What is Recovery?

A recent study has been published in the Journal of Studies on Alcohol and Drugs on what constitutes recovery.  This four year study was conducted by the Alcohol Research Group because:

There is currently no agreement about the definition of ‘recovery’ from alcohol and drug problems.

There is no truer statement than that.  As a profession, addiction medicine has no standard of recovery, no common agreement to approach, method, means, or outcome.  This study begins a ground breaking opportunity to engage in a much needed conversation.

I have been conducting workshops on Mindfulness in Recovery and Mindfulness and the 12 Steps for several years now.  One of the first things I talk about is: “What is Recovery?”  Since I am a bit of a nerd and love reading the dictionary (Oxford English) I discuss with my audience a critical starting point – the definition of recovery.

Recovery  n.  LatinMiddleEnglish.  (recoverie. f. recouvrer.)  1. Possibility or means of recovering or being restored to a former, usual, or correct state. 3. Restoration or return to a former, usual, or correct state or condition, as healthy, prosperity, stability, etc.,  b. The cure of an illness, wound, etc.

So, according to an accepted authority (the dictionary) recovery is being restored to our former/original selves.

That speaks volumes.

What was our former self, then?

It is my belief that we are born in a state of unconditional love, that we come into this world with innate basic goodness.  Dr. Richard Davidson has spent virtually his entire career working in this domain as a neuroscientist and psychiatrist. There are studies that prove we possess basic goodness, but that’s for another time.

The point is, even if we have a terrible childhood, a horrific experience growing up, trauma, abuse, etc., our original selves consist of basic goodness. Call it our spirit, call it our soul, call it what you will. It’s the inner “us” that makes us, us.  Or the inner “me” that makes me, me.  Or you.

Recovery is returning to that state of basic goodness that we hold deep within ourselves.

Here are some of the findings from that study:

  • Recovery is being honest with myself.
  • Recovery is being able to enjoy life without drinking or using drugs like I used to.
  • Recovery is living a life that contributes to society, to your family or to your betterment.
  • Recovery is being the kind of person that people can count on.
  • Recovery is about giving back.
  • Recovery is striving to be consistent with my beliefs & values in activities that take up the major part of my time & energy.

As you read through these and the rest of the results, it becomes evident that all the items deal with goodness.  Enjoying life, is goodness. Giving back is goodness. Living a life that contributes to society is goodness.

Using “recovery” as a starting point in working with clients, perhaps it would be wiser to ask them what their original state was, what their return to their original state would look like, rather than telling them what recovery is to be.

If self-determination is the cornerstone of the therapeutic model, then wouldn’t it make sense for the client to determine what their recovery should look like?

I can hear the vehement responses to this proposition:  They’re addicts, they don’t know what it should look like; they’re alcoholics, they’ve lost their ability to be rational or reasonable; their brains are compromised; once addicted, they have to be told what to do to get better; we are the professionals and we know what they should do and how it is to be done…..

But do we?

Do we really know what and how recovery should be done?

I think we can guide, offer a road map, an end goal – but I believe we need to re-frame how this profession approaches healing from addiction.  I think the starting point is to understand what recovery is for each individual, and use that definition as the basis of their own program.

Of course there is knowledge that we can share with clients, lots of it, that will help them to understand how addiction comes to be, and how it can end.

But in between, we need to be mindful of how the client is going to “recover.”

At the end of the day, isn’t it their journey, and not ours?

 

 

 

 

Sky Mind . . .

When we open our awareness of “now” – this moment – right here – we engage our minds in a process that expands our senses. Instead of the narrow internal dialogue of fear or anger, negativity or resentment, craving or desire, opening our awareness of “now” is as simple as taking a breath – and looking up at the sky.

The concept of “Sky Mind” relates to a Tibetan Buddhist technique in meditation.  The instruction is to breathe, to observe the thoughts as they arise, and to realize that they are nothing more than clouds that cross the sky.  Some are wispy, some clumpy; thin strands, distinct shapes.

Our mind creates thoughts and that is its job. Constantly scanning for danger, for what is about to come, what is about to happen. But we can very easily get caught up in that process and believe that “we” are in danger, “we” are threatened, when in reality, it is just the function of our neurons in parts of our brain to do just that.

Sky Mind brings our awareness to a larger perspective, a larger reality.  There is a slogan on the Internet these days that says:

Go Outside, Look Up, it’s the Sky – it’s Free.

That is the perfect way to approach our mind, and our mindfulness practice. By simply stopping what we are doing from time to time during the day – especially if we are getting wound up, stressed out, overwhelmed – taking a few breaths, and looking out – outward from ourselves, toward a sky, a horizon or even a skyline in a city, we re-set our neurons and our attention.

