that I would soon be a walking petri dish of ringworm, I went to my primary care clinic as a walk-in patient. This clinic treats a lot of homeless people and has quite a few tents parked permanently outside with adjacent grocery carts packed with stuffed animals and recyclables and blankets. People are allowed to shower in the downstairs bathroom and it often gets crowded in the waiting area. But once I told the receptionist of my “condition,” I was quickly escorted to an empty room and quarantined. 

    Four long hours I sat in that room, my phone dying, sneaking out to smoke and feeling more and more depleted and well, just gross. A triage nurse came in briefly and told me that the urgent care doctor had made a huge error by telling me to cover the ringworm. It had created a tiny greenhouse, capturing the moisture and providing the perfect breeding ground for the ringworm to reproduce. Perfect.

    Finally, I was taken to another area to see a doctor. As I waited, I looked at the white cabinets. Two were locked. Where were the syringes, I wondered. 

    Wait, what? An enormous urge to use had come over me. I wanted to get high, call my ex, die…. It’s just ringworm, I tried to tell myself. Calm down. Why the sudden impulse to use? 

    “You’re disgusting and poor and getting old and nobody loves you,” my head said. 

    Thankfully interrupting my horrible inner dialogue, the doctor, a big ruddy guy in his mid-30’s who looked like an ex-linebacker, came in and shook my hand. I cringed inside.

    “I hear you have a rash,” he said.

    “I have ringworm,” I corrected him, hanging my head in shame.

    “Okay, let’s take a look.” He put on gloves initially but then took them off.

    “You have one ringworm,” he said. “The rest of the redness and that other circle is contact dermatitis from the bandage. You’re allergic to something in that bandage.” He touched the irritated area with an ungloved hand.

    “Oh.” I was near tears.

    “I’m going to give you another cream and just wear long sleeves if your cat sleeps with you. Better yet, take him to the vet to get him checked out. This stuff is everywhere. It’s really a reaction to your own flora. Do you do yoga?”

    “No.”

    “It’s very common among wrestlers because of the mats and sweat and body contact.”

    “No wrestling and unfortunately no body contact.”

    “You could have gotten it anywhere. If your immune system is compromised from stress or HIV or chemotherapy…”

    “Stress is my hobby these days,” I said. “Everything feels itchy, doc, like especially my head.”

    “Do you want me to check your scalp?” 

    “Please.”

    I took down my bun and into my dirty hair he plunged with bare hands. I felt ashamed but grateful that somebody was touching me.

    “You’re good,” he said.

    “Thank you for making me feel like a human being. Really…”

    He smiled.

    But as I drove to the pharmacy, I still felt depressed and still felt like using. Why? 

    The answer, as usual, came in a phone call from my friend, addictionologist and psychiatrist Dr. Howard Wetsman.

    “I understand people being scared about the ringworm because of its name and reputation. But what you’re experiencing is being shunned and isolated. People are treating you like your presence can hurt them. Even medical people are treating you like a second-class citizen. Is this really about a skin fungus or is this reminding you of what it’s like to be a person with addiction?” he asked.

    Whoa. 

    “When we’re isolated or feel ‘less than,’ the dopamine receptors in the reward center actually stop being available. You can’t feel your own dopamine as well as before. We need those receptors to keep up dopamine tone, and without that we’re back to feeling restless, irritable, and discontented. And that only goes to one place, right?”

    “Yeah I really wanted to use and it freaked me out.”

    “When you’re an addict and your dopamine tone is lowered, your brain goes ‘we gotta fix this fast.’ It doesn’t care if it’s an éclair or heroin or death…”

    “That’s why I’ve been smoking…”

    “Nicotine will give you dopamine for sure. But let’s talk bigger picture. When we go to treatment and we’re told to sit down and shut up, when we’re treated like stupid people who abused a substance that everyone else was smart enough to stay away from, when we’re told to wait three hours sitting on broken plastic chairs for someone who doesn’t give a shit, the deck is stacked against the treatment working. No healthcare system that systematically lowers people’s dopamine, much less one that treats addiction, will succeed,” he told me.

    “It’s the same in the rooms,” he continued. “The reason the 12 steps work is because you don’t have to feel ‘better than’ to not be ‘less than.’ The two messages you should get from an AA meeting are that you are never alone again and you aren’t less than anyone. But when people don’t sponsor with love, when some old-timer wants to be the boss, when it’s all about some guy with more time being right instead of helping, you lose those messages. That’s not a problem with the message; that’s a problem with the messenger. Don’t let the messenger fuck up the message. You aren’t less than anyone!”

    I sign every copy of My Fair Junkie with “fuck shame” and I don’t think I really knew why until just now.

     

    For more on dopamine and feeling “less than,” check out Dr. Wetsman’s youtube talk.

    View the original article at thefix.com

  • Alone in Sobriety: How I Deal with Dark Thoughts, Cravings, and the Urge to Isolate

    Alone in Sobriety: How I Deal with Dark Thoughts, Cravings, and the Urge to Isolate

    In the beginning of my sobriety, I went to meetings as simply a way of getting out of the house and not being alone. However, a cherished bonus—and one I was not expecting—was the feeling of being loved.

    I’m supine on my couch, peering through my bay windows. The eucalyptus tree gently waves, the sun bouncing off the greyish green foliage. Oh my, never really noticed that before, the way the sun hits the trees… almost looks like diamonds are attached to the leaves. I sigh at the beauty of the agate blue lake against the backdrop of pink hills. In my celestial reverie, I think: Ah, this is the life. I need nothing but my view, my books, and of course my oxys and chardonnay. Life is, um, well, perfecto! I don’t need anybody! Life is dope! Ha, ha, pun intended! 

    But as we all know, the nefarious love affair with our substances has to end—unless we’re recreational users. You know, the type that can indulge, but ends up moving on to smarter and better things—like careers, marriage, and kids.

    But the addicted end up with no such future; and our fate comes at a staggering cost: numerous rehabs, jails, hospitals, and sometimes the ultimate price, death. So, if we want any chance at a decent life, we end up doing a program like AA or NA, or we join secular self-help groups such as SMART, or depend on MAT (medication-assisted treatment such as a methadone or Suboxone program). Others get well through individual therapy or exercise or church. And of course (not to leave anyone out), there is that rarefied set that quit on their own—no help needed.

    Sobriety or Self-Destruction

    But the point is: we get better or we blow up our lives.

    I chose rehab, a Suboxone program (six-month duration, thankfully done), and AA meetings to get well. And now, things . . .are better. 

    In the beginning my sobriety was no fun at all: when I looked through those same bay windows at the same beautiful view, a huge dose of anhedonia would hit me. Who cares if it’s beautiful? I’d think, seamlessly segueing into darker thoughts like: What a loser you are, or aren’t you a little old to still be blowing up your life?

    But gradually (I can’t stress this enough), I recovered and those ugly thoughts subsided. I still have them, but nowhere near as bad. 

    They told me in early sobriety to “stop isolating” and be around people. I found this exceedingly hard because while using, I’d convinced myself that I was an unrepentant misanthrope. Well, when I got sober I realized I didn’t really dislike anyone, I was more afraid of folks. So, again gradually (they call it “slobriety”), I’ve lost my fear of people and have learned to socialize more. Even though I’m a loner by nature, I know that humans are social animals. At the very least, I am going against biology when I’m alone all the time. 

    Learning to Love 12-Step Meetings

    Meetings can be one way to escape isolation without having to be super cheerful or interesting. In the beginning of my precarious sobriety, I went to meetings as simply a way of getting out of the house. However, a cherished bonus—and one I was not expecting—was the feeling of being loved. During my many failed sobriety attempts years ago I scoffed at the “let us love you until you can love yourself” platitude—only because where I came from, love was almost always conditional. Image was everything and being a woman of propriety was paramount (never mind what happens behind closed doors!). 

    But finally I was so desperate to get well that I took love wherever it was freely given. And I was pleased to discover there is nothing wrong with getting unconditional love from random people—because eventually those random people became my friends.

    There are times when being alone is inescapable, and this is when my thoughts can get downright dark. But at least now I have tools to deal with them. I can do some cognitive therapy and challenge my thoughts: “Oh, come on! You are getting better!” Or: “Oh come on! You’re trying, give yourself a break.” If that doesn’t work, I get on my knees and pray.

    “God, please direct my thinking! Give me the strength to manage my life!” Even though I’m not sure I believe in God, I do it as a gesture of humility. And sometimes a calmness, a sense of focus, a clarification of the next “indicated step” presents itself, and I say a prayer of gratitude to the Universe for getting me out of my head and into action. 

