Wednesday, May 29, 2013

Questions About Women and Relapse

Always as I am writing about women and recovery, and especially about women in long-term recovery, the big question is about relapse. There is a certain comfort that comes from having many years and there is a certain confidence too—that is, I think, deserved.

If we are working a good program and benefitting from therapy and other forms of “outside help” we will be safer and stronger. “But,” there is always that caution, “but there are no guarantees” and recovery continues forever.

I had the chance to ask an expert about women and relapse. Here are my questions and some very helpful answers from Erin Goodhart, Clinical Supervisor of the Primary Care Women’s Unit at Caron Treatment Centers. Take a look at Erin’s very helpful answers and perspective:

 Do women relapse more than men? Why?

Relapse is a long and tricky process for anyone in recovery. It is difficult to discern if women relapse quicker than men; however, it does seem that men have significant consequences sooner than women. This would indicate that when women relapse, it is minimized by their significant other, circle of friends or employer. In addition, men seem to seek treatment quicker after a relapse than women do. Research indicates that the longer someone is involved in treatment, the better the chances of continued, long term sobriety.

2.  When women relapse is there a central reason? We often hear that it is because of relationships/romance issues. Is this true?

Many times when someone relapses, whether male or female there is a combination of changes in thoughts, attitudes and beliefs that lead them back to active addiction. For women, relationship issues do play a major role in the relapse process. This can be for several reasons; a main reason being the expectations of the relationship may not be met. Secondly, when a woman is in recovery and is also a mother, there are high expectations. She must be able to take care of the children, home, her work responsibilities and engage in a healthy recovery program. If the relationships in her life are not supportive, it may feel like she is juggling glass plates and begin to think that the recovery process is too time consuming.

In addition, unresolved family of origin issues can be a part of the relapse process for women. In recovery, women are encouraged to engage in healthy relationships with other women. For some, this can be the first time they are having healthy relationships with women and if they have unresolved issues from their childhood with significant female figures in their life, it can be difficult to trust other women. Thirdly, some women have love or relationships “addictions” that have never been addressed. When they put down their drug of choice, they may begin to use relationships as a tool to cope.

Finally, the culture we live in expects women to be nurturing and to take care of others. This can add to the stress that a woman experiences in recovery, and can contribute to relapse as they begin to feel depleted.  

3.  Is relapse prevention different for men and women?

Relapse prevention for all addicts has similar characteristics including a sober support network, alternative activities and continued therapy. The importance of finding other women in recovery is critical as they may also be navigating the difficult map of early recovery in terms of balancing home life, work, leisure and recovery. Additionally, women in recovery also need to deal with the issues of relationship issues, childhood trauma and increasing internal self-esteem in order to avoid relapse. This allows women to have internal self-worth and not need validation from those around her.

4.  Many women find recovery support in "social" ways: lunches, walks, exercising together. Is this valid support?

Social supports can be helpful for women in recovery. However, ideally women would have a support network of other women in a
12 Step recovery program. Research shows that one of the most effective forms of treatment for chemical dependency is involvement in a 12 Step program. As a woman builds a support network of other women in her program, the social events can turn into lunch before a 12 Step meeting, a walk after a 12 Step meeting and can evolve into a healthy friendship that also acts as a support system.

Many thanks to Erin Goodhart, Clinical Supervisor of the Primary Care Women’s Unit at Caron treatment Centers.

Monday, May 27, 2013

The Hidden Casualties of War

At the start of American sporting events we stand up to sing the national anthem. It’s a teaching moment. At a high school game a parent snatches a hat from a youngster or glowers at a texting teen, “Get on your feet.”  And they do.

For many sporting events there is now another requisite moment during the game when we observe a “tribute to our Armed Forces serving overseas”. A soldier in full dress, with excellent posture, comes onto the field and for that moment we pause again.  We feel virtuous and patriotic.

We mean it—we really do. For anywhere from ten to almost 60 seconds we really care about the men and women of our military. We feel appreciation and even concern. And then satisfied that we have cared, and as the soldier, so beautifully decorated, is escorted out of sight, we return to our debate about favorite teams and best commercials.

Our soldiers are dying. They are dying the way that soldiers have always died—killed in combat and by tragic wartime accidents but they are also—increasingly- dying at home by their own hands. That is the part we don’t see, don’t honor and don’t stand up for.

The soldiers we see at sporting events are clean and composed and they exude strength and will and endurance. The conceit is that they are there to remind us of the hardship they endure for us but in fact they may be there to cajole us into believing that the respect we feel for them is enough.