For persons in recovery, this practice is key to moving through cravings, calming the anxiety that comes with early sobriety, and the withdrawal symptoms that can creep up on us when we are least expecting them. Breathing activates our para-sympathetic nervous system. Breathing helps to create dopamine (the feel good chemical in our brains) and reduce cortisol, the hormone created by stress and anxiety.  The best method is ten long, even breaths.  It slows down the anxiety process, brings oxygen to the brain, and kick-starts the parasympathetic system.

But you don’t have to be in recovery to benefit from these techniques.  Our society is catching on that mindfulness really does work at many levels.

Simply observing where we are, what our thoughts are, or what our state of being is, without judgment, without attachment. Simply breathing and being aware of our breath.  Simply being.

At rest, easy and open as the sky.

Sky Mind

The Addiction Counseling Profession

Addiction counseling is like walking a tightrope from a dizzying height.  One mis-step, one mis-statement, and you can lose the trust of the client, lose their commitment to their recovery, or lose your job.

In this day and age we have the added burden of HIPPA and privacy that undermines all our efforts with those who struggle with addiction because until a client has reached the stage of acceptance, is working a program of recovery, they will do anything to manipulate the counselor, staff, doctors, family and others to get their own way.

The treatment models used back in the 1950’s employed harsh and some would say abusive techniques; the models from the 80’s into the 90’s used a bit more humane approaches – and today in the 2015’s we are inundated with such a hodgepodge of approaches that it is hard to say what we are using. Everything from “harm reduction” to “religious based” from “cognitive-behavioral” to “recovery coaching” and from “community support” to “rational recovery.”

According to the CASAColumbia’s 2012 report “Addiction Medicine: Closing the Gap”   (Columbia University, New York City),  There are no national standards of care for addiction, which is an alarming fact.  Addiction is not treated like other diseases – and marginalizes the patient in need of care.

Most doctors are not educated in the parameters of addiction as a disease – if they were they would not have contributed to the opioid addiction pandemic that is ravaging this country.  Medical schools do not engage in curricula that give medical practitioners the tools to offer a diagnosis or provide treatment, much less refer patients to resources.

Our insurance system varies so widely and in many ways is so punitive that most treatment centers won’t take insurance.  This leaves millions of people suffering from the disease without options for care, left to their own devices, relapsing, or death.

The substance abuse counselor is caught between numerous systems – the facility that seeks to make a profit, the family desperate to get help for their loved one, the debilitating co-pay required by the insurance company, and standards and practices that constrain us from engaging in anything that would appear sympathetic to the plight the client is faced with.

It is perhaps why this profession has such a high burnout rate and turnover, and why so many talented but disgruntled counselors who are not heard by administrators, leave organizations for more mediocre employees to take their place.

The solutions to these problems can not be implemented by one person, but rather many. One counselor may find themselves struggling against a tidal wave of opposition when trying to update methods or approaches at a clinic, treatment center or outpatient facility. But when more than one counselor begins to speak the same words, solutions are around the corner.

The biggest solution is for counselors to get involved outside their work in advocacy, volunteering, education, and prevention in the community. That’s a tall order when you are worked to the bone with little to no time off for self-care. But small steps like printing off articles from professional journals, or reports from the National Institute for Drug Addiction (NIDA) or CASAColumbia, to name two of the top organizations working to advance this field, and sharing with co-workers and sympathetic ears, is a good beginning.

There are organizations like “FedUp Rally,” “Shatterproof,” “Faces and Voices in Recovery” and there are local opportunities at churches, police stations and schools as our cities and states try to deal with the overwhelming problems that drugs and alcohol are bringing to their doorsteps.

If you are a counselor, these places need your knowledge. If time is limited, show your support to the work being done by the larger organizations by visiting their sites, liking them on Facebook, and talking about it. Get pamphlets. Share the knowledge.

Above all, don’t give up hope. We are not a perfect profession, by far – and we have a long way to go. But raising your voice, and your knowledge base will go a long way to raise the standards, raise awareness, and raise the national bar.

After all – what do you have to lose – other than devolving into mediocrity?

The Disease of Addiction

If you open up The Big Book of Alcoholics Anonymous and read the first 164 pages a central theme stands out which is repeated over and over – that addiction is a bodily and mental “obsession” and that participating in a spiritual approach to recovery aids the alcoholic or addict in long term sobriety.  Words written back in 1939, many decades before most of us were even thought of, but wisdom nonetheless.