    If the silence gets too deafening, I’ll call someone. To “get out of self,” I generally reach out to someone who may be having a harder go at it than me. Or sometimes I just do something goofy like turn on some old school rap like Too Short’s Shake that Monkey and just jam out like an oblivious white girl. My twerking leaves a lot to be desired, my butt is just too flat. But it’s remarkably good exercise.

    Fear, Rumination, and Acceptance

    Sometimes, I’ll force myself to sit with these dark thoughts: acknowledge my insecurities, my chaotic and destructive past, my fear of never measuring up. This last trajectory can be dangerous because it can immediately put me in an even darker mood that lasts for days where I end up ruminating in obsessive, sad, or angry loops that keep playing like a film projector that won’t shut off. 

    But I do believe that recognizing these dark corners of my psyche and accepting them, then coming up with a plan to negate any further damage by changing my actions to more positive and kinder ones is probably the best way to go. Because sometimes keeping busy in order to avoid thinking is like the old expression: brushing it under the rug. The dirt piles up in my mind, making me toxic.

    When I’m alone and the cravings for drink and pills get fucking intense, I’ll walk around the block like a demented person, or even worse: I’ll go to the smoke shop and buy one cigarette at a time. 

    When I have no social engagements and there are no meetings, self-pity can overwhelm me, my thoughts of loneliness so deep I’ll find myself obsessively checking my phone to see if anyone has texted. This is probably the hardest “alone” time there is, when you realize you’re alone because you have no one to be with. And I want to scream: “I know I fucked up! I know I acted the fool high! But I’m sober now and a totally different person!” Usually there is no answer from the heavens and I have to sigh myself into a grudging acceptance. 

    Remembering “This Too Shall Pass”

    Sometimes the only consolation for being sober is my stubborn refusal to get high no matter how lonely and sad I feel, and the knowledge that this too shall pass. And it always does. That day will surely come again where I’ll be outside, gazing at a gorgeous old Victorian home in the historic part of San Diego, or walking in the woods, or snuggled up with my hubby watching some improbably good show on Netflix, and I’ll say to myself: “I am, right now, presently, 100% good with the Universe.” A warm contentment will engulf me—much subtler than the synthetic euphoria of oxy. But it doesn’t matter because here’s the thing: I earned it, and that alone makes it a far more powerful and beautiful experience than drugs ever gave me.

     

    How do you handle the dark times in sobriety? Let us know in the comments.

    View the original article at thefix.com

  • It's Never Too Late to Change: New Books by Writers in Recovery

    It's Never Too Late to Change: New Books by Writers in Recovery

    If stress has been dogging you and your bandwidth is low, it’s okay to turn off your gadgets so you can refuel. Pick up a book instead and indulge in some battery-free entertainment. Here are 4 faves, all by sober writers.

    Your nerves shot? Mine, too. Winter is a slog and I can’t wait for spring. When I can’t stand one more minute of worrying about the planet, polar bears, politics and hate, I still choose escape. But… instead of rum and cocaine, my go-to is a good book. So, if stress has been dogging you and your bandwidth is low, it’s okay to turn off your gadgets so you can refuel. Breaks from YouTube and the 24/7 news cycle can do wondrous things for the mind. I went radical this week and even turned off my cell. Twitter can consume me if I let it.

    This month I made time to curl up on the couch with my dog and disappeared into these gems:

    Never Enough: The Neuroscience and Experience of Addiction
    by Judith Grisel (Doubleday, Feb. 19, 2019)

    “My response to being overwhelmed by the deep void was to leap into it.” — Judith Grisel

    Judith Grisel writes about the grizzly years of self-destruction. Stories show the author at her messiest. In a decade, she’d consumed a cornucopia of substances; by age 23, she was a self-loathing mess.

    The strength of Grisel’s bestseller is her intimate knowledge about the nervous system and addiction. Grisel peppers the pages with unsettling anecdotes, but she does it sans self-pity. Like a journalist, she reports embarrassing and creepy things.

    “I ripped off stores and stole credit cards when the opportunity presented itself, I was still able to maintain, at least to myself, that I was basically a good person. To an extent, for instance, I could count on my companions, and they could count on me. I say to an extent, because we also knew and expected that we would lie, cheat, or steal from each other if something really important were at stake (that is, drugs).”

    I never tire of drunken-drugalogues, and Grisel doesn’t disappoint on that front. But telling these stories is not to shock or manipulate readers, nor is Grisel trying to prove she was “a bona fide addict.” Her purpose is to illustrate the bleak existence of those who cannot stop drinking and drugging.

    When Grisel “finally reached the dead end” where she felt she was “incapable of living either with or without mind-altering substances,” she sought help. After a 28-day rehab and months in a halfway house, she managed to pull her life together. After seven years of study, she earned a PhD in behavioral neuroscience and became an expert in neurobiology, chemistry, and the genetics of addictive behavior.

    This book doesn’t brag about having the answers, but shows what a sober neuroscientist has learned after 20 years of studying how an addicted brain works. She makes it easy to understand why it’s so difficult to get sober and maybe even harder to stay that way. It irks me when people say they never think about drugs or alcohol anymore. My first feeling is rage—probably because I’ve never experienced anything like that, despite working hard on myself during 30 years in recovery. Grisel refreshingly writes about the temptation that’s always there.

    Grisel’s writing communicates succinctly: “A plaque I later saw posted behind a bar described my first experience [with alcohol] precisely: Alcohol makes you feel like you’re supposed to feel when you’re not drinking alcohol.” In another passage, she quotes George Koob, chief of the National Institute on Alcohol Abuse and Alcoholism: “There are two ways of becoming an alcoholic: either being born one or drinking a lot.” Grisel is careful to explain so you don’t get the wrong idea. “Dr. Koob is not trying to be flip, and the high likelihood that one or the other of these applies to each of us helps explain why the disease is so prevalent.”

    When she writes about her experiences, it’s candid and clear, and it feels like she’s a friend and we’re chatting in a café. I found myself frequently nodding with identification—like a bobblehead on a car dashboard. It’s a fascinating, absorbing, satisfying book about addiction.

    Widows-in-Law
    by Michele W. Miller (Blackstone Publishing, Feb. 26, 2019)

    There was a huge turnout at The Mysterious Bookshop in downtown Manhattan on February 26. The event was the book launch of Michele W. Miller’s second novel, Widows-in-Law. Lawrence Block, the wildly successful, sober crime novelist, sat beside Miller in the role of interviewer, and he was as entertaining as ever.

    See Also: Lawrence Block: One Case at a Time

    Miller, a high-level attorney for New York City, said, “Widows-in-Law is about an attorney who dies suddenly in a fire, leaving behind a first wife who’s a streetwise child abuse prosecutor.” She then jokingly added, “who might resemble me a little bit.” That got a big laugh because many attendees knew that Miller had previously worked as a child abuse prosecutor.

    In a thick and endearing Brooklyn-Queens accent, Miller described the deceased’s second bride. “You know, legs up to the eyeballs…[a] gawgeous trophy wife.” Block jumped in with praise: “That’s the one that resembles you.” Miller blushed and said, “See? That’s why we keep him around for a hundred books. Another big laugh, another inside joke: throughout Block’s astounding career, the well-loved crime writer has churned out 100 books.

    Miller quickly regained her composure and got back to the novel’s setup: Emily is a 16-year-old from Brian’s first marriage, to Lauren. Shortly before Brian died in the fire, Emily moved in with Brian (and his new wife). Lauren hoped they could reel in the out-of-control teen.

    The Miller thriller works well. It’s a fast read with dramatic and believable scenes and dialogue. I wanted to dig deeper and find out how much of the novel was fictional. Many novelists write about the worlds they know. Miller agreed to one-on-one time to discuss the three badass women at the center of the story.

    “Emily’s mom Lauren is my main character. Her backstory includes being a homeless teenager during the 1980s and ‘90s,” Miller said. “Her parents were whacked on drugs so Lauren left. She stayed at a shelter on St. Marks. It’s an iconic recovery building in the East Village.”

    When I asked which parts of the novel are autobiographical, Miller paused, sucked in a deep breath, then let it out slowly.

    “Okay,” she said. “Here goes. I’m in my 30th year clean. I was a low-bottom heroin addict.” Miller’s past included a felony arrest for cocaine possession. She was facing 15 to life. To avoid spoilers, suffice it to say that explained why some of the scenes seemed so thoroughly researched.

    “The book touches on my experiences with jail, illegal after-hours spots, and the complete chaos of addiction,” said Miller, who is now the director of enforcement for the New York City Conflicts of Interest Board. “Basically, that means I’m the chief ethics prosecutor for the city.” She’s aware of the irony. Before getting clean, Miller ran in the same circles as hitmen, such as the infamous Tommy Pitera.

