Answer Addiction

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  • Club Drug Ketamine Nears FDA Approval for Depression Treatment

    Club Drug Ketamine Nears FDA Approval for Depression Treatment

    Ketamine can relieve the symptoms of depression, but it’s especially effective at reducing suicidal thoughts quickly, sometimes within 40 minutes.

    Within an hour of Matthew Ayo’s first ketamine infusion treatment, his mother looked at him and said “I have my son back.”

    Ayo, who is now 23, had been treated for depression, anxiety, and other mental disorders throughout his teens and early twenties. A little more than a year ago his psychiatrist recommended that he try ketamine infusion therapy. For Ayo, the results were immediate and life-changing. He shows off a graph charting his depressive symptoms: “That first sky-rocket up was my first infusion,” he said. “I went from severe depression to no depression symptoms.”

    A year later, Ayo has remained depression-free and has gone from needing 24 pills each day to just 6. He’s moved out of his family’s home, secured a job, and is social. Although he still gets panic attacks, he says he’s better able to handle them.

    “It helped with every aspect: anxiety, depression, psychosis,” Ayo said. “I know that’s not what it’s for, but in my case it changed everything.”

    Stories like Ayo’s are awe-inspiring. Anyone who has experienced depression or watched helplessly as a loved one tries medication after medication hoping to find relief knows that too often the current treatments for depression and other mental illnesses just don’t work. Against this backdrop, ketamine infusion therapy can seem like a miracle treatment. When it works, it works quickly and effectively, often causing a dramatic reduction in symptoms of depression. However, medical providers caution that while ketamine shows a lot of promise, there’s still a long way to go toward understanding how the drug should be used to treat mental health conditions.

    A Conceptual Leap

    Ketamine — also known as the club drug “Special K” or “K”— is a well-established anesthetic, used since the 1970s to sedate people for medical procedures. Because it is safe and effective, ketamine is used widely by the military. During the wars in Iraq and Afghanistan, doctors began noticing that soldiers who were given ketamine for anesthesia often had fewer symptoms of post-traumatic stress disorder (PTSD), according to Dr. Steven Mandel, president of The American Society of Ketamine Physicians.

    “It took a conceptual leap for people to really wrap their heads around that this anesthetic somehow was acting as a mood elevator,” Mandel said.

    Mandel has practiced as an anesthesiologist for decades, but also has a master’s degree in psychology. As he looked into the research on ketamine, he became convinced that it could benefit people with depression, anxiety, and trauma. In 2014, he opened the Ketamine Clinics of Los Angeles and began offering treatments directly to patients, including Ayo. Mandel says that in his patients, ketamine treatments relieve the symptoms of depression 83 percent of the time and stop suicidal ideation more than 90 percent of the time.

    “It almost sounds too good to be true,” he said.

    Like Mandel, the wider medical community has been impressed by ketamine’s potential for treating psychiatric disorders. Although the Food and Drug Administration had only approved ketamine for anesthesia, providers began to use it off-label in ketamine infusion therapy — an intravenous administration of the drug — to provide swift relief of depression symptoms. At the same time, pharmaceutical companies hurried to develop a ketamine formulation specifically for treating mental health conditions.

    The result is Esketamine, developed by Johnson & Johnson, a nasal spray based on ketamine that can be used to treat depression. On Tuesday, February 12th, an FDA expert panel recommended that Esketamine receive federal approval. If approved, the medication will be covered by many insurance plans. Currently, almost all patients must pay out-of-pocket for ketamine infusions, which cost thousands of dollars. Doctors are hopeful that this will change as insurance companies realize that even off-label ketamine treatments can reduce the medical costs for people with mental illness.

    Risk-Benefit Analysis

    Speaking to Mandel and his patients, it’s impossible not to feel excited about ketamine. However, other providers are more cautious in their optimism.

    “There are certain scenarios where ketamine makes a whole lot of sense, and there are certain scenarios where it’s very unclear what the role of ketamine should be,” said Dr. Nolan Williams, assistant professor of Psychiatry and Behavioral Sciences at the Stanford University Medical Center. “I think that the idea that ketamine is going to be a treatment for everyone chronically for their depression forever is not realistic.”

    Most providers still reserve ketamine treatments for people who have already tried more traditional treatments. While the side effects of older medications like SSRIs (such as Prozac and Zoloft) are well understood, there still isn’t a firm medical understanding of ketamine for psychiatric use, said Dr. Robert C. Meisner, the medical director of the Ketamine Service in the Psychiatric Neurotherapeutics Program at McLean Hospital, which is affiliated with Harvard Medical School.

    “One must balance clinical necessity with clinical uncertainty, as well as availability of other treatments,” he said. “We know more about [first-line treatments like SSRIs], so the risk-benefit is easier to access.”

    Meisner oversees ketamine treatments daily for his patients, but says he would like to see further research into the long-term effects of ketamine, what an optimal dose is, and what markers might indicate that a person will respond positively to ketamine.

    The early indications are reassuring, he said. Ketamine appears to be very safe and have a low risk for addiction or dependency. However, studies of recreational users have shown that people who use high levels of ketamine for long periods can have complications in the bladder, liver, biliary tract and suffer cognitive deficits. In order to be more comfortable with ketamine, scientists need to better understand at what point the drug goes from relatively harmless to potentially dangerous.

    “As the risks and benefits become better defined, especially over the long run, it is possible that there may come a point where ketamine isn’t a second- or third-line option, but is used earlier,” Meisner said. “As the research comes in, people will become more or less comfortable recommending ketamine sooner.”

    A Life-Saving Medication

    One area where people have been more apt to use ketamine is among patients who are highly suicidal. Ketamine is especially effective at reducing suicidal ideation, in as little as 40 minutes, making it a potentially powerful medication for people who are acutely suicidal in the emergency room.

    Even outside of emergency situations, ketamine can be lifesaving for people at risk for suicide. SSRIs and other antidepressant medications start working slowly, sometimes not reaching their peak effectiveness until six to eight weeks have passed. This period of time between starting the medication and the onset of full therapeutic effects is considered high-risk for suicide, because someone who is acutely depressed might still be suicidal, but now have enough energy to follow through on a plan that they previously couldn’t execute. Ketamine can be used as a bridging agent in these situations, giving quick, short-term relief of symptoms.

    “Relatively speaking, this is a fast way to rescue some percentage of people with depression from the horrific depths of it, and sustain them until the medication to which we’re bridging becomes therapeutic and can take over,” Meisner said.

    What the Future Holds

    Today, experts and the public hold diverging views about ketamine. Some, like Mandel and Ayo, see ketamine infusion therapy as a life-changing treatment. Much of the medical community, however, is waiting to see more research and to follow the results from these early uses of ketamine.

    “Some argue there is an ethical imperative to move quickly to ketamine,” Meisner said, but he also points out that it’s only been used to treat psychiatric illness in the last ten years, which is not long at all in terms of medicine.

    “Many doctors who work in neurotherapeutics see IV ketamine not as the end of the story, or the treatment that has at last arrived, but as a treatment modality that is evolving and will change as the mechanism is better understood and drugs that leverage that novel mechanism are developed,” he said. “I have high hopes for where the early work on ketamine leads us as we better understand its complex mechanisms.”

    View the original article at thefix.com

  • Exercise: Making Amends to Your Body

    Exercise: Making Amends to Your Body

    In a world where nothing is in my control and living with a head that constantly tells me I’m not doing enough, exercising every day makes me feel like I’ve checked a box.

    Last year, my mom fell and broke her hip. During the surgery, she had a mild heart attack and a pulmonary embolism. Since that fall, she’s become wheelchair bound and has started showing the signs of early dementia. She’s now in assisted living, being bathed by caretakers. On the other hand, my father has a girlfriend, writes screenplays, teaches kids to read, swims, and delivers food to the elderly (even though he is the elderly). My parents are the same age: 81. 

    What could cause such a difference in their physical states?

    Exercise. My dad always exercised while mom was very sedentary. 

    The Dreaded E-Word

    I know, the dreaded “E” word. I take after my mom in this area: I’ve never been an athlete, I pretended I was sick for most high school P.E. classes, and I’m extraordinarily uncoordinated. I hate group classes and I loathe tight name-brand exercise gear. Gyms scare the shit out of me and I have no idea what I’m doing.

