Answer Addiction

Tag: geographic

  • So You Want to Move to a New City in Recovery? First Ask Yourself These Five Questions

    So You Want to Move to a New City in Recovery? First Ask Yourself These Five Questions

    Moving might be the right choice, but examine your motives. When we were drinking and using, we were irrational, impulsive, and at the whim of our heartbreakingly horrible decisions. We get into recovery to be more than that.

    The journey of a thousand miles begins with a single step. – Lao Tzu
    Wherever you go, there you are. – Unknown

    We’ve all heard or tried the myth of the geographic cure: that we can change the unmanageability of our addictions simply by changing locations. The program suggests waiting a year to make major changes in our lives, such as moving to a new place or getting divorced. That suggestion directly contradicts another recovery recommendation: that we should change people, places, and things. And some of us, myself included, struggle for years or even decades to get to that one-year mark, and finally decide—maybe on our own, maybe after a psychic brings it up dozens of times—that the place we are living in isn’t working for us and it’s time to make a move. How do you know if it’s a viable idea? Here are five questions to ask yourself when considering a move.

    1. Do you have a safe, sustainable place to live?

    I cannot stress this enough, especially for the dream cities like New York and Los Angeles. Success in one does not necessarily translate to success in another. This may seem like common sense to some of you, but something about Los Angeles, where I currently live, makes people think they can show up with a dream, a few grand, and a month in an AirBnb in Koreatown.

    The feeling of home, sanctuary, and security is important for all humans, but it’s of paramount importance for those in recovery. The refrain I frequently hear is: “I never felt like I belonged anywhere.” Well, this feeling is exacerbated dramatically by a less than ideal living situation, so make absolutely sure you have a safe place. Is it as good as or better than where you currently live? And can you stay there for at least four to six months?

    1. Is this an impulse move?

    I’ve wanted to live in California my entire life, so much so that when I partied at the University of Hartford at the ages of 14 and 15, I told everyone I was a student at UCLA. I exposed myself when someone burst into the dorm asking where the Bruin was and I stared blankly ahead, not knowing the mascot of the school I pretended to attend. However, there were other moves I made or contemplated that were pure fantastical escapism; in fact, for a few years while I struggled in fauxbriety (marijuana and/or kratom and kava kava, Adderall, Xanax if you’re holding, mushrooms in the summer), I seriously contemplated moving to nearly every place I visited. I travel for my job as a stand-up, and for a few years I traveled desperately trying to “find myself.” Each and every time, I was sure the move would solve the problem of myself. I am now grateful I didn’t have the money and agency then.

    A lot can be said for waiting in recovery. Waiting for the miracle to happen, waiting to date, waiting to speak (so guilty on this), waiting to move. Most things in life that are meant for you will be there when you are ready. Unless you relapse. Sobriety is the only thing that is imperative to grab onto NOW.

    1. Do you know what it’s like to actually live in this place rather than be a tourist?

    Visiting a place is often not a good indicator of whether you will like it as a resident. I really thought I would hate LA. When I got here, it hit me that what I really hated (other than myself and my fauxbriety) were all the costs and inconveniences of staying in a hotel, and not knowing anyone or where the good meetings were. In short, #touristprobs.

    If you’re a person who goes to recovery groups or does a community-based activity like yoga, this is the time to use those resources and talk to other people. If for some reason you aren’t able to spend time in a place before you move there, get creative in searching out Facebook groups, Insta hashtags (actually maybe not that one) and message boards (Miami has an excellent resource for this: MiamiBeach411.com).

    1. Are you motivated by people, places, and things or is this a geographic trap?

    This one is perhaps the trickiest question of all. For me, I don’t know if I would have been able to stay away if I hadn’t first moved away from my ex-husband. Moving away from a person can also lead you to the important but painful conclusion that the hate is coming from inside the house. Our external realities reflect our internal state of being. There are always more of that archetype waiting for you wherever you go. Even Thailand. Costs and benefits, baby.