    “Yeah, we got high together,” said Miller. “People knew him as Tommy Karate because he was into martial arts. But it wasn’t until a book that I found out he was a brutal killer who cut people into little pieces. I was traumatized. We hung out, getting high. I don’t know why he didn’t kill me. I guess he liked me. Maybe because I was an accomplished martial artist?”

    Miller is proof of how much your life can change when you get sober. She’s lucky to have survived her druggy past that included hanging out with murderers. Lawrence Block said, “Michele Miller has had more lives than a cat, and they’ve made her a writer of passion and substance.”

    After you read Widows-in-Law, check out Miller’s first novel, The Thirteenth Step: Zombie Recovery (HOW Club Press, November 4, 2013). It’s another fast-paced doozy and a finalist in the Amazon Breakthrough Novel Awards. Kirkus Reviews wrote, “A humorous and surprising satire of both the zombie apocalypse and the culture of addiction… wholly original… satisfying…. The care taken in both characterization and prose earns the reader’s time. A well-written, thoughtful treatment not just of a popular literary trope but of a nagging social issue.”

    The Addiction Spectrum: A Compassionate Approach to Recovery 
    by Paul Thomas, MD, and Jennifer Margulis, PhD. (HarperOne, Sept. 4. 2018)

    Paul Thomas, MD, is board certified in integrative and holistic medicine and addiction medicine—he’s also in recovery.

    “Addiction isn’t about willpower or blame,” he said. “It’s a disease that, like many other conditions, exists on a spectrum.” The spectrum is about how severely you crave your substance of choice when you don’t have it. It’s about how serious your health consequences are. Death, of course, is the worst end of the spectrum.

    The Addiction Spectrum offers a system that bases the individual’s needs on where they are on the spectrum. Thomas offers seven key methods for healing, whether you’re active in addiction or already in recovery. “Doctors need a new approach to treating pain,” said Thomas. He mentioned the hazards of painkillers within the medical community, “My wife is a nurse and recovering opiate addict,” he said. 

    The book is about any addiction—alcohol, marijuana, opioids, meth, technology. Co-author Jennifer Margulis, PhD, is an award-winning science journalist who’s been writing books about children’s health for over 10 years.

    “Making love, eating delicious food,” said Margulis, “these activities release dopamine and make you feel good. There’s nothing wrong with wanting to feel good. But using heroin or abusing prescription opioids or even excessive computer gaming or binge eating will harm your brain. Too many young people think, ‘Hey, I’m just having fun.’ But there is nothing fun about dying from an overdose.”

    But what is it about right now that can explain the drug epidemic?

    “We’re animals, wired to avoid danger and seek pleasure,” Thomas said. “We scan for threats and have an immediate fight, flight or freeze reaction. We’re talking about dopamine and epinephrine (adrenaline) responses.”

    Margulis agreed: “with cell phone alerts, video games, 24/7 news and high stress from work or school, we are overloaded. We can become addicted to food, social media, cigarettes, and a bunch of other substances and behaviors.”

    Both Thomas and Margulis agree it is time to start looking at the root causes. Why is there an increase in mood disorders, fatigue, and addiction? The book answers so many questions and I learned a lot about how to treat my body and mind better. The writing style makes it easy reading—nothing too tough to get through and very practical.

    The most anticipated book on my list isn’t out yet, but I’ve been lucky enough to read a sample chapter.

    Strung Out
    by Erin Khar (HarperCollins|Park Row Books, Feb. 2020)

    Erin Khar’s much-anticipated memoir will hit the shelves in early 2020. It’s the story of Khar’s decade-long battle with opioids, but it goes even further by searching for answers. Why is it that some people can do drugs and stop, while others become addicted? She explores possible reasons for America’s current drug crisis and its soaring death toll. The CDC statistics are staggering. From 1999 to 2017, more than 700,000 people died from drug overdoses, and 400,000 of those died from an opioid overdose. This epidemic is devouring our nation.

    Khar’s writing beat includes addiction, recovery, mental health, relationships, and self-care. She also writes the “Ask Erin” column for Ravishly.

    For a decade, beginning at age 13, she kept her heroin use a secret from friends and family. When she was caught by her then-fiancé, she went to rehab and her book describes her harrowing withdrawal. Three years later, at age 26, she relapsed. Four months later, her using had dragged her to the bottom.

    Khar, who has written for The Fix, told me, “I’ve been clean from opiates for 15 years!” That’s an enormous achievement for any addict, and in that decade and a half, she’s completely changed her life.

    From Khar’s essay in Self magazine:

    “If you had told me 15 years ago that I would be a happily married mother, living in New York City, doing what she loves for a living… I would have laughed.”

    She hopes that her book will help shatter the stigma; stop the shaming. She describes its genesis: “I wrote the short story ‘David‘ for Cosmonauts Avenue. Agents contacted me about writing a memoir.” After reading her essays, and following her writing career, I’m eager to read a book by this heroine about heroin.

    Every one of these books is written by a sober writer. They are living proof that people’s lives can change at any time.

    Mine sure did.

    Do you have favorite sober authors? Please share them with us in the comments!

    View the original article at thefix.com

  • Today I Celebrate My Brother's Suicide

    Today I Celebrate My Brother's Suicide

    My brother passed away from suicide seven years ago today. Without realizing it, he taught me that you never know what someone else may be going through, so I try to be kind.

    My brother passed away from suicide seven years ago today. It was a day I will never forget. I miss him very much and at times I am still overwhelmed with grief and sadness. When I think about him, warm tears instantly well up in my eyes and roll down my cheeks.

    But not today.

    Typically, those feelings catch me off guard: a song, a memory, a family event where for me his absence is always felt. Or a wedding or the birth of a baby, events that bring so much joy, yet I always remember that he will never experience two of life’s greatest moments.

    But I am prepared for today and what it means to me.

    The American Foundation of Suicide Prevention states that suicide is the tenth leading cause of death in the USA. The World Health Organization estimates that each year approximately 800,000 people die from suicide, which accounts for one death every 40 seconds. Some sources predict that by 2020 that will increase to one death every 20 seconds.

    These deaths are our sons, daughters, moms, dads, brothers, sisters, aunts, uncles, friends, neighbors, and co-workers. And in the approximately six minutes it takes you to read this article, nine people will have taken their life. Nine families will very shortly feel a pain like no other, their lives changed forever.

    The last time I saw my brother is etched forever in my mind.

    On December 3, 2011, I was driving to my mother’s house after work to pick up my family. Everyone was taking me out for dinner for my 43rd birthday, which was the next day. Our brutal winters typically start early in Alberta, slowing everything down; the roads weren’t the best. I was running a little late and was doing my best to hurry since we had a reservation at a nearby Italian restaurant at 6:30.

    I pulled up to a big snowbank in front of Mom’s house and honked the horn, once, twice and no one came. I jumped out and hurried through the front door, calling “Guys, c’mon, we’re going to be late.”

    “Surprise!!” they all yelled, my brother’s dog Yuma barking his welcome and running over to the door. And from behind the couch popped my brother Brett, holding a cup of coffee. “Surprise,” he said.

    We were not going out for dinner at all. I took in the beautifully decorated room and a couple of bags of gifts and smelled the sweet aroma of dinner filling the air. My sons Rick and Ryan looked so proud, beaming as they had managed to keep the party a complete secret. My mom had very obviously taken a great deal of effort to plan this evening, serving up salad and homemade lasagna.

    I was overwhelmed and grateful. I hadn’t seen my younger brother more than a handful of times over the previous five years and my sons had seen him even less. Since childhood, my brother had been my greatest friend, my confidant, the one who was there; the one I could always count on. Always. And vice versa.

    But sadly, things changed during our adulthood as he struggled with alcoholism and more severe mental health issues. I understand his illness so much better now. But back then, I had to set a healthy boundary between us, not because I gave up on him or didn’t love him, and not because I didn’t believe he could get well. My heart just couldn’t take the pain anymore of watching him self-destruct. He wasn’t sober much during those last years, so my love and support was from a safe distance.

    Once the meal was over at my mom’s, I sat on the floor and put on my party hat. Brett snapped a picture, then handed me a blue gift bag. Inside was a little rock.

    “It’s for peace and luck,” he said. “The other thing is kind of a joke.”

    As I pushed back the tissue paper, I found a black coffee mug with the familiar logo of a topless mermaid. I didn’t know what exactly he meant by “joke.” A reminder of our beautiful walk a couple of years earlier when he had been sober for a few months and we met at Starbucks? Or a nod to all those daily coffees we used to share on my front porch when we would just sit and talk and talk? Or was it just his funny way of letting me know that he knew I hated his habit of drinking coffee all day and late into the night, keeping him from sleeping. That is just a small example of me trying to give him advice that he never took.