    But two years after my break up, I was still considerably underweight and what little muscle I’d had was long gone. I could pass in clothes as modelesque but naked I could have been a dummy for an osteology class. (“And here, students, you can see the sternum and entire rib cage….”) I was eating, but stress (about work, life, my mom) kept me from putting on any real weight.

    And then boom. Out of the blue, I’m contacted by Doug Bopst to ask if I’d like to be interviewed for his new book, The Heart of Recovery, coming out March 12th. Sure, I lied. What does Doug happen to do? He’s a fucking trainer! Doug kicked opioids and lost 50 pounds in jail through—you know it—exercise.

    “When we stop using drugs, we have to replace them with healthy coping mechanisms,” Doug says. “Fitness is a great tool and should be a staple in everyone’s recovery.”

    He took pity on me and started training me via Skype (he’s in Maryland and I’m in LA). He also sent me a list of foods I should eat. Sometimes deliveries randomly showed up at my door. Over the next year my living room became littered with resistance bands, a stability ball, dumbbells, a yoga mat. I was living in a mini 24-Hour Fitness but with a cat.

    At the beginning, I complained. A lot. He ignored me. I constantly wanted to skip days (and we were only training three times a week) because I was “tired” or “depressed.” 

    “I train machines, not wussies,” he’d say, knowing it would motivate me.

    “Fuck you!” I’d text back. “See you at 5!”

    A Stronger Body…and Mind

    It’s almost a year later and now I insist we train everyday. There are exercises I could barely do that I bust out so easily now I have to check that I’m doing them right. I can carry a 24-pack of water, a 12-pack of yerba mate and two bags of groceries by myself in one trip from the car. It feels good to be stronger. And yes, I’ve gained some weight. In a world where nothing is in my control and living with a head that constantly tells me I’m not doing enough, working out every day makes me feel like I’ve checked a box. I’m making progress, I’ve done something.

    Addicted to drugs for 20 years, my body was a vessel to get high and something I abused. Nothing more than that. Sure, vanity (and uppers) kept me slim but I could give a shit about health. Now at 49 years old with six years clean, gravity is taking its toll, and friends and family are falling ill. Staying healthy and mobile has, for the first time, become a real priority.

    I wanted to know what my buddy, best-selling Kindle Singles author and long-distance runner Mishka Shubaly, had to say about exercise. Like Doug, Mishka credits exercise as his main tool in getting sober.

    “The mental benefits of exercise are scientifically proven and well-documented… and I’ll leave it to a medical doctor or scientist to quote statistics,” he said. “What I appreciate about exercise is this: exercise is hard. When you exercise, you get the persistent feeling that you are fighting back—fighting back against your alcoholism, your addiction, your depression, your anxiety, your obesity, your anorexia, your sloth, your abuser(s), your poverty, your unemployment, your shithead boss, your shadow self, everything and anything that you feel is holding you back, holding you down. That shift in perspective—from fleeing to fighting back—man, that is incredibly powerful, that turns your entire world around.” 

    Couldn’t agree more. You want me to pump out 10 more diamond push-ups? Just mention my ex and I tap into a whole new level of strength and power.

    And Doug and I have fun. We laugh as I lose my balance and literally fall off screen. He has to mute me if he’s in public during our training sessions since I swear so much. (Hey it hurts!!)

    Also, I needed to be accountable to somebody. I needed somebody to hold my hand and help me get well and fit. And as an addict/alcoholic, self-discipline is not my forte. Now the results motivate me. I can see the physical changes: a rounder booty, some definition in my arms. And of course, I get a brief reprieve from my frequent unwanted visitor, depression. 

    Mood Follows Action

    Don’t get me wrong, I have no plans to do an Ironman triathlon. But as a sedentary writer, moving every day feels like a necessary part of my recovery.

    “One of the first things my first sponsor told me was ‘mood follows action.’ This quote has been a game changer for me, applicable not just in sobriety, but in life,“ ultra-endurance athlete, best-selling author and podcast host Rich Roll told me. “I use it daily with respect to fitness, which has transformed my life wholesale. When we come into the rooms we are broken. Our self-esteem is shattered, our sense of what is possible decimated. Much like the steps, with fitness you see results when you put in the work.”

    “But the trick for me — an alcoholic through and through — is to remember that it isn’t a replacement for the steps,” Roll adds. “Fitness isn’t my higher power. But it is an incredibly powerful and essential ingredient in my sober equation.”

    If you’re still not convinced that exercise is for you, here’s some science to back it up and push you to dust off those running shoes.

    Post-doctoral Fellow at the Center for Neural Science at NYU and neuroscientist, dancer, and science writer Julia Basso reports in a research paper that “We show that the three most consistent cognitive/behavioral effects of a single bout of exercise in humans are improved executive functions, enhanced mood states, and decreased stress levels.”

    Cool. So we all know that exercise can de-stress you and get all those endorphins going but which cognitive functions are we talking about? Well, according to Basso, “….Executive functions including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control receive the most benefit from acute exercise.” 

    In closing, I’ll leave you with words from my two masters. Doug says, “If Amy Dresner can get into a workout regime, anyone can. Her transformation this last year has been life-changing, not only for her, but for me, too. Watching people in recovery see the power of fitness is something I live for.”

    And Rich says, “If it was up to me, I’d add daily physical movement as the 13th step.”


    Has exercise played a role in your recovery? Share your story in the comments.

    View the original article at thefix.com

  • 12-Step vs SMART Recovery: Are You Powerless or Making a Choice?

    12-Step vs SMART Recovery: Are You Powerless or Making a Choice?

    The problem with powerlessness is that it becomes all-encompassing and paralyzing. But the idea that addiction is a choice fails to consider many people’s experiences. Maybe there’s a middle ground.

    As someone who attends (and serves/facilitates) both 12-step and SMART meetings, I am struck by how often they are seen as presenting two very different belief systems about addiction. Although I know many recovering people who attend both, or have swapped one for the other, it is generally decreed that they hold completely opposing views. Though both are mutual aid groups based on the premise that connection with others in recovery can strengthen one’s own recovery, 12-step fellowships are based on a program of spiritual principles, while SMART recovery uses an evidence-based, cognitive-behavioral approach.

    Similarities and Differences

    While there is some overlap in the programs themselves — mindfulness in SMART correlates with the 11th step, and SMART’s thought-challenging worksheets are like 10th step inventories — their starting points could not be more different. Step One states that we are “powerless” over our addiction which is often explained by the disease model, even though this was never the original intention of the founders of AA, the pioneering 12-step fellowship. When we are in active addiction, we have lost the power of choice and cannot overcome our addiction alone. SMART takes a different view. Focusing on empowerment rather than powerlessness, we are encouraged to take ownership of our choices and behaviors. Without shaming anyone for their irrational choices, addiction is still ultimately a choice, not a disease.

    The debate between these two approaches has raged for decades, with most people coming down on one side or the other. My intention here is not to rehash these arguments but rather propose that instead of an either/or dualism, concepts of powerlessness versus choice are instead opposite ends of the same spectrum. For many, the truth of their lived experience may be somewhere in the middle, and polarizing views can lead to many people — certainly myself included — feeling that neither viewpoint really “fits.” This is important, because this ongoing debate influences how we treat, perceive, and support those recovering from addiction.

    The Problem with Powerlessness

    The problem with the concept of “powerlessness,” as understood in the context of the 12-step program, is that it becomes all-encompassing. Not only are we said to be in a state of powerlessness when we are in the throes of active addiction and finding it seemingly impossible to stop – an experience many former addicts will recognize all too well — but the dogma that has grown up around the concept over the years tells us this is a permanent state. We will always, even after years of sobriety, be powerless over our addiction, the threat of relapse forever hanging over us and ready to descend the moment we stop attending meetings, working the program, or listening to our sponsor. Neither is our addiction the only thing we are powerless over — we also have no power over “people, places and things.” While this can be a useful maxim in terms of reminding us that we cannot control other people or outcomes, it can also become stultifying, leading to apathy and a sense of complete dependency upon the program. In this view, the second line of the oft-quoted Serenity Prayer — the courage to change the things we can — is all too easily forgotten. 