What if during the Super Bowl or on Baseball’s Opening Day we saw a group of American soldiers twitching with the physical and mental pain of post-combat fatigue, stress and disability? Not the heroic amputee—we know that symbol of sacrifice—but the one whose hope, sanity and peace have been cut off. What if we stood for 60 seconds to witness the grown men and women who serve and protect us while they shake and cry and go numb?  What if we saw them as they struggle to manage their depression, anxiety and dissociation?
As our nation’s longest war approaches twelve years we are approaching a terrifying statistic. The Army’s own 2011 briefing on military suicide reported that, “If we include accidental death, which frequently is the result of high-risk behavior (drugs, alcohol, driving) we find that less young men and women die in combat than by their own actions.” It is for these men and women that we should be holding our hands over our hearts.

I don’t come from a military family. My understanding of this collateral damage came when I spent a few years interviewing China Marines—pre-World War II veterans. In China they experienced the combination of bloody atrocity and deadly boredom that today’s soldiers endure. The men I visited were in their 80’s and 90’s when they told me how they still—65 years later—struggled with their addictions, insomnia, grief and how their trauma had impacted their families –some for two generations.
We are slow learners. Military mental illness is always with us. It’s had many names –all euphemisms to keep it just out of sight. It is War Fatigue, Shell Shock, Viet Nam Syndrome and Post-Traumatic Stress Disorder.

But every faith has a tenet that asks us not to close our eyes to suffering. And here too we should not look away. This is not to say that war is right or wrong but we should know what it really means when we stand to say it’s worth it.  

Wednesday, May 22, 2013

Questions About Longterm Recovery and Answers from Paul Hokemeyer

Recently I had the opportunity to get some clinical perspective from a leading addictions expert--Dr. Paul Hokemeyer, Senior Clinical Advisor at Ocean Drive-part of Caron Treatment Centers.

It was helpful to ask about things that I have been thinking about in regard to long-term recovery. Here are some of my questions for Dr. Hokemeyer and his responses. I’m very grateful for his perspective

1. Does the risk of relapse decrease with length of sobriety/recovery?

It depends on how diligently the person is working a program of recovery. In my experience, I’ve found the most effective treatment intervention for addiction is regular attendance at 12 Step meetings, and yet this is the very thing that people let slide after they enjoy a period of continuous sobriety. It’s also important for people in recovery to constantly focus on improving their physical, emotional and spiritual life.

2. Does the look and shape of recovery change after ten years? Or 20 or more?

Yes. Perhaps the most significant change comes in what I call “the pinball effect” --the feeling of being overwhelmed by the options of life. One of the gifts of aging in recovery is the ability to ignore the noise and distractions of life. In long-term sobriety, people are able to focus on the qualitative aspects of their lives, like relationships, meaningful work and peace of mind, and let go of the neurotic pursuit for quantitative fulfillment such as power, property and prestige.

3. Why do we tend to see more people of 19 years and younger in 12 Step meetings? There are many people that have 20 or more years, but where are they seeking recovery support? Are they more at risk or recovering in different ways?

In my nearly 20 years experience in the field of recovery, I’ve found that by far the most successful recovery intervention is full participation and attendance in 12 Step meetings. I think that what happens to people in the 20-plus years is that they get caught up in the drama and anxiety that comes from this “launching” phase of their lives. They put romances, finances and status in front of their recovery.  

4. As we accrue more years in recovery, should we address additional addictions, like food, work, TV, etc.? 

Absolutely. I adhere to the concept of the Addiction Syndrome that was articulated by Dr. Howard J. Shaffer at Harvard University. This concept maintains that at the core of addiction is a personality that is pulled toward self-destructive behaviors. If you’re an alcoholic and you put down a drink, you will gravitate towards another self-destructive behavior, such as compulsive sex or distorted eating. It’s a concept that’s been empirically proven, and one that I see in my practice. Caron has recently launched a new program to address the addictions that coexist. This process itself is called Addiction Interaction Disorder.

This is why we refer to recovery as a practice that must be tended to every day for life. The good news is that this practice enables people to grow in a dynamic and rewarding ways.

Sunday, May 19, 2013

More on Not Taking Anything Personally

I’m happy to report that my efforts with Step Six and Step Seven have provided relief. Now the hope that I will remember this next time. But that’s the progress of recovery, isn’t it? We don’t always remember but we get there a tiny bit faster each time.

This week I’ve been making note of other things that are helping me with the “Don’t take anything personally” plan. At the top of the list is a hard one: Let go of being right. Yes, you are laughing. Just wait till it’s your turn.