    Maybe the mermaid mug was all those things—I didn’t care. My brother knew me and I knew him. How much joy you can get from such a simple gift; I love and cherish that mug and drink my morning coffee out of it even today.

    “Thanks,” I said with a warm smile.

    I reveled in seeing my sons, almost 19 and 21, interacting with their uncle, talking, laughing, and sharing what was going on in their lives. Watching Ryan and Brett side by side warmed my heart. Memories of our once-happy family filled my mind. How close Brett used to be with his nephews.

    As I sat and watched them, I felt a complete sense of pride and love. Ryan was taking Power Engineering at college, following in the career path of his uncle. Brett was showing Ry different websites and telling him all about the different engineering plants, which ones are better, what each has to offer. My heart melted for so many reasons. My brother’s addiction and struggles had caused him to miss years of my sons’ lives, but when I sorted through the pain, the destruction, and everything that we had all been through, I realized it had not changed how much they loved him. I hope he knew that. And he loved them, too.

    That cold, snowy evening ended as usual—a hug, a kiss on the cheek.

    “I love you,” I whispered in my brother’s ear.

    “I love you, too,” Brett replied to me, like a thousand times before.

    I never saw my brother again.

    Just after 3 a.m., on March 19, 2012, I was awoken by my husbands’ words, “Jodee, I think someone is here.” I still remember seeing the four black pant legs with yellow stripes on the doorstep as my husband opened the front door.

    My brother had taken his own life.

    My brother died 2,555 days ago today. But whereas others have moved on with their lives, I am one of the few left counting. Please don’t get me wrong, I am glad others have moved on. He would be glad too. But my life and how I see it has changed forever.

    My brother’s death taught me so much: I try to remember to cherish life every day, to be open-minded, empathetic, and understanding, and to tell the ones I care about that I love them. I strive to not be bitter and angry as those emotions serve no purpose other than to break my spirit. I work hard to remember that not everyone has the same opinion, that we all experience life and the circumstances surrounding it differently. So, I never get argumentative when others do not agree with my perspective. They have not lived my life, nor I theirs. Without realizing it, my brother taught me that you never know what someone else may be going through, so I try to be kind.

    Because of my brother and his absence, today, more than any other day of the year, the beauty of life is fresh in my mind.

    I will not spend today crying. It doesn’t mean that I don’t wish he was here, or that I don’t love him. It doesn’t mean I’m not feeling an underlying sense of sadness.

    But I have chosen today to be on a cruise with my husband of 28 years and two of our greatest friends, all of whom I love very much. Today, I will breathe the fresh Caribbean air; I will swim in the ocean and feel the warmth of sunshine on my face. Because of my brother, I remember how precious life is and you can’t take any day for granted. You never know what tomorrow may bring.

    Today, I celebrate life.

    Today, I celebrate everyone who has lost their lives to suicide and the families who loved them.

    Today, my sweet brother, I celebrate you.

     

     

    In loving memory of Brett John Tisdale, September 15, 1972 – March 18, 2012

    If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or Text HOME to 741741. If you think someone is in immediate danger, do not leave them alone, stay with them and call 911. Read about warning signs for suicide and more at mentalhealth.gov.

    View the original article at thefix.com

  • The Ugly Side of Dating in 12-Step Programs

    The Ugly Side of Dating in 12-Step Programs

    When someone acts perfectly, their best selves, when that’s what they present to us, we often fall for it. I wasn’t special or not special. I was typical.

    Recently I was in a relationship with a guy I met in the program. We’d been together about four months, on again-off again. Really twice on, twice off.

    The first breakup wasn’t pretty — we’d had an argument one evening and when we parted he wasn’t happy. I’d say he was disappointed, but it was more than that. But after years of working my AA program, my “people pleaser” was quick to reassure him we were “good.” In fact, while the argument wasn’t really that bad and could have even been food for growth, his anger had frightened me. I’m eleven years sober, he had four years. I thought the recipe was for love, not disaster.

    The truth is: I’d been on the fence about him since we met.

    On our first date, he told me that he’d threatened to kill someone during a relapse. This left me feeling unsettled, but when I told my friends and therapist, I learned it was apparently really, really bad. I thought well, it was a relapse, not the type of thing he would do sober. I remembered him also telling me of a breakup that had happened when he was still using. Maybe all of his negative behavior was when he was using. I’d been through this before with sober men, and it was altogether confusing. An ex had gotten physical with a few women before I knew him, and I assumed it was while he was drinking. I learned at the end of our relationship that it was actually during a dry period. 

    I sound so judgmental. I guess we all have to be, to some extent, while we’re choosing who and who not to date. But apparently I’m not judgmental enough. I ended up dating the man who’d threatened someone’s life, and now here we were, post-fight, all my protective feelings swirling around inside me. I hate it when people say they were a hot mess, because it implies that they are or were hot, which is a little too narcissistic for my taste, so let’s just say I was a mess. (Not that I’m completely free of narcissism, but I choose to believe in the good in myself and focus on my character defects one at a time, rather than bundling them together.) 

    I’d like to say I was fine, but really I wasn’t fine. I was going to act like I was, though, to maintain the status quo. In other words, I’d said everything was okay, so I’d act like it was. Acting as if is a skill I learned fairly early in sobriety, and it had served me well.

    The morning after the fight I awoke to a long Facebook messenger message, really a few long messages from him, clustered together. This was the guy I was dating exclusively, and sleeping with, and basically in a “sober” relationship with. His messages were angry and spiteful. I’d thought all was okay enough to at least be civil to one another, but no such luck. And I felt sick about it. 

    I can’t remember if we spoke after the messages, but I don’t think we did. I was livid and hurt, an ugly combination of emotions. I broke up with him. Over messenger. The way we loved, we died.

    The Resurrection

    Until he started love-bombing me. I call it “The Resurrection.” It started with things he was going to give me, restaurants he wanted to take me to. He gifted me with a very personal family heirloom… and on and on. After about a month, I caved. Our second-round first date was at a park near my home. When this guy was on, he was on. We ended up kissing at my place, just kissing, and I was falling in love like I never had with him before. When someone acts perfectly, their best selves, when that’s what they present to us, we often fall for it. I wasn’t special or not special. I was typical. 

    The love affair lasted about two days, and then the old him reappeared: not listening well, an underlying frustration, a continuation of great and comforting sex (that’s where the connection stemmed from). All in all, except for the sex, nothing very exciting. Except I’m leaving out my behavior in the whole episode. Knowing I didn’t feel as strongly about him as he did about me, I should have ended it the first time around.

    Then the second time, about a month in, we went to a couple of galleries and walked around on a Friday night when everyone in New York City, like us, was mulling around for free. I wasn’t in a very good mood; my insecurity and self-hatred were getting the best of me. We had an argument — again, not so bad — but he got too angry for the situation.

    I woke up the next morning, upset and out of sorts, and called my sponsor, as I had a few times during our courtship. I asked her if I should keep my date with him that night. For the third time, she suggested I take a break from seeing him, but I didn’t listen. Suggestions are just that, I told myself, and at 11 years sober, who was I to have to listen to my sponsor.

    I went over to his place around six that evening. We took a taxi to a restaurant we liked, and the whole ride there was awkward, with short bursts of forced conversation. It got worse at the restaurant and culminated in me telling him I didn’t have the same feelings for him that he had for me. Read: My Part. I shouldn’t have gone in the first place, should have broken up with him the night before (as I didn’t hesitate to mention during what I now realize was a fight from the minute I set foot in his apartment).

    But then his anger moved in, like a dark cloud.

    “I’m breaking up with you, bitch,” he said and slammed his hand on the table. He started to walk out, which I feared would leave me stranded, far from home, with no means of getting back to my warm apartment and my sweet cat. At times of high stress, I, like so many others, go to the worst place, a place of abandonment and rejection. And as much as he really might have been rejecting me, I knew in my heart I had left the relationship months ago.

    I ended up begging him to let me ride home with him — that feeling of being stranded, scared, and alone that reminds me of all the reasons I drank and drugged — and we ended up sharing a taxi back to his apartment so I could take the subway the rest of the way home. During the 45-minute ride he alternated between yelling at me and saying he wasn’t going to be mean to me any longer, an agreement he broke countless times during the drive. He spewed hate at me while I mainly stayed silent and looked out the window. And then he said the most danger-filled and threatening thing anyone’s ever said to me: “if you think this is bad, try pouring alcohol and coke on it.”

    The moral? I should have left sort-of-well-enough-alone. After I knew who he was, I never should have gone back and dated him the second time. Or, if I am honest with myself, the first. I’m glad I got out before something really awful happened, though I remain worried that he might stalk me. I don’t know if that’s his style, but he did tell me that I had reason to be terrified of him. He said there are only a few people in the city who he hates, and they are scared of him.