    Small wonder then that for many, SMART burst onto the scene like a breath of fresh air, telling us that we do have a choice, that we can take ownership of our actions, and that a rational rather than spiritual (assuming that the two are mutually exclusive, an attitude with which I disagree) approach is the best way to recover. SMART claims to have an evidence base, and indeed it does — yet in recent studies it has not been shown to be significantly more or less effective than the 12-step approach. Nevertheless, SMART offers an alternative for those who take issue with being told they will always be powerless. Social justice researchers have pointed out that telling people in minority communities in particular that they have no power and must be dependent on a program forever only increases their sense and experience of oppression.

    Addiction as a Choice Is Equally Problematic

    Yet the idea of addiction as a choice is, I believe, equally problematic. Firstly, no matter how much researchers and SMART advocates stress that a choice model is empowering and should not contribute to stigma, there is no doubt that in terms of the wider society, labeling addiction a choice can all too easily contribute to the criminalizing of those suffering with addiction and substance misuse, not to mention making it easier for insurance or health care providers to refuse to cover the cost of addiction treatment. Also, and this seems to have been somewhat overlooked, blanket statements that addiction is a choice fail to consider the experiences of some significant populations, such as people who are using drugs to self-medicate undiagnosed mental health conditions or to deal with debilitating after-effects of trauma. Simply stating addiction is a choice which they can rationally think their way out of is of little use in such situations and may have the opposite effect, pushing people further into self-destructive cycles. Of course, the 12-step program may also have little to offer in these scenarios.

    If addiction is a choice, it is usually a severely impaired one. Addiction researcher Maia Szalavitz argues in Unbroken Brain that rather than seeing addiction as a chronic disease or a set of bad choices, we recognize the parallels with developmental learning disorders. Like a child with ADHD behaviors, or a teenager caught in a maelstrom of emotional dysregulation, those suffering with addiction (and possibly co-occurring trauma, mental health disorders, or external oppression) find their ability to make rational choices increasingly impaired, until “using” becomes a survival instinct. At this point we may indeed feel utterly powerless. However, we can learn over time to take control back and make better choices.

    Both approaches have something to offer people in recovery — but only if we start recognizing the middle ground and gray areas between the two. It’s time to start tailoring addiction treatment to fit the individual, rather than trying to tailor the individual to fit the treatment.

    View the original article at thefix.com

  • For My Mother, Putting Down the Alcohol Wasn't Enough

    For My Mother, Putting Down the Alcohol Wasn't Enough

    As an adult, I struggled to reconcile how my mother could be bone sober but still function like the manipulative, bewildering, and self-absorbed alcoholic I sat next to in all those corner bars as a kid.

    A fruit fly was floating in a glob of liquor stuck to the bar. Next to it was a plastic, black ashtray holding a mound of white ash and lipstick-ringed cigarette butts. The butts belonged to my mother, who I was sitting next to and whose free hand was wrapped around a bottle of Budweiser. The bartender, a pasty man with a few thin strands of black hair matted to his head, slammed a Shirley Temple down in front of me. The base of the glass landed in the puddle of liquor smashing the already dead fly.

    My mother didn’t notice my barstool nearly tipping over as I swung my legs forward and back to inch my seat closer to the bar. If she were paying attention, she would’ve noticed my arms weren’t long enough to reach my Shirley Temple. Instead, she was focused on a random guy at the opposite end of the bar. They were yelling over each other, which made it impossible to understand their argument. Their words clashed in midair and became one tangled cluster of sound. But by the tense curl of my mother’s upper lip, and from the way she wildly poked and whipped her lit cigarette in the air, I knew she was miles from sober.

    For me, at six years old, this was how I understood my mother. I didn’t know who she was or how her mind worked without alcohol. But I believed if she put the bottle down, she would become the stable and sane woman I wanted her to be.

    Unfortunately, it took my mother roughly 30 years to become sober. And during that time, we were estranged. Over those decades, with little to no contact, I had no idea how paralyzing my mother’s habit had become. I didn’t know she’d swapped out beer for hard liquor and was downing a bottle or two a day. I didn’t realize she’d reached a point in her addiction where she was so consistently drunk, she had to crap in an adult diaper. Her live-in artist boyfriend kept her shelves stocked with liquor and changed her as needed.

    At some point in her early 50s, my mother walked into her first AA meeting. In those rooms, she discovered sobriety. Eventually, she found a sponsor, broke up with her caretaker boyfriend and replaced her stockpile of booze with tins of Maxwell House coffee. My mother went on disability, found a primary doctor, and saved money to fix up her home.

    On the outside, she appeared to have reached sobriety nirvana. And when, in my early 30s, I was told by a relative that my mother, then in her 60s, had been clean for a decade, I couldn’t fathom it. My mind couldn’t hold an image of her without a mouthful of beer and a cigarette twisted between her fingers. I struggled to believe it: if she was certifiably sober I needed to experience it for myself. It took me a few days, but after some digging I found her phone number and called.

    “Hi Mom, it’s me… Dawn,” I told her.

    “What? My daughter?” she said. “You can’t be. My daughter’s dead.”

    “No… Mom. What?” I didn’t know whether to laugh or hang up. “I swear it’s me,” I repeated. “I’m not dead.”

    “No, no, no,” she said. “My daughter’s dead. You stole her identity.”

    Given how bizarre our exchange was, perhaps I should’ve proceeded with more caution, but when I discovered the rumors of her sobriety were true, I decided to reach out again. After all, if my six-year-old self was right, all my mother needed to do was put down the bottle.

    Over the next year, through measured contact, I discovered the holes in my mother’s recovery revealed an intricate system of emotional IEDs. Each one, when detonated, caused a familiar flinching in my gut and appeared to be constructed from the same materials she so deftly used when I was a kid. As an adult, I struggled to reconcile how my mother could be bone sober but still function like the manipulative, bewildering, and self-absorbed alcoholic I sat next to in all those shitty corner bars as a kid. Luckily, I had enough therapy to know I was under no obligation to fix my mother or to stay in contact with her.

    During our last phone call, I let my mother know I’d reached my limit with our relationship. And in response, at every point where there was the slightest pause in the conversation, she repeated, “I get it, I get it,” which pushed the exchange far beyond confusing. Days before, my mother had erupted when I missed her phone call, but when I told her I was walking away from whatever our relationship was, she appeared oddly understanding and supportive.

    Before we hung up, my mother said she loved me, that she was proud of the woman I’d become, and that she was sorry for being an alcoholic instead of the mother I needed her to be. Unlike in previous exchanges, there wasn’t a trace of sarcasm in her voice, which made me wonder if I’d misunderstood my mother’s behavior. Were my instincts leading me in the wrong direction? Was the guilt I felt actually punishment for potentially hurting my mother? Was I too defensive? At that time, no matter how hard I obsessed over the questions, I couldn’t lock down the answers.

    But eventually, my mother showed me everything I needed to know.

    Several years passed, and during that time my mother and I remained estranged. While I enjoyed the overall emotional freedom the distance created, I occasionally got snagged by lingering doubt and guilt. To cope, I began writing about my experience, and soon I landed a gig with a popular, national magazine. They commissioned me to write about estrangement and the challenges I faced growing up with an alcoholic mother. Not only was this my chance to validate my experience, but I also hoped the finished product would provide comfort to other women emotionally scarred by their mother’s addiction.

    For months I worked on the draft, and during that time I relived many of the disturbing events that destroyed my relationship with my mother: the nights my pajamas reeked of cigarette smoke from the bar, the incident when she flipped into a drunken rage and attempted to throw me out of a third-story window, and the times, when I was a kid, that she chased me around the house, swinging a serrated steak knife at my back, threatening to kill me.

    Days before the piece was set to go live, my editor informed me that for legal reasons the magazine needed to acquire my mother’s consent to publish. Given that I hadn’t spoken to her in years, I was torn over how to proceed. I didn’t want to hurt or shame my mother, but at the same time, I felt compelled to tell my story. Ultimately, I embraced the unknown and passed on her number. Nearly a week passed before I heard from my editor.

    “I spoke with your mom today, and the conversation was very positive,” my editor excitedly shared over the phone.

    “Are you serious?” I responded in disbelief.

    “She’s given her consent, admitted to being a long-time alcoholic, and she’s totally supportive of you telling your story,” she told me.

    “So… she didn’t give you a hard time or anything?”

    “No, not at all.”

    Although I had no idea what to expect from my mother, her positive reaction left me dizzy. And while I felt an unparalleled sense of accomplishment knowing my piece and my story would be floating, unencumbered, across the internet, my gut churned with guilt. Admittedly, my mother’s response would’ve been easier to process if she had reacted with the rage I expected her to. But because she gave her consent without a tinge of condemnation, I felt I betrayed her. I felt as if I hadn’t given her sobriety a chance. Perhaps I failed to give her the credit she deserved.