What we now know in the 21st Century is that addiction is a disease of the brain and that treatment includes a spiritual approach that aids in the recovery toward long term sobriety.  The National Institute of Drug Addiction (NIDA) one of the premiere institutes at the National Institutes of Health (Health and Human Services) has taken the lead on this research, led by Dr. Nora Volkow.  The scientific breakthroughs that have taken place as a result of her leadership and the tireless work of the NIDA team is nothing short of revolutionary.  NIDA has also made research possible by the many grants and funding of projects, broadening the base to include scholars and leaders of this domain worldwide.

Many still debate the veracity of whether addiction really is a “disease” and whether it really is a disease of the “brain.” That debate will continue as long as there are opinions, and as long as there are nay-sayers.  For the purposes here, the basis of this blog is grounded in the neurobiology of addiction, and supports the spiritual approach to recovery, with a foundation of education, and affecting change in ourselves and our human experience.

Addiction is not a moral issue:

There is still a pervasive stigma about addiction and individuals who have succumbed to its grip that if they “just pulled themselves up by their bootstraps” or “stopped being so selfish” or “scale back a bit” or a multitude of other comments that we have all heard, then the alcoholic or addict would no longer be in the grips of the substance they are using.

If that were true, then there would not be a pandemic of heroin addiction in the US, nor would we have an epidemic of college age binge drinking, older adult addiction, and nor would the numbers seeking treatment for alcoholism continue to rise.  Everyone would just give themselves a good talking to and be done with it.

But it doesn’t work that way – and for anyone who has gone through it, they can tell you that with absolute certainty – and for anyone who has worked with this population, they can confirm what we all know:  Addiction is not about morals.  Once the disease of addiction has set in, the morals of an individual may be affected – stealing, lying, cheating  or manipulating to get the drug or the drink – but it doesn’t start with a moral failing.

It ends with one.

 

 

Rising Recovery

In 1998 I purchased a book that had been published two years prior entitled “The Healing Power of the Mind.”  The Foreword was written by Daniel Goldman who had just broken ground with his publication of Emotional Intelligence. The Healing Power of the Mind intrigued me because (a) it was written by a Tibetan Monk (Tulku Thondup) who was a visiting scholar at Harvard, and (b) because the work focused on something so simple yet so profound, compelling and straightforward – that as an emerging Social Worker with all the attendant enthusiasm and rose colored lenses of optimism, I wanted EVERYONE to read it. My friends, my colleagues, my doctoral professors, strangers, potential clients – but they all looked at me with the blankest of stares: What do you mean meditation as a means to heal the mind? What do you mean the mind can heal? Tell that to the mentally ill or the addict!

“Read the book! Read the book!” I exclaimed over and over. But the scoffing was certain, and the opinions set. This was nonsense and of no scientific consequence, no evidence-based principles, no validity or reliability. Never mind that the techniques had been used for over 3,000 years – the reaction was, across the board, “bah humbug.”

Fast forward to the first decade of the new Millennium. By 2008 the world it seemed was busting at the seams with “Mindfulness”, “Meditation”, and the healing power of that thing called “mind.” In fact a day doesn’t go by that one doesn’t see some reference to it at some level.

Schopenhauer said that when a new idea (known as a truth) is introduced it is immediately dismissed as impossible; then violently opposed; and finally accepted as self evident.

Nothing could be more true of Mindfulness and Mind. In the world of addiction, my chosen field (or perhaps it chose me), the acceptance of self evidence of the addicted brain is ubiquitous. We now understand the workings of the Amygdala, Hippocampus, Nucleus Accumbens and the like, and have established evidence based, scientific certainties of the cause of addiction.

But one thing that is not certain is the path to treatment. In the days of Synanon, patients were stripped down to the core to be built up again. In the era of Betty Ford a kinder more gentle approach emerged. But what of today?

Today we need to re-examine our addiction treatment approaches and ask ourselves if we are using outdated methods for what is essentially a cutting edge understanding. If addiction is a disease of the brain, then shouldn’t we be using the mind to heal the brain? Daniel Seigel, MD, for one would say “Yes!” As would Rick Hanson, PhD. And many others whose work has influenced the science of neurobiology and addiction.

I propose that there is a “neuroscience of recovery” waiting in the wings – poised to make its grand entrance. The curtain is rising, the spotlight is pointed to center stage.

I propose the time is right to develop a mechanism of treatment that can become the new paradigm of wellness for those “still suffering”.

Call me an eternal optimist – an enthusiast for the profound and the simple – but I know this much is true: our minds are the ultimate final frontiers.