    I’m dating again and it’s hard. I’ve had difficult breakups, in and out of sobriety, but this has to be the worst. It’s an all-time low; the one that leaves you with the most vile taste in your mouth. I don’t even know if I want to publish this, for fear he might read it, for fear you might. I’m going to go with HP on this one — pray like there’s no tomorrow, pray to be of service, to learn what HP has brought me in offering me this experience which I have embraced and then, finally, un-embraced, and to affirm that whatever happens, I’ll be taken care of.

    View the original article at thefix.com

  • Florida Versus Evidence: How I Lost My Children Because of Past Drug Use

    Florida Versus Evidence: How I Lost My Children Because of Past Drug Use

    When my first slew of drug tests returned negative, the opposition began slinging whatever they could think of in my direction, hoping something would stick.

    I am living in two worlds. One is a world populated by doctors and advocates, run on the tenets of research and science and reason. It is a world in which addiction is treated with medicine, and where there’s no question that people who use drugs deserve to be safe and free of avoidable infections and diseases. In this world, nobody hesitates to administer naloxone if the occasion calls for it. In this world, people are not afraid to touch the bodies of drug users, and we all understand that if you can self-administer naloxone, you don’t need naloxone. I experience this world through phone lines, e-mails, and social media. I write about this world; this world is my template for how all worlds should be.

    Addiction as Moral Failure

    Then there is the world where my life takes place. In this world, having an addiction is a moral failure. Drug use is met with punishment. Judges replace doctors and toxicologists, making medical decisions and determining the results of drug tests with reckless abandon. In this world, abstinence is the only route to health. In this world, a hit of pot is just as chaotic as compulsive, daily injections of heroin. In this world, there is no sterile equipment; in this world, everyone is sick. Here, you can be sentenced to death just for being the friend of someone who overdoses. This is the world I touch with my fingers and teeth—the world where I walk, and eat, and breathe. This is the world where I live.

    I became involved with the Florida Department of Children and Families in April 2018. I was never charged with a crime or afforded the presumption of innocence, evidentiary standards, or jury decision that would have accompanied a criminal charge. Instead, one judge—virtually accountable to no one and equipped with full immunity—deemed my husband and me guilty of some nebulous pre-crime like the woeful characters in Philip K. Dick’s short-story-turned-film “Minority Report.” Apparently, I am guilty of the possibility of neglecting or otherwise harming my children in the future because I have a diagnosed substance use disorder.

    Since that decision, I have been forced to obey the mandates set forth by my county’s child welfare authorities in an attempt to win back custody of my girls. So far, not a single mandate has been evidence-based.

    I love writing about harm reduction, evidence-based addiction care, and trauma-informed mental health practices. I enjoy staying informed about best practices in addiction medicine. I am proud that I get to help demystify and destigmatize addiction and mental illness, and I am honored to have the opportunity to speak with the researchers who have dedicated themselves to driving us out of the dark ages of addiction medicine. But now that I am living in those dark ages myself, I can’t shake a sense of bitterness: I write about a better world, but it’s one that I only get to view from afar.

    Substance Use Disorder Treatment and Geography

    In 2017, I wrote an article for OZY about the general disparities between addiction care in red states and blue states. I was living in Seattle, Washington, at the time but I’d had some experience trying to get help for addiction in Florida—so I knew how backward providers could be. For example, when I gave birth to my daughter in Palm Beach while on prescribed methadone, hospital staff refused to let me breastfeed her. She was treated for Neonatal Abstinence Syndrome (NAS) and pediatric staff claimed that enough methadone would be passed through my breast milk to potentially harm her. In reality, numerous studies have found the exact opposite to be true and breastfeeding is now recognized as one of the most effective balms for NAS, due to the maternal contact and general health benefits of breast milk. The amount of methadone passed through breast milk is too negligible to help or harm.

    As I wrote in the OZY article, Democratic-ruled states are more likely to offer Medicaid coverage for methadone and buprenorphine, while Republican states are less likely to even offer the medications themselves, much less cover them. People in red states also face harsher penalties for drug crimes and are less likely to be allowed to continue a methadone or buprenorphine prescription while incarcerated. (Though this is a nationwide issue, blue states are leading the reform.) But writing the story from Seattle meant writing from a place of comfort: I was living among the reformers—walking within the pages of history that will be attributed to the good guys. I was able to take my buprenorphine every day because my state insurance covered it. I was surrounded by intelligent, informed people with whom I could speak honestly about my decision to engage in non-abstinence-based recovery. When I wrote about the issues in the system, I wrote from a place of distance. Of privilege.

    I did not appreciate how lucky I was until I dove headlong into the true trenches of the Drug War. 

    In Recovery and Losing Custody

    In Broward County, Florida, my children were removed from me because of unsubstantiated accusations of drug use. When my first slew of drug tests returned negative, the opposition began slinging whatever they could think of in my direction, hoping something would stick. Most of it revolved around the fact that I was poor—but ignorance about mental illness and addiction reared its ugly face yet again. The opposition cited my prior child welfare investigation in Florida—the one that was triggered by my daughter’s NAS. It was a routine investigation that had been deemed unsubstantiated. These types of investigations are typically labeled “harmless.” I had been in compliance with my methadone program, and my daughter’s doctors had no concerns—but five years later, the opposition used that prior methadone prescription as a basis for deeming me an unreliable witness: the dirty, lying junkie. 

    When I was asked under oath whether I had spoken with one of my husband’s siblings about possibly purchasing marijuana, I admitted that I had. Clinicians in addiction treatment recognize that drug cravings are normal and applaud us when we admit that we think about buying drugs but then decide against it. But the guardian ad litem attorney—the counsel whose job it is to protect my daughters’ interests—argued that by considering using marijuana, I placed my sobriety and therefore my children at risk. It didn’t matter that I canceled the purchase and honestly acknowledged that I’d thought about it. The judge called my process of considering marijuana but then deciding against it “drug-seeking behavior.” She gave custody of my daughters to my husband’s parents.

    The terribly irony underscoring the entire proceeding is that if I were still living in a state that embraced the most current research on addiction, I would never even have been in a courtroom. The accusation against me stated that I left my daughters in the care of their grandparents for three days while I used drugs outside of the home. According to the U.S. Department of Health and Human Services, “drug tests do not provide sufficient information for substantiating allegations of child abuse or neglect or for making decisions about the disposition of a case.” Drug use on its own, away from any children, is not child abuse. A parent who leaves their child with a family member to go to a bar for an evening is generally considered to be engaging in responsible substance use.

    The federal government recognizes that child abuse cannot reasonably be defined as placing a child with a trusted caregiver, leaving the home for a couple days, and returning sober. It doesn’t much matter what went on during those two days. True or false—the accusation against me never described child abuse. A more enlightened jurisdiction would have recognized that. The separation trauma that my children and I have endured over the past nine months is completely attributable to our location.

    I used to write about addiction and drug policy from a place of privilege. Now I am writing from the deep trenches. I feel as though I am performing a kind of literary necromancy whenever I publish—except that instead of communing with the dead or demonic, I am writing from within that unillumined place, hoping that, by disseminating research, facts, and the words of distant experts, I can summon reason back into my life.

    View the original article at thefix.com

  • 7 Tips to Help You Find the Right Therapist (and Why You Need One)

    7 Tips to Help You Find the Right Therapist (and Why You Need One)

    It was a therapist who first told me that I wasn’t in therapy because I was bad and out of control, like my mother said; I was in therapy to learn how to deal with having an emotionally unstable mother.

    My mother believes everyone needs therapy. And she’s right, they do. After being around her. Everyone, that is, except her. Don’t be like my mother, requiring the world to change around you. (It won’t.) And don’t be like my Dad either, who tells me I’m overreacting every time I have an emotion. Don’t be like me, either, an asshole exploiting her parents for profit. Wait. 

    Do you need therapy? Probably. Could you benefit from therapy? Definitely. Can you afford therapy? More easily than you think. Many therapists keep sliding scale spots open in their practice, for those who need help but don’t have health insurance or a large income. I found my current gem of a therapist through Open Path Collective, a network of clinicians who offer therapy at a rate of $30 to $60 per session for individuals.

    It was a therapist who first told me that I wasn’t in therapy because I was bad and out of control, like my mother said; I was in therapy to learn how to deal with having an emotionally unstable mother. And I didn’t talk too much and ask too many questions; actually I was curious, the therapist said, and had a lot to say.

    It was a therapist who said: “I can’t see you and your husband at the same time, the relationship is too damaged and he just shuts down and threatens to end it.” The same therapist asked “Are you drinking every single night?” And, “Have you tried AA?” And when I couldn’t get myself to stop or go to AA, she found a rehab, called my parents, and helped make all the arrangements from her office.