    Again I was obsessed with a nagging question I couldn’t answer: Was my mother finally the sane and sober woman I’d always wanted her to be? But then, a few days later, I received another call.

    “I’ve got bad news,” my editor told me. “Your mom called me today and has changed her mind, saying she disputes everything and denies ever being an alcoholic.”

    “You’ve got to be kidding me,” I sighed.

    “Your mom sounded completely different on the phone… aggressive and unhinged,” my editor explained. “I can’t be sure, but I think she may have been drinking.”

    With one phone call, not only was my piece killed, but I also realized that the confusion and doubt I wrestled with over the depth of my mother’s sobriety were instinctive warnings. On all accounts, my mother was sober: she hadn’t picked up a drink in 10 years. But she wasn’t in recovery. She hadn’t yet faced the issues that convinced her a life of perpetual hangovers and adult diapers was better than living with whatever reality had to offer. My mother no longer slurred her words, but she was as unstable and unreliable as ever.

    Today, I’m convinced my instincts instantly picked up on the disparity between my mother’s sobriety—or abstinence—and her lack of real recovery. Looking back, I realize there were numerous times that I was in contact with her as an adult when I felt like a confused six-year-old kid again, sitting next to her at some shitty corner bar, watching her get loaded. Thankfully, my confusion finally made sense.

    While I can’t speak for every person with alcoholism or addiction, and I prefer not to generalize when it comes to an individual’s sobriety, I know at least for my mother, putting down the bottle—as difficult as that may have been—was only the first step. And now it’s up to her to keep on walking.

    View the original article at thefix.com

  • 6 Things Everyone Should Know About Children in Families with Mental Illness

    6 Things Everyone Should Know About Children in Families with Mental Illness

    We don’t talk enough about the children who live with, and rely on, a family member with a mental illness. What sort of support do they need and how can we provide it?

    I grew up with a mentally ill father. More than once, I woke up on the “morning after” my father was institutionalized during a mental breakdown. My father would hallucinate that someone or something was out to get him: aliens, God, the FBI, his coworkers, famous people. It was usually the culmination of months of paranoia—a hard stop on reality during which my father would scream accusations at people in public, moan and sob at the top of his lungs, and act like a trapped animal trying to elude capture if someone came near him.

    My mother always found a way to trick my dad into checking into a hospital for treatment. Waking up midweek at either of my grandparents’ houses was a sure sign that something had gone wrong with my dad.

    My father’s illness progressed gradually over time. He was briefly institutionalized when I was five, again when I was six, and then, lastly, when I was 12. All three times, my family welcomed back a functional, but not healed, father. Although doctors deemed him treated and sent him home, his behaviors remained bizarre and upsetting to me.

    When I was younger, my father was distant, yet never disturbing. We did some of the typical father-son activities: went to football and basketball games at the local university, talked about sports, and visited his parents to have snacks and throw darts with my grandfather. But then, when I was 12, he publicly accused my family of being aliens sent to harvest his testicles.

    After that, he changed forever: talking to himself in public, watching Catholic mass on TV three times daily, and amassing a basement full of unopened books, records, CDs, and videos. My father’s illness had a huge impact on who I was and how I developed as a teenager, and also on how I’ve developed as an adult.

    We frequently turn our attention to mental illness in the aftermath of horrific acts. We wonder what makes people do crazy things, and how we can we prevent these tragedies. Politicians debate the issue, yet we see little movement towards a resolution. Our community members ask why there isn’t more support for identifying and treating mental health problems. Children in families with mental illness ask this same question every day.

    But we don’t talk enough about the children who live with, and rely on, a family member with a mental illness. What sort of support do they need and how can we provide it?

    Here are six things I think everyone should know about children in families where one or more members have a mental health condition.

    1) They need to know that their loved one is not “nuts,” “crazy,” and “psycho.”

    I hated having a crazy family. I knew it was bad and I knew it made me a bad person, without even thinking about it. The media handed me much of the stigma I attached to mental illness. I saw reports on the news of a “psycho” killer on the loose. The TV roared with recorded laugh tracks when someone did something “nuts” and acted like a “loony”—words that sound silly unless you internalize them because they reflect someone responsible for your creation.

    The media portrays crazy as synonymous with criminal, violent, and murderous.

    I remember lying in bed the night before my father was due to come home from the hospital. I vowed to keep an eye on him. I knew he would come home and want to kill his family. The TV told me this is what crazy people do. I’d protect my mother and sister, damn it. Instead, he moped around acting confused, talking to himself, and spending all his money on useless records, CDs, and videos that sat piled and unopened in the basement. My father ignored me completely. He managed to hold down his job, but his family fell apart around him.

    I turned into the one who wanted to become violent. Watching my functional yet useless-to-me-as-a-parent father enraged and embarrassed me. The homeless men on the streets of D.C. were the only other people I saw talking to themselves in public as adamantly as my father talked to himself in public and at home. I walked the halls of my school fearing I had “Son of a crazy man” written on my chest. I stood as far from my father as possible when we were in public. He didn’t seem to notice. He was busy crossing himself and muttering in a half-shout about God and the devil.

    The media freely hands out stigmas, particularly for mental illness. This is unacceptable. Many successful people are managing mental illness, and most never harm a soul. Numerous friends and family members are better people because they know and love someone who has a mental health diagnosis. We should discuss mental illness as a serious topic, worthy of respect to both the people with the mental health condition and their families.

    2) They feel they are alone.

    Growing up, I usually felt alone. I was the only person I knew with a family like mine, except for my younger sister. I looked at my friends’ families and they seemed normal.

    My father hallucinating Martians with a mission to harvest his testicles had replaced his family. He talked to himself and gestured wildly in public. I didn’t see any of my friends’ parents doing that.

    My father’s life, a non-stop cycle of work, watching mass on TV, and then shopping for media, seemed different and bad compared to the lives I thought everyone else was living. I didn’t want people to know this about me.

    I felt disconnected and unable to communicate with friends. I was afraid of discussing my home life, particularly my father. I always preferred to play or stay at a friend’s house. I lived in fear of being exposed as the child with a crazy father. I never brought my father up in conversation. If any of my friends ever met him, I told them my mother was planning to divorce him—something I prayed for daily. I knew it would never happen. She told me she was sticking to her wedding vows. She firmly believed we were better off as a whole family than as a single mom raising two kids on her income alone.

    I didn’t realize at the time how prevalent mental illness is. Many of my friends likely had parents with mental illness, parents with addictions, or abusive parents. If I had realized anyone had a family life like mine, I would have reached out to try to connect with someone else my age. I was alone and aloof in the solitude I created. In a high school with over a thousand students, I did my best to go unnoticed. I refused to bare my soul, express my emotions, or have anything related to a deep conversation with friends. I knew if I spoke up I might reveal my embarrassing secret—a mentally ill father. All I had to do to feel my stomach squeeze with anxiety was to imagine my peers knowing about my family. I carried the stigma of mental illness internally. No one else had to tell me I was inferior.

    Keep this in mind if you know a child with a family member with a mental health problem. These children need to know their situation isn’t unique; many others have experienced mental illness or live with someone who has. They know they’ve been dealt an unfair hand. You can’t change that, but you can provide comfort and understanding. My mother used to say that my sister and I were dealing with something that wasn’t fair for kids. That was true. I felt like she understood me when she made statements like that. Empathy goes a long way for helping children in families with mental illness.

    3) They need free access to behavioral health services.

    I saw a counselor for a number of years. My mother demanded I attend the meetings at first. As an adult, I am appreciative that she did. I know it cost money she didn’t have. At the time, I was angry and confused at everything. It wasn’t until afterward that I realized the value in seeing the counselor. He was truly my only outlet for emotions. We teach children to go to their parents or a teacher if something is bothering them. If you are in a family with mental illness, you learn to keep your thoughts to yourself. You don’t want to risk having your feelings invalidated by a maniacal laugh or an accusation that you are an alien.

    In middle school, I called a helpline. The guy answering the call thought I was a liar when I described my father’s actions. He told me nothing I said made sense. I hung up feeling empty, because if the person staffing a helpline couldn’t acknowledge my situation, it proved my family life was shameful and wrong.