    Miami, for me, was a people, a place, and a thing. I can go there now if I have a reason to, and even enjoy it. At one year out, I went to meet with my divorce lawyer and send some stuff home that I had left at a friend’s. I relapsed off the plane on mojitos, which led to cocaine, which led to spending days holed up with my ex-husband, missing my meeting and flight home, and trusting him to ship off my journals and personal effects. Soon I received an email that said, “You wrote in here I was BAD IN BED, here are detailed instructions on how to hang yourself, I threw out your shit.” I guess what I am saying is: usually you don’t have to make a dramatic move, like crossing state lines, to escape people, places, and things. However, if you have been in an abusive relationship where you were using together, moving across state lines or even across the country may be the best thing to do—that is, if you have a safe place to live. Which leads us to the final question…

    1. Work, work, work, work, work, work?

    It is a sometimes unfortunate fact of life that most of us must work, even in early sobriety. If you are lucky enough to not have to, I say hold off as long as you can. Your career isn’t going anywhere. Momentum is somewhat of a myth. It can be achieved later, from a more stable foundation. But if you can’t afford or don’t have time to scope out the job situation in advance of your move, you might not be able to make this move in a healthy and sustainable way.

    Imagine this scenario: You are a sober bartender in New York to great applause. However, you don’t have a great online presence, which seems to matter here in Los Angeles. Pride keeps you from raising your hand when suggested, but eventually sharing outside of meetings gets you an offer with a sober-owned cater waiter company. It isn’t bartending, and doesn’t fit in with your idea of yourself, so you decline, deciding the problem is that you keep getting asked about your Insta followers at interviews. Soon you will know what it’s like to follow your dreams across the country; you’re gonna sleep in your car. My point is this: manage your expectations on the job front, and research as much as you can. Visit and meet locals. Ask them questions. Listen… If you are working on recovery, less than stellar work opportunities are SO temporary. I promise you that. So take them. And try to appear grateful.

    I hope I’ve got you thinking seriously about your possible plan to move, or perhaps made you feel a little better about your lack of plan to move. Either way, amassing information and managing pride and expectations, otherwise known as willingness, stands at the forefront. It all comes down to love and fear. Examine your motives. Safety concerns are paramount. Talk to someone (you are welcome to email me: [email protected]) before you go. Get a second opinion. Nobody knows everything. Meditate on it. Make lists of pros and cons. Pray.

    When we were drinking and using, we were irrational, impulsive, and at the whim of our heartbreakingly horrible decisions. We get into recovery to be more than that. Perhaps you are thinking, well, that just isn’t how I operate! Try it. I spent years wanting to move to California. Now that I am finally here, I am so grateful I didn’t move one moment earlier—had I done so, I’d be smoking meth in a tent in DTLA right now. I’m really glad I don’t have to do that. And that you don’t either.

    Did you make a move in early recovery? Give us the details: was it a good or bad experience? 

    View the original article at thefix.com

  • In Praise of the Geographical Cure

    In Praise of the Geographical Cure

    For me, leaving was about survival and going back to supportive friends and family who had known me my whole life and who would give me a temporary place to stay.

    When I moved to the city of my dreams, I drove my Navy Subaru Impreza stuffed so full that I couldn’t see out of the rearview mirror the entire 1300-mile trek. My backseat was packed with my white cat Toby, my maple-bass guitar Helga, a vintage amp, a typewriter, a case of angsty journals, and a ridiculous amount of polka-dot and striped clothes. All things that I deemed too valuable for the moving truck. A month later, my serious boyfriend finished welding school back home and joined me. After finally leaving our sleepy home state of North Dakota, we were excited to start our new life together.

    Fast forward a few chaotic years to a plot that is achingly familiar for those of us who struggle with addiction; a plot almost sad and pathetic enough to make me a country song — if only I drove a pick-up truck and was a dog person rather than a cat lady. When the city of my dreams became the city of my nightmares, I decided to leave. My addiction counselor warned me that running away from my problems wouldn’t fix me, but I didn’t care. My drug hook-ups practically lived outside the Whole Foods across the street from my apartment, the same store that I had been kicked out of for stealing. My rent check bounced so I was on the verge of eviction. I needed to get the hell out.