    It hasn’t been all Aha! moments and cleansing cries on couches though. I’ve had a couple of negative experiences. None, however, were as negative as the summer I tried to therapize myself on my own with just books. That experiment ended with me smoking crack for the first time, shooting up heroin while smoking crack (neither of those were my thing, but that summer!), and my first DUI.

    Maybe you’re surviving – but you could be thriving. 

    It might be helpful to look for a therapist who specializes in addiction or whatever you believe your specific issues are, but it’s not necessary. Your intuition is your greatest asset in your search. If you don’t like your therapist, leave and find another one. Repeat until you have the seven experiences I describe below.

    1. Your emotions are validated.

    Therapy helps you accept that your emotions are valid, something our culture certainly doesn’t want you to do. Allowing yourself to feel your feelings is an underrated gift. Your emotions may seem out of proportion to the event that caused them, and that’s okay. You learn that they are actually a response triggered by the event to a deeper, older wound. You will learn, as the poet Rumi said, to “meet them at the door laughing and invite them in.”

    2. You get to talk about anything you want.

    This is one of the most exciting things with a trusted therapist, thinking what would I like to discuss today? The toxic friendship I want to find the courage to give up; that awful conversation with my dad; or do I want to recount everything that happened this week? It’s all up to you! You can plan it in advance, and you don’t even have to stick to the plan, you can talk about whatever comes up! Where else do you have this kind of freedom, where you don’t have to dance around sensitive issues, where there is no fear of being judged that isn’t your own projection, where you are safe, completely safe, to talk about the most trivial and most traumatizing of issues? What joy! The time is truly yours.

    3. You don’t have to caretake or worry about anyone else’s thoughts or feelings.

    If you aren’t worried about your friend’s thoughts and feelings at all and constantly dump your problems on them, quit being an asshole. That isn’t their job, even if they think it is. The only thing addicts are better at finding than their drug is codependents. Your therapist is one of only people in the world with whom you don’t have this burden. This doesn’t mean you should abuse them, just that you don’t have to worry if they are sick of hearing about your dumb boyfriend again. 

    4. Unconditional presence.

    Therapists are masters at the art of holding space. They are fully with you as you explore the pains and confusions of life. You are never too much, never unacceptable. You just are. We live in a culture that doesn’t teach anything unconditional, least of all love and presence. People have to learn how to do it. Your therapist knows how, and it is their job to provide this for you. Your therapist isn’t invested in pushing the journey to a certain place for their own benefit. They are just there to walk with you along the way. My therapist held that space and accepted me until I could learn to accept myself. When I beat myself up after another relapse, she didn’t join in. Her unconditional presence and nonjudgmental interest helped me to finally break that pattern.

    5. You’re given the space to work out your problems on your own.

    Therapists aren’t there to solve your problems for you. They are impartial witnesses, bringing a gentle, open, and noncritical attitude to your experience. It’s the exact opposite of my childhood. I can tell you from experience that nothing feels better than figuring out a problem on your own, with someone with no skin in the game standing by as a witness, someone who only wants to see you do well and who isn’t going to scold you when you fall (but will encourage you to explore why).

    6. They notice, and can help point out your patterns.

    After I stopped obsessing about a man who treated me carelessly, my therapist pointed out that I had a pattern of acting as if sex was all I had to offer and offering it to people who didn’t deserve it. I remember the moment because she said it so gently, as a question, and then she paused. She knew to bring it up only after I had described a scenario which shown I had grown in self-love and respect. It blows my mind how she is able to hold back until the moment is right. I had a previous therapist who I never let get a single word in, and when I finally asked after a year, “What do you think?” She said, “I thought you’d never ask!” She told me that she had been planning to bring it up soon, but that she sensed that it was going to take what it took for me to learn to trust her.

    7. Safety.

    Before we can change anything, we first need to get to a place of safety. I breathe a huge sigh of relief every time I walk into my therapist’s office. There is nothing more important than feeling safe. And it is so rare in this world, in this time. To paraphrase the great Eddie Pepitone, “It’s a sign that a society is falling apart when murder is entertainment, though the Ted Bundy special was very good.” I can’t think of anyone I know who hasn’t had their car broken into, or their body broken into, or their mind hijacked by the needs of another who didn’t see them as real. Therapy is a true safe space. And in therapy, you can learn to create safe space within yourself, which is something nobody can take from you. 

    In conclusion, get a therapist. I mean it. What are you waiting for? Give your friends a break. Learn to see your parents as flawed humans who did the best they could. Lean on your sponsor for no more and no less than they can handle. Get. A. Therapist. You don’t have to stay stuck anymore, you don’t have to keep hurting yourself with a million tiny infractions. Help yourself. Allow yourself to be helped.

    I love you. Especially the nastiest among you. You need it the most. Leave your excuses in the comments.

    View the original article at thefix.com

  • Should Your Mental Health Determine How Your Pain Is Treated?

    Should Your Mental Health Determine How Your Pain Is Treated?

    Patients with a mental health condition might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their symptoms. Finding treatment can be frustrating and humiliating.

    Four years ago, Dez Nelson’s pain management clinic demanded that she complete a visit with a psychologist. Nelson was surprised, since she had no history of mental illness, but she didn’t feel that she could push back on the request.

    “Of course I said okay — I didn’t want to lose my treatment,” Nelson told The Fix. “I was not happy about it, but I did it.”

    Nelson, 38, went to the appointment and had a mixed experience with the psychologist. She hasn’t been back since and the pain clinic hasn’t asked her to visit a psychologist again. Still, Nelson said that the experience highlighted — yet again — the discrimination pain patients face.

    “It was a condition of my continued care,” she said. “It seemed like they’re bringing it up in a beneficial light, as part of a multi-pronged approach to pain care. But I don’t think [mental health treatment] should be forced on a patient who doesn’t think they need it.”

    Chronic pain and mental illness are among the most stigmatized conditions in modern medicine. The conditions frequently intersect and change the way that patients are cared for and treated. Patients who have a mental illness might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their physical symptoms. At the same time, research suggests there is a strong connection between mental health and pain: depression can cause painful physical symptoms, while living with chronic pain can cause people to become depressed.

    All of this makes treating chronic pain and mental illness complex and frustrating for doctors and patients alike.

    A Mental Health Diagnosis Affects the Way Your Doctor Treats You

    Elizabeth* is a professor in her mid-thirties who had undiagnosed Lyme disease for eight years. Her Lyme contributed to the development of an autoimmune disease that has led to widespread inflammatory and nerve pain throughout her body. Elizabeth also has bipolar disorder. Despite the fact that she has been stable on medication for a decade, her mental health diagnosis complicates her pain treatment.

    “Doctors’ demeanor changes when I tell them my medications. When I say I have bipolar disorder, it’s a whole different ballpark. To them that’s clearly a risk factor and red flag for drug abuse,” Elizabeth said.

    Opioids are one of the only treatments Elizabeth has found that works to alleviate her pain. But she also takes benzodiazepines on an as-needed basis to control her anxiety (usually once a week). Even though Elizabeth is well aware of the risk of combining the two medications and knows better than to take the two pills together, doctors refuse to prescribe both. They don’t seem to trust her not to abuse them.

    “I could tell them that I wouldn’t take them together. But that’s not a valid choice,” Elizabeth said.

    While doctors were extremely cautious about this drug interaction, they didn’t focus on another drug-related risk: medications that are used to treat nerve pain can cause adverse reactions in patients with bipolar disorder. No one warned Elizabeth of this danger, and she ended up being hospitalized for psychosis after a long stretch of stability.

    “The doctors didn’t talk about it because it’s just a side effect, not a liability concern,” she said.

    On the flip-side, Elizabeth has experienced psychiatric providers who were skeptical of her pain diagnosis.

    “They wrote in my chart that I had a delusion that I had Lyme disease,” she said.

    The Intersection of Pain and Mental Illness

    Treating patients with pain and mental illness is complicated because both conditions rely on patient reports rather than objective tests for a diagnosis and to create or adjust a treatment plan.

    “Pain is a subjective symptom of the people feeling it. There is no way to measure it,” said Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at Memorial Care Orange Coast Medical Center in Fountain Valley, California

    Pain and mental illness can exacerbate each other. In addition, medications for the conditions can interact in rare and serious ways, like what Elizabeth experienced. Finally — and at the forefront for many pain specialists — is the fact that many people with mental health conditions also develop substance use disorders and treating them with highly-addictive opioids can be dangerous. 

    “We address these issues with patients head on, explain that staying on these medications is very risky for them,” Mikhael said.