    As an adult, I found out these helplines are often staffed by volunteers, most likely taking social work courses in college. Helpline volunteers need training to handle calls from children such as myself. Never tell a child from a family with mental health problems that what they have seen or heard doesn’t make sense. Of course it doesn’t. We must help children deal with how to process the odd acts and the pain their family situation causes. Validating their situation is the first step toward accomplishing this.

    Children witnessing mental illness up close and personal do not feel like they can share their life with others. Often things aren’t all right, but you won’t find out just by asking. Mental health care services by trained professionals should be the norm for children with mental illness in the family, ideally free of charge. Without mental health interventions, we increase the likelihood that the children will struggle with a mental health challenge themselves. Heredity already increases this risk. Social and economic costs increase exponentially when we fail to treat an illness at the onset—mental healthcare for a child should be proactive, and can be preventative.

    4) Simple things mean the world to them.

    Children with a family member who has a mood disorder or other mental health condition fantasize about being “normal.” For me, this meant having a dad who came home and threw a baseball with me. Or better yet, a dad who took me to baseball games, called me “slugger,” and told me how proud he was of me, but didn’t cross himself and utter to God while we sat in the bleachers. I was fully invested in the most prominent cliché about American fatherhood, and I certainly wasn’t seeing examples of my father portrayed in cartoons or sitcoms.

    Families with mentally ill members need a sense of normalcy. Community support systems need to include an understanding of the trauma these children are going through. Our focus should shift from what we consider normal to how a family with mental illness might define normal. Children going home to unstable or destructive parents need outside support so they can focus their energy on constructive tasks and find their talents. They want understanding and love.

    5) They don’t trust stability—they crave the excitement of drama.

    You quickly get used to a series of peaks and valleys when you live with mentally ill family members: the adrenaline rush of watching your father screaming that the FBI is after him as he refuses to come inside the house; the thrill of a car ride when your father tells you he might get reassigned to an office in outer space, as he swerves through rush hour traffic; waking up every day unsure what to expect. These adrenaline rushes become addictive.

    I realized in my mid-30s that I was living a cycle of adrenaline-fueled drama. I could never sit still and accept the current situation. If things were okay, I’d have to get drunk and destroy something. I’m less than two years out of an abusive relationship with alcohol—one that stunted my professional and personal growth almost as much as growing up with a father with mental illness. I pressed the reset button on progress every time I chose to get drunk. I found comfort in the whirlwind of negative activity that followed a binge drinking session that might end with me sleeping in the backseat of my car.

    If things were bad, I’d have to stay up all night worrying about what was next. My mind was stuck on finding the drama in every situation. I reflect on my childhood and I can see where this started: fretting over the next breakdown, experiencing the adrenaline rush of watching my father start speaking in tongues in the middle of the mall, and knowing that any calm moment was just the prelude to the next screaming match between my parents.

    Youth in these families develop a craving for drama. We don’t have the right to judge these children. We have the responsibility to understand that a child might continually act out in school, commit crimes to end up in juvenile detention, set fires, or create lists of people they would like to see harmed. These children spend a lot of time contemplating their fate. Will they suffer from the same illness as their parent? This question swirled in my head and rung in my ears as I grew up. I made a number of poor decisions with the mindset that insanity might be my destiny, so why worry about the future.

    6) They need exposure to adults who behave like adults.

    One of the most confusing things for me was leaving the family and not realizing what a responsible adult male is supposed to do. I graduated high school into a great abyss of confusion. My male role model taught me everything I didn’t want to be, but I had no clue how to go about finding what I wanted to be. Yes, I had years of counseling that was comforting during the time I was in it. But I did not have a roadmap or even a trail of breadcrumbs to follow a path to becoming a responsible adult. I had fear and uncertainty.

    Children without suitable adult role models at home need to see how adults take on their duties and responsibilities. We need to connect children, especially once they are teenagers, with role models through school and after-school programs. We should be proactive in offering our advice and experience to children in mentally ill families.

    We are all part of raising the future, whether our children are from families with mental illness or not. We need to have a generation that stops passing along the stigma of mental illness. We need to remove the belief that being mentally ill means you aren’t a part of the “normal” piece of society. We can do this by publicly saying that someone can successfully manage mental illness and have a great life, and by not blaming what goes wrong on “crazy” people.

    View the original article at thefix.com

  • How to Get a Job If You Have a Felony Drug Charge on Your Record

    How to Get a Job If You Have a Felony Drug Charge on Your Record

    When someone in recovery from addiction has a felony conviction on their record, rejoining society as a normal functioning member can be daunting and far more difficult than anticipated.

    People in recovery from drug addiction who are trying to rebuild their lives with criminal records hanging over their heads now have more options than ever. For instance, they can find employment with one of the hundreds of felon-friendly companies nationwide, or take necessary steps toward getting their records expunged.

    If you are part of the ex-drug using community, you will have heard one or more of the following phrases, possibly many times:

    “I have a disease that has me breaking out in handcuffs.”

    “We’ll be signing court-cards after the meeting.”

    “What are you in for?” 
    “Felony possession of narcotics.”

    It’s no surprise when people suffering from various substance use disorders land in jail, and once you’re part of the criminal justice system, it’s difficult to ever truly be free of it. One of many unfortunate symptoms and side effects of addiction is incarceration, because although addiction is classified as a disease, the possession of narcotics is a punishable offense that often results in a misdemeanor or felony charge. Once someone is convicted of their first charge and entered into the system, a cycle is initiated. After the person is released from jail or court-mandated treatment, they are often placed on probation, which means they will either be subject to check-ins and drug tests or can be searched when pulled over or stopped. If a police officer driving behind you runs your plates and your name comes up with probation or past convictions, you are far more likely to be pulled over. Because you are now more visible and increasingly vulnerable to searches and random drug tests, it is easier to get yet another drug charge. This can go on and on until someone becomes clean, or changes their identity (just kidding, don’t do that).

    When someone in recovery from substance use disorder has a criminal record, trying to rejoin society as a normal functioning member can be daunting and far more difficult than anticipated. In addition to working on your recovery and learning to live your life in an entirely new way, you also have to worry about the wreckage of your past, including your rap sheet. Your résumé may have some random “holes” in it, which could raise questions with potential employers. And of course there are the background checks: If 30 people apply for the same job, and 29 of them don’t have heroin possession or paraphernalia charges, the employer is likely to go for one of the 29 without the rap sheet. Recovering addicts aren’t starting over with a clean slate; they have a tarnished slate and have to work that much harder and fill out that many more applications to try to catch a break. Because of this struggle, the vicious cycle of relapse, crime, and convictions is perpetuated and thus harder to break.

    Although struggling people in recovery may feel like they’re lugging around heavy baggage and a bad reputation that can be discovered in just a few minutes via Google—there is hope! There are companies that hire people with felony convictions and an abundance of resources out there to help connect job seekers with their felon-friendly potential employers. In 2016, President Obama launched a call-to-action for companies to eliminate barriers for convicts trying to rebuild their lives and gain legitimate employment. The Fair Chance Business Pledge has been signed by over 300 companies, including Google, Facebook, Uber, Starbucks, American Airlines, and The Coca-Cola Company. Several websites are designed specifically to help felons find employment, such as professional and personal development specialist Eric Mayo’s site jailtojob.com. It features links to companies that hire felons; information about his book which is designed to help convicts rejoin the workforce; and his blog and email, where he answers specific questions from people struggling with criminal pasts. Second Chance Jobs For Felons is another site designed for this purpose, and it links to hundreds of companies’ information, stats, ratings, and job openings.

    In addition to the Fair Chance Business Pledge, an initiative known as “ban the box” has been adopted by 33 states nationwide, with over 150 cities and counties. Ban the box encourages companies to ditch the check box asking applicants if they have a criminal history on their hiring applications. The goal is for ex-offenders to have an equal chance at making an impression and nailing an interview. Companies are still free to perform background checks, but it occurs later in the hiring process rather than before a candidate is fairly considered.

    Recovering addicts with criminal histories might find it frustrating to be restricted to a fraction of companies, having to track down employers that are felon friendly and then plead their case. Not all felons have to stay felons—in many states, drug-related convictions can be cleared with time and by showing a judge you’ve worked toward a better life. Ex-offenders can also take steps to have felonies expunged from their records completely.

