How We Learn to Self-Medicate

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It is said that in any AA or NA meeting 60% of its group members will have experienced some form of abuse (physical, emotional or sexual) as a child. Childhood abuse is a good indicator of later substance abuse and addiction. 

Recently I posted about ACE (Adverse Childhood Experiences) Study which showed that early adverse experiences, or traumas, predict adult physical and mental health problems that ultimately lead to early death. Adult substance abuse is one such consequence, in addition to smoking and obesity.

In this context, I've been thinking a lot of about validation. To validate simply means recognizing another person's experience of an emotion and their reaction.

If a friend is crying because his dog recently died, I would validate by saying something like "I see that you are really sad" or "You are really missing Buster." In my wanting to help, I might instinctively want to problem solve or advise him so he feels less hurt. I will get there, but first and foremost I acknowledge that his sadness is real and valid.

Imagine a little girl falls and scrapes her knee, and she cries. Her mother or caretaker hopefully will say something like "Oh, no, you fell. Come and let me look at it" or "Let me see. I think it's going to be okay." Both statements indirectly validate that an accident has happened and that the little girl's reaction is valid. But, another parent might simply order the child to stop crying, or say something like "I told you not to run" or "This is what happens when you misbehave by running." 

In a dysfunctional or abusive family, a child's feelings and reactions are invalidated, as the latter examples illustrate. It doesn't seem so bad when looking at just one example, but when it is long-established pattern, parental invalidation teaches the child that her feelings, especially negative ones, can't and shouldn't be felt or expressed. 

The same girl might grow to ignore, disregard, deny or avoid her feelings, especially uncomfortable ones like sadness, anger, shame, guilt, boredom, loneliness, even though they are part of every person's experience.

Enter alcohol and drugs, which in the short-term help her avoid unpleasant feelings. Repeat this way of coping and a dependence and addiction develops. And a cycle of self-medication begins: Immediate relief from unpleasant feelings followed by intensification of those feelings, and so on...

16 Danger Signs of Relapse

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This list is from an excellent Facebook post. Even though the list seems it's from AA (Alcoholics Anonymous) for AA members, I think we can all benefit from this list even if we are not struggling with a severe addiction. I feel addicted can also mean we compulsively repeat certain patterns of behavior based on a set of beliefs, which can hold us back from growth.

For those of you who say you are "allergic" to the AA model,  go ahead and read the list and replace AA, sponsor, meetings with family, friend, get together, etc...

Relapse can mean returning to an old behavior which you attempted to change or correct. Or it can mean actual addiction to alcohol and drugs.

Basically, be present and be mindful of what's going on in yourself.

DANGER SIGNS OF RELAPSE

1. Exhaustion — Allowing oneself to become overly tired; usually associated with work addiction as an excuse for not facing personal frustrations.

2. Dishonesty — Begins with pattern of little lies; escalated to self-delusion and making excuses for not doing what's called for.

3. Impatience — I want what I want NOW. Others aren't doing what I think they should or living the way I know is right. Instant gratification is a monster that needs to be tamed.

4. Argumentativeness — No point is too small or insignificant not to be debated to the point of anger and submission.

5. Depression  — All unreasonable, unaccountable despair should be exposed and discussed, not repressed: what is the "exact nature" of those feelings?

6. Frustration  — Controlled anger/resentment when things don't go according to our plans. Lack of acceptance. See #3. Being a baby.

7. Self-pity — Feeling victimized, put-upon, used, unappreciated, disrespected: convinced we are being singled out for bad luck.

8. Cockiness — Got it made. Know all there is to know. Can go anywhere, including frequent visits just to hang-out at bars, boozy parties or an other potentially complicated setting where the addiction monster may get tempted.

9. Complacency - Like #8, no longer sees value of daily program, meetings, contact with other(s) alcoholics, (especially sponsor!), feels healthy, on top of the world, things are going well. Heck may even be cured!

10. Expecting too much of others — Why can't they read my mind? I've changed, what's holding them up? If they just do what I know is best for them? Leads to feeling misunderstood, unappreciated. See #6.

11. Letting up on disciplines — Allowing established habits of recovery - meditations, prayer, spiritual reading, emotional support system or AA contact, daily inventory, meetings or getting together with a pal — to slip out of our routines; allowing recovery to get boring and no longer stimulating for growth. Why bother?!

12. Using mood-altering chemicals — May have a valid medical reason, but misused to help avoid the real problems of impending alcoholic, drug or a behavioral addiction relapse.

13. Wanting too much — Setting unrealistic goals: not providing for short-term successes; placing too much value on material success, not enough on value of spiritual growth.

14. Forgetting gratitude — Because of several listed above, may lose sight of the abundant blessings in our everyday lives: too focused on # 13.

15. "It can't happen to me." — Feeling immune; forgetting what we know about the disease of addiction, including alcoholism and its progressive nature.

16. Omnipotence — A combination of several attitudes listed above; leads to ignoring danger signs, disregarding warnings and advice from fellow members or emotional support network.

Watch Now! Russell Brand: From Addiction to Recovery

Russell Brand is one celebrity who is pretty cool. This isn't the first time I've written about him. I can respect him because he uses his fame to bring attention to the problem of addiction and benefits of meditation and yoga.

So I was happy to discover that after Amy Winehouse’s death from alcohol withdrawal, Brand made a short documentary with BBC about addiction and recovery. And The Guardian published a moving eulogy he wrote for her.

Discovering this short doc (about an hour long) several years late does not diminish its significance. Brand discusses with experts about opiate replacement therapy. At times, he can be overbearing and appears fixated on his recovery process. However, Brand’s narcissism is tolerable, because he argues that for addicts like himself it's abstinence or death.

