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I want to thank people for their very encouraging comments and suggestions following my last post. They have really inspired me. So…I’m going to keep the blog going for a while, and I’m going to enjoy it.

Now here’s that guest post I promised you–

 

…by Michael A…

After going through 28 rehabs within 3 years, I now carry 3½ years of sobriety. During my recovery attempts, I fell into an unforeseeable yet common addiction. I became addicted to rehab itself, sometimes called the “Treatment Shuffle.”

My addiction started as many commonly do – partying at a young age and going too far until I needed drugs every day to feel ok with all my insecurities. By the age of 21, I was crying for help, addicted to cocaine and opioids. Thanks to my mother and her insurance, we were confident we could find affordable treatment. Researching treatment revealed an overwhelming number of drug rehab centers, most of which looked like 5-star resorts. This appeared like a nice way to step away from my broken lifestyle. Neither I nor my mom knew how to appropriately vet treatment, and I chose the one that appealed to me aesthetically. My mom was just happy I was going somewhere safe, away from drugs.

 I was astonished by the luxury when I arrived, but still nervous about this life change. I was approached by a client who befriended me, giving me an education on the “how to screw the system” plan that most of the clients followed. I learned about abusing detox meds, how to act like the perfect client, and who to get real (illegal) drugs from, all within the first week.

After the detox and stabilization phase, I was sent to a less structured environment to transition back to normal life. This concept should work. However, this center, like many others, placed me in a low-income area surrounded by drug activity. Imagine 50 people from all over the country who just want to get high in a house where drugs are right over the fence. Most clients hopped the fence every day, got high, and hooked up with girls (it was a coed rehab). It was chaos. Being insecure, I fell right in. We’d get caught, sent back to detox, loaded up on suboxone and benzos (detox meds we’d get high on) and start treatment all over. The insurance billing cycle restarts and we would too. These types of centers benefit if you relapse because they can bill your insurance at a higher level of care.

I didn’t learn much at this 30-day treatment center. No healing took place, and all I wanted was to keep numbing my emotions with drugs. When I finished, I went to a sober living house, attempted AA, but continued to relapse. I still needed some real therapy. As time continued, I met more experienced users, got into new drugs, and learned more about how to use rehabs and detoxes to support my addiction.

I played out the same pattern for about 3 years. I’d get high until I ran out of money, then go to detox for a free (insurance covered) high on opioid-benzo detox cocktails. When I really needed a reset, I would check into luxury treatment centers to get food, sleep and “work the system.” My insurance was great, and I found sober living homes that welcomed me to live there for free and get high, as long as I attended their outpatient rehab program. Treatment centers got paid for every relapse, and my addiction got worse. I knew I needed something more. I had to get away from this lifestyle of rehab hopping. There had to be something different.

By talking to people who had sustained sobriety and success in life, I heard about different approaches to recovery: Centers that were long term (3-5 months), challenging physically and mentally, and forced you to confront your traumas and negative thinking patterns. Places that used alternative approaches to therapy, such as SMART recovery, Rational Emotive Behavior Therapy, fitness therapy, and other critical thinking techniques to heal an addicted brain. For an analytical, physically broken person like me, this sounded like what I needed. I was guided to a place called Tree House Recovery in California, which offered this alternative approach.

When I got to Tree House, I began a routine of daily fitness therapy, team based training in the ocean that forced the pre-frontal cortex (logic & connection) to be engaged, intense motivational interviewing and therapy, and an addiction education that was more in depth than any other center had offered. It was impossible for me not to heal here. My brain got rewired, I felt empowered, and began to love life sober. I would highly recommend exploring Tree House Recovery to get an idea of evidence-based treatment that works. This was the one that worked best for me, but I would suggest doing the appropriate research for each individual circumstance.

If you know someone struggling with addiction, whether it’s their first time looking for treatment or the 28th time, look through the options. DO NOT let someone pick the easiest route. Do not rush into the first one that will take someone. Spend the time necessary time to make this the only/last treatment needed. Ask the centers you’re looking at for their success rates, and ask how they define success. Is it graduation rates, or graduates that have remained sober for at least a year after treatment? Ask how they obtain this data and how often. Ask what methods are used for treating the biological, psychological, and societal aspects of addiction: how often and why? Most importantly, read a lot of testimonials from graduates and parents.