    However difficult rebuilding a life may feel now, it doesn’t always have to feel this way. Recovering addicts with criminal records have more options than ever, including landing good jobs, getting their records expunged, and taking the necessary steps toward a brighter future. If you take these steps today, maybe you’ll be the one doing the hiring tomorrow.

    View the original article at thefix.com

  • Why You Should Embrace AA Groupthink and Shed Your Terminal Uniqueness

    Why You Should Embrace AA Groupthink and Shed Your Terminal Uniqueness

    AA encouraged me, a sauced snowflake loaded on liquor and individualistic narcissism, to put aside enough of myself to embrace two traits required to curb my alcoholism: discipline and structure.

    Addiction has a grand irony: For a disease whose treatment thrives on identification with fellow sufferers, its symptoms are extraordinarily individual. Precisely how addiction manifests in each of us — drug of choice, length of active substance abuse, depth of debauchery — varies more widely than nearly any major affliction.

    This is because addiction, like no other ailment, turns us insane and then turns us loose on the world. Ours is not a disease subject to controlled clinical settings; we find ourselves in circumstances that, though certainly following a pattern, have variables as unique as life is complicated. I have a recovering friend who, unlike me, has never sideswiped a taxi in the Holland Tunnel, blind drunk, and kept going. But alas, I’ve never been so creative as to hide vodka in a vase, as he has (#HappyHourFlowers).

    As an alcoholic, then, my addiction-fueled adventures differ from the experiences of other problem drinkers. These exploits also are so abnormal in terms of their setting — namely, civilized society — that they feed another peculiarity of addiction: the “terminally unique” mindset that I am, somehow, alone in my inability to stop drinking at any cost.

    For me, the result was a hopeless alienation that, in turn, only further fed my alcoholism. Afraid and isolated, I gave up trying to give up.

    Amid this lonesome landscape lies the tailored times in which we live. A solid case can be made that we are in the single most individualistic era in human history.

    Take me, for example. Like most people Gen X or younger, from early childhood I’ve been called unique, singular, special. I’ve been told I can do anything, be anyone, and was perfect exactly as I was. I am, it appears, a gentle snowflake.

    Fast forward to today’s iWorld. We have made-to-order music playlists, binge TV watchlists, e-newsletter subscriptions. Our Facebook and Twitter feeds serve up personally-algorithmed news items between posts from our personally-constructed list of cyber-friends. From our social media silos, we see, hear, and click on hyper-customized content — our own little gated communities in the World Wide Web. For God’s sake, even our sleep is customized.

    We do exactly what we want, when we want, how we want. We ultra-individualize, then wonder why modern society is so uber-fractured.

    And then, those of us with addiction get too high or too drunk for too long, and need help. Suddenly, we uber-individuals need help from… well… ourselves.

    And when we walk into the rooms of Alcoholics Anonymous, that’s exactly what we get.

    AA Pluribus Unum

    Despite its imperfections — including those noted by yours truly — nothing has ever made me feel so simultaneously special and ordinary as my early experiences in Alcoholics Anonymous. As a newcomer, I was told I was the most important person in the room; but as a person in the room I was told that, though our experiences may be vastly dissimilar, we were all here for the same reprieve to the same disease.

    First and foremost — before I ever considered that I may have found a solution to my compulsive, destructive drinking — AA provided a cure for my self-diagnosed tragic uniqueness. I wasn’t sure I could quit drinking but, after just a few meetings of identifying with the similar compulsions of fellow alcoholics, I was damn sure that I wasn’t the only one who had this affliction. A lot of acronyms get thrown around in AA; perhaps one should be Alienation Antidote.

    For me, this prerequisite to recovery — this normalization of my abnormality — was an immediate and amazing upside to AA, one that fortunately superseded or masked some of my preconceived concerns.

    Like most people, I skidded along the bottom before finding recovery. Months before my eventual sobriety date, I’d been warned by peers during an unsuccessful rehab stint that AA was a cult or, at least, cultish in its groupthink. I was told that there would be a lot of people spouting a lot of nonsense and, worse, telling me what to believe while they did it.

    And you know what? They were partially right. AA did indeed ask me to set aside some of my individualism — my preconceived notions, my longstanding perceptions, the personal penchants that made me me — in favor of a program that, I was told, had a well-established track record of helping alcoholics achieve sobriety.

    AA encouraged me, a sauced snowflake loaded on liquor and individualistic narcissism, to put aside enough of myself to embrace two traits required to curb my alcoholism: discipline and structure.

    Structured Settlement

    I came into AA a stone-cold atheist and remain a skeptical agnostic, and for a long time I thought AA’s first requirement for newcomers was that they develop faith in a higher power.

    I now realize that this isn’t true. Before AA asks for anything enshrined in the 12 steps (the higher power concept is introduced in Step 2), AA asks us to stop having complete faith in ourselves — or, at least, the drunk and desperate versions of ourselves that, alone, simply cannot stop drinking.

    The salve for this outsized self-reliance comprises some of the very same group-centric activities many AA-haters find cultish: chants like the Serenity Prayer offering a simplified perspective; readings like “How It Works” providing experience-driven direction; ubiquitous signage with familiar phrases and, of course, the ever-present Twelve Steps.

    As someone who entered AA as the Smartest Person on Earth (an unofficial title, it turned out), I fully understand how threatening this can seem. Even as a scared newcomer in desperate search of a solution, I didn’t want to trade my hellish life for a post-apocalyptic Zombieland. Despite the attraction of folks who’d clearly found a way to stay sober, I’ll admit to checking the coffee machine for Kool-Aid during my first few meetings. 

    But what I soon realized was that there was a simplistic beauty to AA’s anti-individualism that, for me, was extraordinarily effective in early recovery. My rehab roomies, I found, were just so full of themselves that, when confronted with a different approach, they reflexively labeled it full of shit.

    Are there cultish aspects to AA? Absolutely. Even Catholic masses don’t end with everyone standing in a circle holding hands. Anyone wondering why some people duck out of meetings five minutes early should re-examine that ritual.

    But by and large, AA’s so-called groupthink offers newcomers a keep-it-simple structure that — as fledgling sobriety becomes longstanding recovery — can be selectively shed. It asks spiritually disarmed newcomers to buy the whole standardized toolset… then allows us to return some piecemeal as we acquire new, more customized tools.

    I for one needed some discipline to replace the chaos my life had become. I also needed certain concepts — powerlessness over alcohol, the hurt I was causing others, the incredibly alien concept that there was, in fact, hope — beaten into my brain. In hindsight, I realize AA is repetitive for a reason.

    I see a lot of newcomers enter the rooms as customized as they are clueless. For them as for myself, rigidity en route to freedom is an entirely worthwhile tradeoff. There is value in a traditions-based organization with agreed upon rules that, when adhered to successfully, work well for many people.

    How has AA’s emphasis on the group helped you? Let us know in the comments.

    View the original article at thefix.com

  • 3 Things My Father Taught Me About Addiction

    3 Things My Father Taught Me About Addiction

    Reframing the addiction as a disease helped me understand that my father didn’t want to hurt himself or my family.

    Every time I talk to my dad about his experience with addiction, I come away with beautiful—although sometimes painful—new insights. Listening to him talk about his longtime struggle with opioid addiction has taught me not only about the complex and labyrinthine nature of addiction itself, but also about love and forgiveness.

    The most important thing I’ve learned is that no matter the struggle, there is a person who deserves real compassion—before (or under) the addiction, before (or under) the trauma that may have caused them to use drugs, before (or under) the pain and suffering.

    I’ve seen prison time, loss of custody, and disease take hold as a result of addiction, and yet I can see the other side as well. While everyone’s experiences are different, here’s what I’ve learned from my father and his experience:

    1. People with addictions don’t want to be addicted

    Within the dark void of addiction—and its loneliness, shame, powerlessness, and disaster—it can be hard to really see the person who is suffering. This is true both from the outside and if it’s yourself you’re looking to find. It’s also hard to accept that someone isn’t making an active choice to suffer (and cause suffering around them). They may have made a choice to pick up a drug, but addiction is an actual disease, and its grip is real.

    According to the National Institute on Drug Abuse, “Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to.”

    Reframing the addiction as a disease helped me understand that my father didn’t want to hurt himself or my family. And in talking frankly with him today, it’s very clear that he knew he was suffering, but he simply couldn’t figure out the steps to get out of it. It took so much loss before he got himself into recovery, and that’s something I stay compassionate about. I think this empathy can go a long way in both understanding your family’s narrative and forging a path toward potential forgiveness (and maybe even advocacy for others).