    When I left the nightmare city, my cat Toby had died, my car had died, my identity had been stolen, and worst of all, I had broken up with that boyfriend who was supposed to be my forever mate. Then I fell in love again and that passionate, drug-fueled love also didn’t work out. Since I had sold or given away most of my possessions, pawned my bass and amp, there was no need for a moving truck this time around. I left, feeling broken.

    I sobbed as I said goodbye to the stunning Pacific Northwest wonderland with its gleaming snow-topped mountains and volcanoes, waterfalls, rainforest. As I drove east, I felt as flattened and empty as the prairies of my home state.

    I knew that just because I was moving home, it didn’t mean that I’d be magically fixed. I tried not to fall under the spell of what folks in the program call the “geographical cure.” Kerry Neville recently wrote a beautiful, lyrical, and illuminating piece on the geographical cure in which she says: “a change in external position on the map doesn’t reset the compass and point us to true north, because we always meet up with the self we are, no matter where we are.”

    I agree with some of Neville’s points, namely that taking vacations to topical locales will not get rid of our problems and provide us with a healthy, extended recovery. Yes, I knew that changing my zip code wouldn’t necessarily change my soul. I knew that I’d have to really dig down and do the hard, gritty work of recovery. But for me, leaving wasn’t about a vacation. I couldn’t afford vacation, I couldn’t even afford my rent. For me, leaving was about survival and going back to supportive friends and family who had known me my whole life and who would give me a temporary place to stay.

    Now that I mention it, the geographical cure warning is ironic because it contradicts other 12-step platitudes. These platitudes are like currency in the rooms, exchanged as freely as the collection basket for money and meeting lists: If you go to the barbershop enough times, eventually you’re going to get a cut, and: The only thing you have to change is everything. Change people, places, and things.

    Why are those of us who do decide to change our location criticized? Why do certain meetings and rehabs keep using their one-size-fits-all mottos rather than listen and embrace the many winding paths that lead us to recovery? In the few meetings I attended and the online recovery groups I participated in, people reacted negatively when I told them what I was doing. The consensus was that I was making a mistake. Even my counselor was quick to remind me that I wasn’t “special and unique,” and if this plan didn’t work for others, then why should it work for me? But I chose to do the thing that I knew would help me and my recovery. It wasn’t a mistake; it saved my life.

    Surely I wasn’t the only one who felt that perhaps the geographical cure may have been successful, so I decided to research the power of environmental cues, aka triggers, for addiction, relapse, and recovery. It’s likely you’re familiar with Pavlov’s classic dog study and the mechanics of classical conditioning, but I want to review it because it’s the foundation of every study that I read on this topic. Russian physiologist Ivan Pavlov was studying salivation in dogs when he noticed that the dogs salivated every time a door was opened, even when researchers didn’t have food. This was because the dogs began associating a neutral stimulus like opening a door (or, later, ringing a bell or flashing a light), with food. Researchers later used this model to study people with addictions.

    Studies found that people who develop alcoholism and addictions develop strong associations with drug-associated cues and environmental stimuli like Pavlov’s dogs. In other words, after repeated experiences, drug users relate the rewarding effects of a drug (like euphoria and relaxation) with the people, places, and things that are present when we are using. For example, one study found that smokers who received IV nicotine still reported cravings, whereas smokers who received IV nicotine and nicotine-free cigarettes didn’t. Why? Because of the power of environmental cues, including the feeling of holding a cigarette in one’s hand, the smell of smoke, and even packaging of a cigarette box.

    I mention these study results not just because they confirm what I already knew in my heart to be true and I love being right, but because they are vital for understanding recovery and relapse prevention. We must acknowledge the power of our environment and triggers. Although most of us won’t take the extreme step of moving across the country, we all can minimize our exposure to triggers until we feel strong enough to deal with them. We can also bring a friend or family member to face triggers and create new associations, as the studies I read suggested.

    Above all, we should all learn to embrace our own unique path to find what works best for us, even if it goes against the current of AA axioms. I will always be grateful that I listened to the fluttering in my chest. Wisdom means knowing when to keep your feet firmly planted in place or when to take flight. Sometimes leaving is the thing that saves you after all.

    View the original article at thefix.com

  • A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    It took me 10 hours of phone calls, 20 voicemails, 3 chewed fingernails, and many packs of cigarettes before I found a Suboxone provider in my new town. This is the list I wish I had then.