Rehabs do work if you go to the right one and follow a successful routine to maintain a healthy lifestyle. I got sober to succeed in life. I learned how to use my drive (once used on drug seeking) to find happiness,  to achieve excellence and follow my passions. Having an addictive disposition can be seen as an advantage in life when that “go go go” mentality is used for good. I love life today, and am fortunate I survived the “Treatment Shuffle.” 6 ½ years later, I can say success is possible.

 

 

 

 

Hi people. I haven’t posted anything in the last couple of months. My last post went up in mid-July, then there was a guest post, and then…the silence of the tomb.

But I’m still here.

It has been a challenging and chaotic summer. Our planned (temporary) move to Toronto got rescheduled and rescheduled due to a death in the family and our wish to support the person left behind. Which meant a few trips back and forth to Europe for Isabel (my wife) and one extra trip for the kids and me. It wasn’t all bleak. We spent two weeks in the south of France, and there aren’t many places more beautiful than that. But it was surely disorienting.

Now back in Toronto, finally to roost, for at least four more months. But we had to shift from one rental to another. We’re still trying to get settled. And four days before the start of school, we found that our boys (12-year-old twins) weren’t allowed to attend the public school we’d planned for them. Frantic search for a new school — which now seems to have panned out well. Discovered a great ping-pong spot. Life goes on.

Now, with a little peace, I’m tempted to start blogging again. But I ask myself: do I have much more to offer in the domain of addiction and “recovery” or have I covered what I’ve got to say? I’m not sure. I’ve become a little less interested in the neurobiology of addiction for a very simple reason. Short of neurosurgery (and a very few available pharmaceuticals, which were already in use decades ago), there’s not much to do about the neural basis of addiction except to understand it better and then get to work on changing behaviour. So why not go straight to the behaviour? Which of course means the thoughts, feelings, internal voices and psychological background (emotional difficulties at younger ages) leading to the behaviour. I’m more interested in that right now.

This interest is fed by my growing psychotherapy practice with people in addiction (or struggling at the border of it). I am learning a lot. And I hope I’m helping my clients. At the same time, I’m pretty tuned into the gradual evolution of the treatment field, the growing strength of the harm reduction ethos, increasing frustration with the dominion of AA and its offshoots, and gradual changes in the policy/legal/medical/political issues that swirl around the enormous problem of opioid addiction in the US. Not to mention the social and societal factors that make it so hard for many people to quit or cut down. I get what residential rehabs sometimes do right and what they so often do wrong. I get the power of mindfulness/meditation and the various psychotherapeutic approaches (e.g., ACT, mindfulness-based relapse prevention, dialectical behaviour therapy) that incorporate it, along with the best (hopefully) from clinical psychology. So maybe there is more to talk about.

By the way, I still give talks on addiction all over the place and write occasional articles for scientific journals as well as the popular press. And I’m still working on that novel.

I also wonder if I should get more personal. I haven’t done anything illegal in a long time (except when it comes to parking and such). But am I a completely different person than when I was using opiates and coke (and acid and a few other things) and breaking the law almost daily? Of course not. I sometimes still feel incomplete and empty in ways I’ve felt since age 18. I still attach a particular meaning to substances, though my substances these days are pretty benign — and occasional. But I don’t talk about myself much, and maybe I should. You guys share a lot. Maybe I should share more.

That’s it for now. Just wanted to indulge in some speculation, thinking aloud. And I have an excellent guest post coming up in a few more days.

I hope you, my readers, are doing as well as you can. Warm wishes to all.

Sorry I haven’t written much lately. My family and I just moved from the Netherlands back to Toronto for six months. Busy summer! But here’s a guest post that may be especially valuable for those of us who keep on keeping on.

…by Danielle Kunkle…

As a Medicare insurance broker, I’ve seen everything under the sun when it comes to healthcare. We’ve had clients who are who are 95 go to the gym every day and take not a single medication. We’ve also had people who are 45, on Medicare early due to disability, taking over 20 medications.

There are both acute and chronic health conditions, and of course, there are mental health conditions and substance use disorders.

Far more than you might think.

In fact, Medicare foots the bill for millions of dollars of substance use treatment every year. It also pays for treatment of depression in the elderly, which is very common. There are many aspects of depression in the elderly such as loneliness and isolation which can lead to addiction.

As we age, we have fewer opportunities. Our bodies and sometimes our brains aren’t as functional as they used to be. We might lose our sense of purpose once we retire. We start to lose people we’ve known and/or loved for a long time. Kids grow up and move away, creating a sense of emptiness. We also must shift from actively earning a living to stretching Social Security and savings to last the rest of our lives.