    1. Addiction doesn’t magically disappear

    On a trip to see my dad recently, I was taken aback when he said, “I still get cravings.” Although I know—I mean, rationally—that just because someone is in recovery doesn’t mean they won’t feel temptation or relapse, it’s harder to hear it from your parents. It’s scary, yes, but it’s also just sad. On my end, I wanted to say, “But you’re okay, right?!”

    I held my tongue. Instead of seeking comfort from him in his truth and struggle, I decided to simply listen—as an adult, as a human. As a child of two people who have struggled with addiction, I have learned to see my parents as humans, and part of that is constantly reminding myself to actively choose to listen and find compassion in their story. It’s not always easy—and some will argue that this isn’t fair to the child—but it’s what has worked for me.

    I asked my dad, “So when do these cravings happen? Is it often?” And I simply listened to what he had to say. I learned about the mechanics of his addiction, how he manages it, and what he feels in those moments.

    That illumination has given me insight and compassion, and even though it’s hard, I wouldn’t trade it for anything. It’s enabled me to treat others as human beings and advocate when and how I can. It also helps me to see my dad fairly.

    1. Hardship often creates beauty and wisdom

    Although there’s no way this can be true for everyone, and although it’s almost a cliché, sometimes our suffering can yield something beautiful—even when it’s not our intention.

    Sitting in my dad’s house, I watched him pull out notebook after notebook filled with song lyrics and poetry. Most of these poems were about his addiction, and the sadness, loneliness, pain, and self-questioning it caused. Some of the poems were about finding a divine source, or fighting past the pain. Some weren’t so positive. Reading his words surprised me. I’ve been an active poet for years, and yet I had no idea how prolific a writer my dad is, and how he uses writing to cope with trauma as well.

    Reading his words connected me to him, but it did more than that: It proved that even in our darkest moments, humanity has an uncanny ability to try to cipher that pain into something bigger than ourselves. This is not just a mythology we tell ourselves, though. It’s real: Just look at the many writers, for example, who lived with addiction throughout their lives.

    I am grateful to see the so-called silver lining in these insights, but it only underscores the real tragedy of addiction: that far more people with substance use disorders are misunderstood and underrepresented, and that their stories, when told, are told poorly and without nuance. There is grief and hope in addiction. There is recovery and there is relapse, and there is everything in between.

    There is access to care for some and a desperate lack of access to care for others. There are abstinence-touting programs and there are clean needle centers. Addiction is a huge issue, with no one story or approach or outcome that represents everyone’s perspective. But as someone watching from the outside, as a family member, it’s my goal to listen, be compassionate, and share what I’ve learned in a way that makes space for some good.

    View the original article at thefix.com

  • There's Nothing Wrong With You If AA Doesn’t Work

    There's Nothing Wrong With You If AA Doesn’t Work

    It isn’t that you’re incapable of being honest with yourself, or that you’re not working a “program” well enough. You are not too broken, or too far gone.

    I spoke to a friend, Damien, last week. He was devastated at losing someone close to him to alcohol use disorder. What is particularly harrowing about this person’s passing is that it might have been prevented. Damien’s friend was repeatedly pushed toward Alcoholics Anonymous (AA), even though it clearly wasn’t the right fit for him. Just like many others, instead of being supported by peers and professionals and given alternative options, this friend was left feeling that the problem was him.

    “It’s really frustrating to see friends die because the default treatment option doesn’t work for them,” Damien says. “We are losing far too many people with substance use disorder who find 12-step incompatible with their life experiences and belief systems.”

    He goes on to say, “It’s not because they aren’t willing. It’s not because they can’t ‘get it.’ It’s because, for many people, treating addiction requires more than hope, spirituality, and fellowship. And yet, the only option most are presented with is founded on those three pillars. If the recommended treatment for bacterial infections had the same success rate as the 12 steps, then antibiotics would not be our go-to treatment plan for staph infections.”

    My overarching message is: There is nothing wrong with you if AA doesn’t work. It isn’t that you’re incapable of being honest with yourself, or that you’re not working a “program” well enough. You are not too broken, or too far gone. You simply haven’t found the right pathway for you.

    These kinds of beliefs stem from the Big Book of Alcoholics Anonymous, which states: “Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.” [emphasis added]

    During my five years of attending countless AA and Narcotics Anonymous (NA) meetings, I have heard many members criticize those who come in and out of the rooms but return to using in between, categorizing them as unwilling, or incapable of being honest. “They just need to surrender to the program and work it like their life depends on it,” was the kind of statement I heard over and over again.

    I threw myself into the program because there were no other options for me in the northwest of England. I was so desperate to find something that would help me that I believed anything members said, even if there was no evidence to back it up. I did a fair amount of perpetuating these myths too. I was instructed to ignore my instincts and critical mind (because that was my “disease talking”), and do what I was told. Giving away my free will to a person in the sky or a church basement seemed weird, but I went with it for several years. After all, it had worked for many other members.

    With a period of sobriety under my belt, I couldn’t ignore my inner doubts any longer. They became louder. It was as though, even after years in recovery, I suddenly woke up. And I started to slowly unpack all the myths I’d been told.

    In particular, I tried to unpack “it works if you work it.” There is substantial evidence that shows there’s no one-size-fits-all method when it comes to recovery. If this program were suitable for everyone with substance use disorders, its success rate would be much higher. The fact is that success rates of 12-step programs vary wildly, from as low as 5 to 8 percent, with dropout rates from 69 to 86 percent, to as high as 42 percent after four years. I should point out that these dropout rates are a reflection of the attrition rates of addiction treatment generally. This underscores the point that the way we treat addiction isn’t appropriate for everyone and we need to get better at personalizing care based on individual circumstances.

    When I moved to the U.S., it was like my world opened up. I saw that despite what I’d been told in AA — that it was the only method for successful recovery — there was actually an open landscape of diverse recovery pathways.

    A leading study shows that tens of millions of Americans have successfully resolved an alcohol or drug problem through a variety of traditional and nontraditional methods. That means:

    • 9 percent recovered with “assisted pathway use” that consisted of mutual-aid groups (45.1 percent), treatment (27.6 percent), and emerging recovery support services (21.8 percent). 95.8 percent of those who used mutual-aid groups attended 12-step mutual aid meetings.
    • Just under half of those who did not report using an assisted pathway recovered without the use of formal treatment and recovery supports.

    I’m aware that an ideal model of treatment, individualized based on the person’s particular medical and psychological needs, is not always available to most people. Not all of us have the luxury of therapeutic treatment from a psychologist or psychiatrist. This is another reason mutual-aid groups are the most accessible form of recovery pathway — they’re free! We’re fortunate in the U.S. to have plenty of other support groups that are not all based on religion, and some have a solid evidence-based program. They include Refuge Recovery, LifeRing Secular Recovery, SMART Recovery, Moderation Management, Wellbriety — among many others listed here — and they have been shown to be equally as successful as 12-step groups.

    A study comparing 12-step groups to alternative mutual aid groups found that LifeRing, SMART, and Women for Sobriety were just as effective as 12-step groups. Study author Dr. Sarah Zemore and her team reported that “findings for high levels of participation, satisfaction, and cohesion among members of the mutual help alternatives suggest promise for these groups in addressing addiction problems.”

    Despite my reporting about AA’s success rate and some of the myths perpetuated by the fellowship, I’m not here to bash AA. I’m here to shine a light on the false statement that it is the only successful way. There are many others. For those AA does work for, I respect your path. We just need to have a clearer picture of what recovery looks like so when someone is suffering, instead of saying they are the problem, we can be better informed to direct them to what may be a more suitable pathway. After all, we all have the same goal: recovery.

    View the original article at thefix.com

  • Addiction as a Metaphor for the Climate Crisis: An Interview with Charles Eisenstein

    Addiction as a Metaphor for the Climate Crisis: An Interview with Charles Eisenstein

    The conventional response to climate change is like the conventional response to addiction: “Well, you’re just going to have to try harder to stop.” I understand climate change as a symptom of a much deeper malady that is inherent to civilization as we know it.

    In the fall of 2011, a small protest began in New York City that would later become known as the “Occupy Wall Street” movement; it later emerged in major cities around the world. Among the many leading voices to provide an analysis of the economic crisis that preceded the movement was author Charles Eisenstein.