But our insistence on being right is at the center of taking things personally. We want to be right. Our primitive brain would have us believe that our life depends on it. A new book—just in time—is helping me to loosen this belief. I have started reading Kathryn Schulz book, “Being Wrong” which is about our belief in rightness, why we insist and what happens when we face situations in which we are wrong. She details why being wrong is so painful and how we get trapped and stuck in our rightness. The chapter called “Heartbreak” which is about the ways we are wrong in love is worth the read: “Of all the things we like to be right about, none is so important to us as being right about other people.”

A couple of other things came to me this week as adjuncts to my “not personal” practice. One is this oldie but goodie from early recovery: “If it doesn’t have your name on it don’t pick it up.” I can practice not picking up other people’s business, their opinions (including their opinions about me) and not picking up fear, jealousy, comparison etc.

And then, recognizing that our Third Step is important, I heard and love this quote from theologian Richard Rohr: “We cannot say Thy Kingdom Come unless we are willing to say My Kingdom Go.”

Friday, May 17, 2013

And What to Do When You Do Take Things Personally

Well, that good intention of mine from earlier in the week: “Don’t take things personally” seems to have gone out as an invitation to my character defects to come to a party.

Within hours of my new experiment I was taking lots of things personally and worse, I was noticing it and feeling unable to wrassle the defects down. Not fun!  I found myself particularly challenged by an old habit of thinking that I thought I had dealt with ages ago: “What About Me?” And “I’m important too.” Not attractive and miserably uncomfortable.

But here is the value of long-term recovery: it becomes so hard to entertain those thoughts and feelings for very long. Not that they shimmer once and disappear but it’s hard to pretend that issues belong to other people and are not mine.

In the same way that AA can ruin your drinking, AA can also ruin the pleasure of being right and the dark joy of holding onto a resentment. Even while my hand is on my hip and I am certain of my superior self a tiny voice is whispering,  “What is your part in this?”

My “personalization” had attached itself to two people and I knew that I needed my recovery toolbox and some outside help. So here’s is what I did…and what I am still doing:

First: I began to pray for help. The first prayers sounded like this: “Oh God what is this crap in my head? Help me. Yuck. I hate this. Remove this. Come on, come on, come on…get this out of me. Hurry up.”

Second: I knew I had to tell on myself so I emailed my sponsor and a close friend. I told them my mean thoughts and the nasty burning feeling I was having about people. I admitted that I was actually wishing someone ill and that while I knew it was my yuck, I was mad.  I was also sad and scared to find myself in this yuck.

Then: I changed my prayer to something like, “Please help me. I think this is old family stuff and its getting attached to someone who triggers old jealousy and fear. I know this is mine but I can’t see my way out. Give me courage to do what I need to do to get clarity. I want to be free. Help.”

Fourth: The written word. I got on the train to go to New York City. The rhythm of the train and the beautiful river views from Albany to Manhattan helped me and I kept praying. I had my Kindle with me and I opened it looking for some kind of help and there I found the book, “Drop the Rock.” Perfect. It told me that this was all about Steps Six and Seven. Bingo. I know that, so I began to pray the Seventh Step prayer. That helped too.

Throughout the day in New York my mantra was, “I turn my will and my life over to you.” It wasn’t perfect. My yuck kept breaking through to remind me about “her” and “him”. But I used 6 and 7 and my mantra prayer. By the time I was back on the train to come home the grip was lessening.

Then: The next day I went out to walk and took my IPod Shuffle along. The Shuffle is a God tool. I’ve got a mix of music, talks, and recovery stuff on the Shuffle and as you know—it shuffles—so it’s unpredictable. And what popped right up as I began to walk and listen? A Joe and Charlie talk on Steps 6 and 7. Uh huh. Again 6 and 7. By now I’m laughing.

But I listened and here’s what they had to say about Six and Seven: God will remove what God can remove and God will do what I can’t do. But God doesn’t do what I can. Yeah. And what I can do in steps 6 and 7 is “Do the opposite”. Brilliant but shocking.

“Do the opposite.” God will remove the defect if and when we start doing the opposite of the defect we want removed. Want lying removed? Start telling the truth. I wanted jealousy and scarcity removed so I had to start sharing and praising and being really emotionally generous. Ha! Not easy but I was motivated by wanting relief so I began. And because I like to measure everything I began to count my new behaviors. I made a game of it. How many times each day can I do the very opposite of the thing I am struggling with? (Of course, you see that making it into a game lightened the weight and gave me some power back—in a good way.)

So here I am days later. No, not fixed. But hyper-aware of my part and of a simple set of actions that I can take to shift a defect of character while God does his thing with it. And yes, I am still praying “hurry up, hurry up” cause I hate discomfort just like you. But I can see my part and I have some steps to take and the light is there at the end of this tunnel. And that, I am taking very personally.