    Mikhael said that there’s a reason doctors ask patients so frequently about their mental health and substance abuse history. While some patients find that exhausting and repetitive, Mikhael feels it is his responsibility to be constantly evaluating the risk and benefits of using pain medications for people more susceptible to substance misuse or addiction.

    “I have to give them the benefits of the doubt, particularly if the history does not show they’re going doctor shopping. I have to trust them and I have to help them,” he said. “But trust has limits. I can’t say I trust the patient and let go.”

    My Body Is in Pain, I Do Not Need Psychiatric Care

    As the medical community grapples with how to manage pain in light of the opioid epidemic, there is an increased focus on holistic approaches to pain management. Nelson, however, believes this can be harmful to patients who need the pain-relieving power of opioids.

    “They’re trying to turn into bio-psycho-social model, and there are people with real diseases who are dying,” Nelson said. “My pain has nothing to do with my psyche. It has to do with the fact that my body is sick.”

    Before she was diagnosed with arthritis, emphysema and hemiplegic migraines, Nelson was often sent to psychiatric care when she arrived at the emergency room in pain. She had one provider tell her that facial paralysis — later found to be a symptom of her migraines — was psychogenic.

    “Instead of doing their jobs and investigating the physiological issues, they jumped right to the psychological,” she said, pointing to the long history of doctors believing that women’s pain was not real. Eventually, these experiences began to take a toll on Nelson.

    “There was a time when I began to question my own sanity. I thought ‘maybe they’re right, maybe this is just in my head.’”

    Untreated Pain Is Like a “Time Bomb.”

    Both Nelson and Elizabeth have been able to advocate for themselves. While they’ve still struggled with the medical community, they’re been able to improve their care. Yet many people with chronic pain and mental illness don’t have the ability to advocate for themselves in this way.

    “I’ve had a lot of education, so I feel comfortable and confident talking to a doctor,” Elizabeth said. She also has the money to be able to travel to a pain clinic and the support of a spouse and therapist.

    “I have a lot of these privileges that a lot of people don’t have,” she said. “I’m grateful for that, but I shouldn’t have to be. It should be ordinary.”

    Elizabeth often thinks about patients who have uncontrolled or treatment-resistant mental illness, and how that might affect their access to pain relief.

    “Should they just not get pain management because they’re not well with their mental illness? Of course not.”

    Having in-depth conversations, sharing information between different specialists, and providing community support could all help improve outcomes for people dealing with chronic pain and mental health conditions, she said.

    “People need help, not a punitive approach of taking [pain management] away,” she said. “Energy should be put into safe approach to dealing with pain. You can’t ignore it — it’s like a time bomb.”

    View the original article at thefix.com

  • Learning How to Love and Be Loved: An Interview with Eva Hagberg Fisher

    Learning How to Love and Be Loved: An Interview with Eva Hagberg Fisher

    I think illness was the great wind that just blew through my life and cleared away a lot of the resistance that I had to being vulnerable, by making my need to ask for help a literally life and death decision.

    A medical mystery intertwined with a tale of friendship and sobriety, Eva Hagberg Fisher’s How To Be Loved: A Memoir of Lifesaving Friendship provides a lesson that many of us need to learn: true love does not exist only in the realm of family or romance. Sometimes the most meaningful and life-changing love is found in friendships: the ones who stay even when it gets messy, even when you don’t want them to.

    For Fisher, overcoming addiction and embracing long-term recovery did not mean the end of suffering. Mysterious illnesses, warped family dynamics, and complicated relationships threaten and almost undermine her sobriety. When the doctors are baffled as extreme havoc dominates her health, she wonders how she’ll maintain her balance and move forward with faith in the future.

    With the help of friends made in 12-step programs and elsewhere, Fisher faces the hardest challenges of her health crisis. But maybe the biggest challenge is allowing herself to be loved, which requires more than being brave; it means she’ll have to be vulnerable. In this stirring memoir, Fisher learns to surrender, and through surrender she finds relief, courage, gratitude, resilience, and love.

    Of course, we wanted to know more.

    The Fix: How do you define radical surrender and what part has it played in your life? In 12-step programs, they often say that the meaning of surrender is “joining the winning side.” Do you agree?

    Eva Hagberg Fisher: For me, it’s a constant, ideally daily practice. I don’t know if it’s joining the winning side so much as, for me, joining the only side that is ever going to give me a chance at having a good life. Or any kind of life that’s worth living. Life keeps happening to me, even though the book has an ending! And I need to keep surrendering. I want to keep surrendering because the feeling of safety and relief that I get is what I was always looking for.

    The Buddha’s First Noble Truth is that “Life is suffering.” Do you believe we need to suffer to a certain extent to learn how to grow spiritually? Is the recognition of suffering and how a person then handles that challenge a key to spiritual growth?

    I don’t know that we need to, but it does seem to sort of fast-track a greater sense of compassion and the need for connection. I don’t know whether or not my suffering was necessary, but I think that the way in which I kept wanting to be awake for what was happening is what led me to be able to experience what I’ve seen described as post-traumatic growth.

    Somewhat similar to your experience, my friend just underwent his second operation on a brain tumor and is now going through radiation treatments. It astounds me that he can maintain his sobriety and his sanity through such a life-altering time. Humor and music both seem to play a significant role for him. How were you able to accomplish this?

    I’m so sorry to hear about your friend. And I’m so glad that he has you there. For me, a sense of humor and just highlighting how ridiculous and seemingly inconceivable the complications I faced were was just essential. I think a lot of that is just innate personality — my father is intensely optimistic, as am I. And my friends helped me to have a sense of humor; once they saw that laughing about my situation was really helpful for me, they put a lot of emphasis on being funny with me.

    In September 2015, you were diagnosed with a rare disease called mast cell activation syndrome. This devastating syndrome makes the body feel like it’s allergic to everything. How did you overcome this condition?

    A variety of treatments: a really intense antihistamine protocol, bio-energetic de-sensitization, various meditative modalities, frequency-specific microcurrent, supplements, nettle tea, time. It’s so different for everyone, so I’m definitely not recommending this, but it’s what I did.

    In your book, your illness becomes the force that opens the door to profound friendship. Do you feel like you needed an extreme crisis to be vulnerable enough to accept such friendship and be such a friend?

    Definitely. I think illness was the great wind that just blew through my life and cleared away a lot of the resistance that I had to being vulnerable, by making my need to ask for help a literally life and death decision.

    When you say that you were “constitutionally unlovable” before the events of the book happened, what do you mean?

    I just felt and believed that at my core I was a bad person. That all the mistakes I’d made were evidence for my being constitutionally bad, and that I didn’t inherently deserve to be loved. That I had to prove my value by being helpful or useful or financially supportive.

    What role should the ego play in the context of friendship?

    The role of ego is definitely one that I play with – I try to remember that my true friends are the ones who can spot my ego and lovingly point it out and help me to ground myself. And I also think that my ego drives me to produce art, and be in the world, and I’m grateful for it.

    Tell us a little about Allison and the role she has played in your life.

    She is someone who saw me really clearly — and saw so many other people really clearly — and had no compunction about accepting that everyone has deep and often irreversible flaws, and they are still worthy of love. We had a sort of imbalanced friendship for a while, and then when I got sick I lived with her for a few weeks and prepared for brain surgery, and she showed me how to get through something that I thought was totally unsurvivable. She loved me really completely, and that experience started to put new grooves into my brain for what being really loved could feel like.

    You have said, “My wish is for people who are suffering to not feel like they have to hide it or fit into a certain narrative.” What narrative did people try to fit you into during both your illness and your recovery? What working narrative did you choose to create for yourself?

    I think it’s common for people to see a sick person as a sort of wise sage. It’s definitely a role that I also love because it helps me feel strong and smart and therefore safe, but I think also people were just really compassionate and felt really bad for me that I was going through this, and wanted to be helpful. My own narrative changes all the time — sometimes I want to feel like I’m really blowing everyone’s minds with deep thoughts from the edge of the abyss, and sometimes I just want to feel really kind of regular and like I’m just the same as all my friends.

    This interview has been edited for length and clarity

    View the original article at thefix.com

  • How to Deal with Dental Anxiety in Recovery: An Interview with Dr. Tasha Bollermann

    How to Deal with Dental Anxiety in Recovery: An Interview with Dr. Tasha Bollermann

    Lying in a dental chair and having someone work on something so vital to survival is a very vulnerable position to be in, especially for those of us in recovery from addiction who have neglected our health and self-care.

    I suffer with near-debilitating dental anxiety. Every time I visit the dentist it affects my whole body: I struggle to articulate how I feel and the issues I’m experiencing, I become so tense that I have to be reminded to breathe, and I typically lose the whole next day due to exhaustion and an emotional hangover. And I’m not alone. Almost everyone I speak to in recovery has some kind of dental anxiety — so much so that many avoid the dentist altogether, neglecting care they desperately need. 