    Eisenstein had been writing about a variety of crises afflicting postmodern society for years, but his views on the perils of capitalism and the growing ecological and climate issues resonated strongly with the people involved with the Occupy movement.

    Perhaps to humanize, or just to make sense of many of the complex, broad, and intertwining topics he writes about, Eisenstein relies heavily on the power of storytelling, and often uses analogies. One analogy he regularly comes back to is the phenomenology of addiction. Though he does not personally identify as having an addiction (at least in the conventional, pathologized sense), his writing indicates his deep understanding of the myriad ways that addiction may be the best metaphor we have for understanding some of society’s greatest ills.

    Eisenstein recently published his sixth book, Climate: A New Story, and agreed to an interview with The Fix:

    The Fix: Your writing has often relied on the phenomenology of addiction as a metaphor for the harms of capitalism, and now in Climate: A New Story you rely on the metaphor again to help explain the global climate crisis. Why do you often come back to the metaphor of addiction?

    Charles Eisenstein: In the popular media, we hear things like “our addiction to fossil fuels,” and it’s usually used in disparaging terms, which taps into the general prejudice people often use against addicts, too. But I like to take the metaphor seriously – if we are addicted to fossil fuels, what is the underlying need that drives the addiction that the fossil fuels aren’t actually meeting? Fossil fuel consumption, of course, is a symptom of the addiction to economic growth. Or the addiction to consumption; accumulating more and more stuff – bigger and bigger houses, and so on.

    What is addiction, in your view?

    Addiction, in my view, is the result of an attempt to meet a genuine need with something that does not actually meet the need. You’re using a substitute for what you really want, so no amount of it will be enough to meet the real need.

    One should ask then, what drives such an addiction? Well, we have to look at the unmet needs of our society. One of those is certainly the need for community, which has broken down even in the course of my lifetime, but especially in the last century or two. When I was a kid growing up in a suburban neighborhood, we had community. Everybody on the street knew everybody else, and all the kids knew each other, and we all pretty much knew what was going on in everyone’s lives. All the families talked with each other, and we had neighborhood volleyball games, and all the kids were playing stickball in the church parking lot.

    Years later, when I resettled in suburbia for a brief time, after I started having kids, it was a totally different scene. You didn’t see packs of kids roaming around on bikes. The playground in the park, in the middle of the sub-development, was empty most of the time. The neighbors didn’t really know each other. I remember when one neighbor got a divorce and no one even knew about it until six months later. We had no community. We were simply living in proximity to each other.

    How did you first come to learn about addiction, and what perspective are you hoping to bring through your writing?

    I guess I just picked up little bits and pieces of it from the popular culture. I came of age in the mid-eighties/early-nineties, and at that time, there was certainly mention of addiction as a disease in the media. I read some books that had an impact, like Whiskey Children, which was a really beautiful book, but really, my understanding of addiction is part of a more comprehensive worldview.

    I’m looking at the ways in which we are at war with nature, and at war with each other, and at war with parts of ourselves, and how addiction fits into that pattern. I’ve never identified as an addict; I don’t have that kind of story. But, like most people, I saw people around me suffering from addiction and what it did to their lives. My views on addiction are part of a larger program of ending the war against the self, which is a reflection of the war on nature. And that’s why I’m attracted to using addiction as a metaphor.

    Our society likes to wage war on problematic areas – the “War on Drugs” is an obvious one, but we’ve also had the “War on Poverty,” the “War on Terror,” and so on.

    Dealing with an addiction is not about fighting yourself – [it’s] finding an enemy and overcoming that enemy. That is the near universal template of problem-solving in our culture. Find the disease. Find the germ. Find the weed. Find the bug. Find the criminal. Find the bad guy. Find the terrorist – kill him. Find a bad thing in yourself. Destroy it, overcome it. That’s a recipe for endless war. If the conditions that breed disease, weeds, terrorism, crime, and addiction remain present, then fighting the symptom while leaving the cause untouched is a recipe for endless war. I am a peace worker. I want the war to end.

    The first step in 12-step programs is to admit powerlessness over addiction. Another way of viewing this in terms of “internal warfare” is the paradox of “surrendering to win.”

    I have a soft spot in my heart for 12-step programs. My ex-wife had been an addict, and she got tremendous value from being a member. She had this book of daily meditations called Just for Today that she would read. For her it was a source of not only comfort, but also inspiration and strength.

    The principle of the first step is one that I find most aligned with my understanding of addiction. “We realized we were powerless over our addiction.” That’s a key insight. Because in the mindset of fighting the addiction, the implicit solution is, “My willpower will overcome my desire. My willpower will overcome my craving.” The problem with that is that willpower is finite, and the unmet need is an infinite generator of craving. You can resist it for a while, but then you’re going to have that moment of weakness and the willpower disintegrates. And you have a binge, because the unmet desire isn’t met.

    How does the climate crisis resemble this paradox of the failure of willpower to overcome addiction?

    This is obviously a society in pain. When looking at climate change, the conventional response to it looks a lot like the kind of ignorant conventional response to addiction, which essentially is, “Well, you’re just going to have to try harder to stop.” But it doesn’t look at the underlying causes. I understand climate change as a symptom of a much deeper malady that is inherent to civilization as we know it.

    What are the underlying causes?

    The idea that there is a linear direction of our ascent to dominance over nature. That is what needs to change. In my new book, I weave different threads of that narrative. One is our perspective of nature as an instrument for human utility, as a resource. This view might compel us to do something about climate change, because otherwise bad things will happen to us. But that separation from nature is part of the problem; that kind of relationship to nature, where it is an object for our use. That is part of what has distanced us, and isolated us, and cut off our intimate connections with the soil, and water, and plants and animals around us, that makes us feel so lonely and so in need of compensating for that lost connection with more and more stuff.

    And yet it is often said that in order to surrender, one must hit “rock bottom.”

    What “rock bottom” is varies from person to person, and the more love that someone has had in their life, the higher their bottom is going to be. One way to look at it is then, of course, how do we raise the bottom for the people and the planet that we love? Why is it that for one person, rock bottom is when their spouse walks out for a day, or they go to jail for a night? Yet, for another person it’s smoking their last cigarette through their tracheostomy hole after they’ve already gotten lung cancer and emphysema.

    That’s a really important question, which I look at in my Sacred Economics. I look at the question of how do we get out of our addiction to debt? How do we raise the bottom before everything is consumed in order to service the debt? Which is what’s happening. That’s what drives the entire world destroying machine – the debt-based financial system. So how do we raise bottom? In the economic context, the question becomes, “What functions can we reclaim that have been lost to the money economy?”

    What have we as a society lost because of our economic pursuits?

    We are not separate individuals that can thrive as long as our quantifiable needs are met. We are in relation to all beings. As our relationships to other people and to nature are truncated, we suffer a hunger, a loss of our “being-ness,” if you will. We then seek to compensate for that loss through many addictions, but especially through acquisition – adding more and more onto this narrow, cramped, separate self in futile compensation for the loss of connections to people and to nature.

    To make matters worse, the growth economy destroys community, because with economic growth we meet more and more of our needs through the money economy – we purchase more like that’s what economic growth is. It’s the expansion of the realm of monetized interests, and that expansion comes at the expense of the gift realm, the realm of reciprocity, of people helping each other, taking care of each other’s kids, sharing, sharing meals, creating our own fun instead of purchasing fun, creating our own entertainment, our own recreation. Helping each other out with projects, borrowing things from each other instead of renting them.

    When all of those communal functions are converted into owning, or renting it, or hiring someone to do it, the economy grows. But our connectedness withers and our felt connectedness to each other disappears, and we’re left even more lonely. So that’s maybe another hallmark of an addiction, is that the results of the addictive habit strengthen the wound from which the addiction is coming. They make your life worse so then you need even more of the things that fuel the addiction.

    How do we stop fueling the addiction then?

    Our story of the world that told us who we were – how to live life, how to be human, what was important, and what we served – is falling apart. And not only our story, but the systems that are built on that story are not working very well anymore, either. We have a crisis – not only is it a crisis of meaning, but it’s also a crisis of our being, because we are storytelling creatures, and our weave of stories is also a weave of our identity. Until we emerge with a new story, and regain our relational identification with all beings, we will remain stuck in the downward spiral of addiction.

    View the original article at thefix.com