He argues against methadone saying it’s an opiate replacing heroin, which means that the addict is not drug free, and an addict wiI am certain he would criticize Suboxone since it too is a synthetic opiate prescribed to curb cravings and withdrawal symptoms, just like methadone. The difference is that Suboxone is prescribed by a psychiatrist, as opposed to daily pick ups at a methadone clinic, so it no longer carries the stigma of having to drop in every morning at your local MMTP (Methadone Maintenance Treatment Program).

An addict, Brand stresses, must be free of all drugs, although whether he includes psychotropic medications, it’s unclear. Both AA and NA agree with Brand; and they consider prescription medications as drugs. Therefore, an AA member who is prescribed medication, for say depression and anxiety, is not drug free or abstinent. I find problem with this, because so many people struggling with substance abuse suffer from underlying mental illness. 

What are your thoughts?

Coming Out from the Closet of Anonymity: New Recovery Advocacy Movement

I have written before about many of my clients' disfavor towards AA/NA approach to recovery. Complaints range from discomfort about its "religious" or "spiritual" take, emphasis on handing your life to "higher power": the necessity of admitting of "powerlessness": the depressive atmosphere of the meetings "AA/NA meetings are for older addicts who've run out of options.

I have addressed some of these criticisms and offered alternative communities where people can come together to provide mutual support and commiserate about their personal daily struggles.

New Recovery Advocacy Movement is gaining momentum by challenging the anonymity of recovery and declaring that it contributes to stigmatization of addiction and recovery. I very much agree about the problem of stigmatization (societal/personal). If the addict is alone with it it only contributes to the cycle of shame, guilt and isolation.

People behind movement have produced a documentary "Anonymous People."

This is the trailer, to view the full documentary you need to purchase it on Vimeo on Demand.
And here is the link to the longer piece from the Fix.

Sex addiction and recovery: Thanks for Sharing

Here is a link to a really thoughtful piece/film review by Robert Weiss MSW on Thanks for Sharing. http://m.huffpost.com/us/entry/3982933

The movie was released a few months ago and it stars big name actors. I didn't think twice about it but reading the review made me want to see it.

I am interested in addiction to sex even though it's outside my training and professional expertise, because it can and does overlap with other addictions. The movie is also about recovery and the culture (hence its title) of 12 step programs (AA being the grand daddy), an essential part of addiction treatment and maintainence of sobriety.

Couple of points the wise Mr. Weiss wrote stood out for me, and I am going to paraphrase them: he said alcohol, food, sex, drugs and the like are used to fill the "primitive need to self medicate." Also, he said treatment and recovery from any type of addictions does not happen in isolation. Human connection is a necessary ingredient in healing.

More on these two points in future blog entries. 

Again, here is the link: http://m.huffpost.com/us/entry/3982933

Blogging for Sobriety

I am a big proponent of journaling as a way to keep things honest between you and yourself. It's an invaluable tool that deepens self-awareness, whether or not you are in therapy.

And, there is blogging, not blogging as marketing, but personal blogging. It is a form of journaling, but it's not the lock-and-key, Dear Diary variety. Personal blogging is like keeping a journal that's meant to be read by whomever. It's personal and public at the same time.


It's therapeutic because making a declaration, which isn't exactly shouting, blogger reminds herself of who she is and what she aspires to become. It's writing for self-reflection and inviting others to witness the process, which CAN be an act of courage and commitment, or just a form of narcissism. It's much like "Hi, I am so and so, and I am an alcoholic" part of AA. 

Which brings me back to sober blogging. I like this blog very much for the reasons cited above and more. I hope it can inspire others to rethink their relationship to alcohol.

http://drunkydrunkgirl.wordpress.com/2013/09/02/inspiration-to-others/

Why AA Isn't Hip

Some of my clients are young problem drinkers whose alcohol abuse is severe enough to warrant their own concern. They come to me and other psychotherapists with the hope that they can gain control over their drinking habit which seems to be winning. Addicts they are not, they say, it’s just a matter of learning why they drink so much and to reassess their priorities and values. The objective is to no longer feel as if they are controlled by alcohol. Most are above average in intelligence with a promising future in one of the creative professions. Before seeking therapy, they have tried to stop drinking on their own and/or have gone to Alcoholics Anonymous for support, some repeatedly. Most of these clients stop going to AA for several reasons.Many complain that the atmosphere is depressing and off-putting. They feel they have little or no common with the majority of other AA members, besides alcohol. To them the typical AA goer is a wizened old timer who appears to have no other options other than to stop drinking entirely and attend AA meetings round the clock. Unlike them, my clients feel they still have options, and they feel they can re-learn to drink moderately, after a period of abstinence. 

I would like to address that sentiment with the following:

It's true that many people in AA are older and even just plain old. AA was originally intended for serious alcoholics who had bottomed out over and over again, meaning nothing else helped them to stop drinking. AA worked because it was a refuge, a place of last resort. It accepted them for who they are, and they found community. 

AA is still around because it does help serious alcoholics recover from active alcoholism and maintain sobriety through community. One reason why you see more older people is that older addicts are more likely to abstain for reasons that are connected to poor health resulting from years of sustained abuse. They may die if they continue to drink, and so they NEED the AA community to not drink again. Also, dealing with or avoiding consequences of addiction is exhausting, and older addicts are emotionally and mentally TIRED from running.

Having said that, it does not mean there is no place for younger people in AA. Which reminds me, there is a great independent feature that deals with this: it's called Smashed.

The role of AA for problem drinkers will be continued...