    When I pulled a “geographic” a few years ago, leaving Portland for my home state of North Dakota, I underestimated the stress of starting over. In fact, stress isn’t a strong enough word to describe driving 1,300 miles with my recent ex-boyfriend in the passenger seat and the fear of restarting life without heroin; not to mention I had no full-time job prospect, no health insurance, no apartment, and very few of my possessions. I also had a unique fear that loomed over me like an ominous storm cloud: trying to find a new Suboxone* provider in a rural state. 

    It took me almost ten hours of phone calls, twenty voicemails, ten games of phone tag, three chewed fingernails, and many packs of cigarettes to find a clinic that would dispense the medicine I take to maintain my recovery. 

    Unfortunately, my situation is a common one. Despite our nation being in the throes of an opioid epidemic, finding a Suboxone provider is a widespread problem; only about one-third of addiction rehabilitation programs offer long-term use of methadone or buprenorphine (the active ingredient in Suboxone). And according to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), only about half of all Suboxone providers are accepting new patients.

    Finding this life-saving medication shouldn’t be so hard. When you are committed to getting better, you shouldn’t have to worry about whether or not you’ll be able to find a clinic to dispense your medicine. A person with diabetes wouldn’t have to search hard to find insulin. So I’ve compiled a round-up of tips and suggestions. 

    This is the list I wish I’d had in early recovery:

    1. Find friends and family who are supportive of your Suboxone journey.

    2. Remember that your form of treatment is just as valid as all other types of treatment and recovery.

    Although Suboxone is a widely stigmatized and divisive medication in the recovery community, it has been shown to reduce opioid overdose death rates by 40 percent.

    3. Join online support groups and forums for people on Suboxone.

    Since I lived in a rural area, I couldn’t find any in person groups. So I joined secret social media Suboxone support groups on Facebook, recovery Reddit threads, and peer-support forums such as the Addiction Survivors website and Suboxone Talk Zone.

    4. Allow Plenty of Time to Research, Call, and Locate Providers.

    This was the most daunting and lengthy part of finding a new provider. Dr. Bruce Seligsohn has been a board-certified internist in Southern California for 30 years and practicing addiction medicine for 10 years. Dr. Seligsohn advises: “Patients really need to be very careful selecting a doctor if they have a choice. I would suggest that a patient looking for a new doctor do their due diligence and see what comes up online about the doctor.”

    I have compiled the most current resources available as of August 2018. See the sidebar for a sample phone script for calling providers.  

    Pros: Convenience, ease of navigation. You will be able to easily search for a provider based upon zip code, state, and the distance that you’re able to travel for a clinic.

    Cons: Out of date, inaccurate, not comprehensive. Be prepared for hours of phone calls depending on your location and financial situation. Not all providers are listed on the site. I also found that some of the clinics listed were not accepting new patients, had been closed, or had their numbers disconnected.

    Pros: Ease of navigation, instant results. Similar to the Suboxone manufacturer’s website, this is a good launching point for starting your search based upon zip code, state, and the distance that you’re able to travel. 

    Cons:  Not comprehensive and despite being a government resource, it is not up-to-date.

    Pros: Easy to use, more accurate. Treatment Match only connects you with providers in your area who are accepting new patients, reducing dead ends and calls to providers who aren’t accepting new patients or insurance. 

    Cons: Wait time/ lack of timeliness, not as many provider connections. This is not a straightforward directory and while it’s easy to sign up, you have to wait for a provider to respond to your email. The site claims that doctors respond 24/7, including weekends and holidays, but I only heard from them during normal business hours.

    • Yelp Reviews of Clinics

    Pros: Hearing directly from other patients about their experiences, easy to use, instantaneous, accessible.

    Cons: Questionable trustworthiness. Dr Seligsohn said: “Patient reviews can sometimes be very misleading.”

    • Calling Your Insurance Company

    Note: Insurance companies vary widely, so I can only speak from my experience. For example, in Oregon I was easily able to locate a Suboxone provider through my insurance company, but my North Dakota insurance did not provide referrals. They stated that their preferred addiction treatment was therapy and 12-step based treatment programs rather than medication.  