    Thankfully, I have a great therapist. She suggested that I mindfully explore the process of receiving dental care, advocating for my needs, and recovering my ability to self-regulate my fight or flight response. I have complex PTSD, which makes this whole process more challenging.

    Since moving to America I’ve spent thousands of dollars on dental care. I had no choice but to deal with months of dental pain by having a whole host of procedures, including root canals and crowns — all of which were unpleasant, to say the least. During one procedure I even had a panic attack, and I left many doctors’ offices feeling like I was too sensitive, an inconvenience.

    In my heart I knew that there had to be a dentist out there for me. I was so tired of feeling dismissed by doctors who roll patients in and out like they’re on a conveyor belt, only treating the symptom and never looking deeper.

    I had to find a doctor who understood the complexity of my situation and medical history and was thoughtful and patient enough to look at my experience holistically. After four dentists, I finally found one who demonstrated listening and compassion on a scale I’d never experienced. She had me when she told me that it was an honor to do her job.

    Curious to find out more about why people in recovery neglect their oral health, and the impact that drugs have on our teeth, I interviewed Dr. Tasha Bollermann for The Fix.

    The Fix: Thank you for taking the time to participate in this interview.

    Dr. Bollermann: I would like to thank you for giving me the opportunity to participate in this dialogue. The work you are doing to help people in recovery is important and powerful. My goal is to help people who are suffering live healthier and happier lives. I would also like to thank the reader for showing up and being ready to take the next step in their journey. Whether you know it or not, some part of you brought you to this article. Some part of you wants to break the cycle and pattern of where you have been and move into wholeness. You are ready for the next level of growth and healing. Otherwise you would not be reading this right now. Some of what I say might make you uncomfortable. This could be a signal that it is an area you are ready to begin to heal. So, congratulations on being here. I hope my words help you make progress in your journey.

    In your opinion, why do you think there is a tendency to neglect oral health even when the person is in recovery? What do you think are the main barriers preventing necessary treatment?

    Substance use may stem from a lack of self-love and self-respect. The basic needs for survival were not met, and therefore self-respect was not able to develop from a very early age. Often people show signs of self-loathing. This can lead to a desire to numb the shame with substances.

    I have witnessed the transformation from self-loathing to self-love. The habits of self-neglect need to be replaced with habits of self-care and nurturing. Teeth are vital for our survival. A person with a nice smile will get a job that a person with obvious dental diseases will not. Statistics show that the first thing we notice about a stranger is their eyes, and the second is their smile. So, breaking the habit of self-neglect and replacing it with a habit of self-care is essential to success. In my experience, the biggest barrier to oral health care in recovery is the lack of desire to care for yourself, and the lack of good habits. Neglect can lead to severe damage to the teeth and other organs. Often the damage to teeth is obvious without the expert opinion of a dentist. It is blatantly obvious to everyone you meet, as well as yourself when you look in a mirror. In comparison, the damage to the internal organs is less obvious. A return to overall health can be costly in time and money. There are financial obstacles in some cases and location obstacles in others, but a lot can be done with a toothbrush, some floss, a healthy diet, and a desire to get better.

    What are some of the effects that certain drugs have on the teeth, like meth for example? Are these effects from the drugs themselves, or rather from neglect?

    First of all, most drugs are harmful to teeth, so I don’t want you to think that this is a complete list of problems. However, some drugs deserve a mention here. Meth, for example, is one of the most destructive drugs I have encountered. It destroys the teeth rapidly. To my understanding, the drug itself is corrosive, which means it dissolves the teeth. Second, it creates extreme sugar cravings, which accelerates the process of tooth destruction. Ecstasy causes permanent neurologic changes in the brain. These changes create severe clenching and/or grinding of the teeth during sleep.

    Another substance use-related challenge is not being able to get adequately numb for comfortable dental treatment. This is most commonly seen with heroin and cocaine, but I also see it with alcohol consumption.

    Alcohol, marijuana, and tobacco are probably the most common drugs I encounter in my practice. The risk of losing the teeth to gum disease is significant, not to mention the risk of oral cancer. The more you drink and smoke, the higher your risk.

    Dental phobia is prevalent within the recovery community. How can people deal with that?

    Severe dental anxiety is best addressed before the dental appointment with a skilled practitioner of hypnosis, EMDR, neuro-linguistic programming, or other anxiety and recovery therapy. Once the patient can step into a dental office, it’s important for them to understand that they are not alone in their fear. The majority of people have fear around dental treatment. The stories my patients tell me are often heart-wrenching. Lying in a dental chair and having someone work on something so vital to your survival is a very vulnerable position to be in. Finding a dentist you can trust will help you build habits of success to manage your anxiety.

    Some patients are so terrified of communicating with their dentist that they often experience a frozen sensation, unable to articulate their fears or level of discomfort. What would you recommend to a patient that is even terrified to raise their hand to ask you to stop?

    This is tricky. As dentists, we rely on our patients to give us feedback on how they are doing. If the patient knows that this kind of freezing up has happened in the past and they share it with the dentist, then together they can work out a plan of action. A touch on the shoulder to reassure and check in can break the spell, so to speak. However, some patients don’t want to be touched. Again, I would say that needs to be discussed, and some kind of signal has to be arranged. Everyone has to be involved in the conversation. The dental assistant is, more often than not, the person who sees and acknowledges the signal, so the patient needs to include the assistant in the conversation as an important part of the team. If the patient is intimidated by the dentist, they should talk to the assistant about ways they can signal a concern that needs to be addressed.

    Many people in recovery will refuse pain medication stronger than Tylenol and local anesthetic. What do you recommend as a way to ease dental anxiety, and how would they compare to say traditional anxiety medications like benzodiazepines?

    The patients who refuse strong pain or anxiety medications are very wise. Benzodiazepines and opioids are highly addictive and can interfere with the recovery process. There are alternative ways to achieve relaxation and pain relief. Double-blind studies show time and again that ibuprofen and Tylenol are better pain control medications than prescription narcotics. Some of my patients visualize a safe and happy place that they escape to in their mind. Others take a combination of over-the-counter relaxation aids. Another approach is the use of acupuncture, aromatherapy, or naturopathic treatments before or after a dental appointment. Anyone in recovery should be careful about what they take for relaxation and pain control.

    L-theanine reduces anxiety. It promotes relaxation and stress reduction without sedating. L-theanine can help foster a state of calm, attentive wakefulness. It has positive effects on both the mental and physical symptoms of stress, including lowering heart rate and blood pressure. It is available in most health food stores.

    GABA (Gamma-Aminobutyric acid) is an amino acid produced naturally in the brain. It reduces the activity of neurons in the brain and central nervous system, which in turn has a broad range of effects on the body and mind, including increased relaxation, reduced stress, a more calm, balanced mood, alleviation of pain, and a boost to sleep. It’s available in most health food stores. It should not be used by patients already taking gabapentin.

    Brainwave entrainment works for almost everyone. It is a great way to lead your mind into states that you might usually have difficulty reaching, allowing you to experience a sense of calm relaxation without medication. Instructions are available on YouTube.

    If you plan on using any of these alternatives, I recommend you try them out in the comfort of your home first to see how it affects you. (Editor’s note: Consult your physician before taking any supplements. Even benign substances may interact with other medications or have unintended side effects.)

    What are some dental advancements that people may not be aware of since their last visit, but which would make the experience a whole lot less stressful?

    While most of the advances in dentistry are technical in nature, many shorten the time you have to spend in the chair. These include digital X-rays. You used to have to wait 15 or 20 minutes for the dentist, hygienist or assistant to process the films and bring them back, leaving you waiting and worrying. Now they are instantly available. The biggest advancement I would recommend is exercising your personal choice in dentists. Many dental offices today are very patient focused, virtually gone are the days of little to no concern for patient comfort. Choose your next dental office carefully, with the assumption that you will find a compassionate office.

    Tell me what similarities you see between dental disease and substance use disorders.

    Both dental disease and substance use disorder are lifestyle diseases. You can overcome both by creating small lifestyle changes that build on themselves. Achievement in oral health, or in substance use recovery, is a practice in the art of daily living. People who grow up in an environment of brushing and flossing daily are more likely to continue doing those things into adulthood. Those who grow up in an environment where the basic needs of survival are either not met or are minimally met are likely to continue those patterns into adulthood. Sponsors help keep the substance use at bay, and in a way the dental team is a sponsor for oral health. Regular checkups allow connection and repetition, which build habits of success. Habits of success build self-respect and self-love.

    Many of us neglect our teeth while in active addiction and sometimes this continues into recovery. How are you taking care of your teeth today? Let us know in the comments.

    View the original article at thefix.com