    Pros: Possible thorough list of doctors certified to prescribe Suboxone. Those Suboxone providers who accept your insurance are required to keep their information listed and up-to-date.

    Cons: Time-consuming and you have to deal with the hurdles of bureaucracy. Plus, some studies have found that only about 50% of eligible Suboxone doctors accept insurance. Some insurance companies like mine will allow you to submit an appeal asking them to cover part of your Suboxone visit or prescription, especially in rural areas. I saved all of my receipts and had my psychiatrist and Suboxone doctors write letters of support. After months of appeals, the insurance company agreed to cover part of each appointment. Each month I sent in a claim and receipt, and then I received a reimbursement check about a month later. 

    • Asking for a referral from your primary care provider, psychiatrist, or hospital.

    Another note: This is also difficult to give specific advice on because they vary depending according to location and providers, among many other factors.

    Pros: In-person support and assistance, more direct medical guidance and advice. 

    Cons: Stigma, lack of education about Suboxone, judgement, lack of timeliness. 

    5. Be Persistent!  

    6. Moving? Set Up an Appointment Months in Advance.

    Dr. Seligsohn advises finding a doctor and setting up an appointment prior to moving. “Patients need to find out as much information about how their perspective new doctor runs his practice…They also need to find out what the doctor’s philosophy is about long-term vs short-term Suboxone. If I was a patient I’d be reluctant to move to an area where there’s a shortage of Suboxone doctors.”


    Sidebar: Sample Phone Script for Calling Suboxone Providers

    I remember being so nervous, overwhelmed, and frustrated while also dealing with the symptoms of opioid withdrawal. Make sure you set aside a few hours for making calls in a quiet, safe place. I know some of these tips might seem like common sense, but when you’re in crisis and everything feels overwhelming, it can be a relief to have a guide.

    1. Introduce yourself and tell them that you’re looking for a suboxone provider.

    2. Where are you located?

    3. Are you accepting new patients?

    • If yes- when is your earliest available appointment?
    • If no- don’t hang up just yet! Ask: do you have a waiting list? Can you give me an estimate for how long it would take me to get an appointment? 
    • Do you have a cancellation list and if so, can you please add me to it?

    4. How often do I need to come to the clinic or office? 

    • Most clinics and offices require monthly or bi-monthly visits, but some require daily visits and dispense suboxone in a similar manner to methadone.

    4. Do you accept my insurance? 

    5. If the clinic does not accept insurance, how much does each appointment cost?

    • How much does the intake appointment/ first visit cost? This is an important question to ask because initial intake appointments can cost anywhere from $100 – $200 more than a regular visit.
    • Some clinics require pre-payment to reserve your appointment and prevent cancellation. Do you require a down payment before the appointment?
    • What forms of payment do you accept? (cash, credit, check?) Note that most clinics do not accept checks.
    • Do you allow payment plans or is payment due on the day of the appointment? A majority of clinics will not allow patients to do a payment plan and payment is due on the day of the appointment.
    • Are there any additional costs or required fees? Some charge additional fees for mandatory counseling, drug screens, etc.

    6. What are the counseling requirements?

    • You may be required to do weekly or monthly therapy groups with others at the clinic, and/or meet with an addiction counselor. This varies depending on how long you’ve been clean and your insurance coverage. (For example, one of my previous clinics had no counseling requirement, but my new clinic requires me to meet with an addiction counselor for one hour each month. Other clinics require weekly or bi-monthly group support meetings.)

    Quick Resource List:

    The Substance Abuse and Mental Health Administration (SAMHSA)’s Buprenorphine Treatment Practitioner Locator

    Suboxone Website’s Treatment Provider Directory

    Buprenorphine Matching System on Treatment Match on The National Alliance of Advocates for Buprenorphine Treatment (NAABT)

    Addiction Survivors

    Suboxone Talk Zone

      

    *(Writer’s Note: Suboxone is the most common brand-name buprenorphine medication, but this article is also applicable for patients seeking any form of buprenorphine treatment including: Subutex, Zubsolv, Bunavail, and Probuphine).  

    View the original article at thefix.com