My grandmother used to say: “Growing old is for the birds, Dani.” She may have been right.

While grief or money woes can cause depression at any stage of life, there are specific factors that make older people who experience depression more vulnerable to addiction, which in turn may be harder to treat.

One factor is that it is particularly easy for elderly people to gain access to prescription medications that later become a problem. Medicare beneficiaries might begin using pain medication innocently enough, but they can easily become hooked on drugs like opioids for chronic pain or benzodiazepines to treat insomnia or anxiety.

Doctors are often willing to prescribe these potentially addictive drugs for sleep problems or for vague aches and pains. They also may not spot a developing addiction because it’s too easy to misdiagnose declining mental ability or a dishevelled appearance as being due to depression or dementia rather than substance use.

Because Medicare is not part of a health insurance network managed by an insurance carrier, it’s easier for elderly individuals to “doctor-shop” for more medication than they need. Physicians can’t easily see who else is prescribing the same or similar medications.

Drug addiction is especially dangerous because our metabolism slows as we age. Substances take longer to filter through the liver and may build up in the body. This puts older adults at greater risk of dangerous side effects or accidental overdoses.

Another factor is the limited social circles of many elderly individuals. Many older adults live in isolation after the death of their spouse, which makes addiction easier to fall into. What used to be a glass of wine after dinner can turn into an evening of drinking away one’s sorrows.

Not all of these individuals will have children or younger family members living nearby who see them often enough to spot the problem. Even if they do, they may dismiss the signs because they don’t really think of addiction as being a problem for elderly people.

Addicted people may also contribute to this oversight. They may be secretive in their drug or alcohol use. They may feel embarrassed or ashamed of their addiction and go to lengths to hide it. Because no one is aware of the problem, an elderly person may have a harder time climbing out of an addiction.

While all of these things point to a greater need to identify substance use disorders in the elderly, there seems to be less urgency to treat them, as if this would be a waste of resources. Indeed, not everyone considers an addiction to be entirely negative. Someone who is living out their last years may prefer to be addicted if this means they are free from physical pain.

Yet older adults deserve the option to seek treatment if they want help with a substance use disorder. Just like younger people, they can and do overcome addictions with proper counselling and support.

Treatment, as many readers here know, can be expensive and ineffective. However, Medicare does provide considerable benefits for available treatment modalities:

Medicare includes an annual screening for depression and substance misuse or addiction. Speak to the Medicare doctor and request a screening.

If risky behaviours are identified, you can ask a physician to make a referral to services. Medicare will cover therapy in an individual or group session as well as treatment in an outpatient clinic.

Some cases may require care in an inpatient psychiatric unit or residential treatment center, both of which would be covered by Medicare for up to 190 days in a person’s lifetime.

Part A hospital benefits may also cover methadone or Suboxone that you receive during an inpatient stay whereas these medications are unfortunately not covered when prescribed for addiction on an outpatient basis.

If the prescribed treatment plan calls for other types of outpatient medications, you’ll want to be enrolled in a Medicare Part D drug plan. All Medicare drug plans include some medications designed to treat addiction, withdrawal symptoms, and depression.

To take advantage of Medicare’s benefits for these services, you must receive treatment from healthcare providers who are in Medicare’s network. There are over 800,000 providers nationwide and programs covered by Medicare can be found online.

Be aware that Medicare requires the Medicare beneficiary to share in some of the costs of treatment. They are responsible for deductibles, coinsurance, and copays.  However, individuals with Medicare supplement coverage may find that their plan covers some or all of their cost-sharing responsibility.

Often, elderly clients are unaware of their Medicare benefits for mental health and substance use problems. Spreading the word might help someone near you find the support they need.

………………………

Danielle Kunkle is the co-founder of Boomer Benefits and is a licensed Medicare insurance agent in 47 states. She and her team of Medicare experts can be found at https://boomerbenefits.com.

 

 

I promised that I’d come back to the problem of the internal critic — and how it might be constructive or (more often) destructive when it comes to addiction. This was part of my plan to translate Jordan Peterson’s prognostications into practical advice for people in addiction. Now, two months later, I hesitate to refer back to JP because of the ongoing shitstorm that has clouded his online presence and scrambled many people’s attempts to interpret just about anything he’s ever said. It seems the controversy has caught up with and overwhelmed the content, which is a shame. But it doesn’t matter much for the purpose of this post. Thoughts about the internal dialogue and self-criticism didn’t start with JP.

In modern times, the idea of an internal critic goes back to Freud, who envisioned a superego that oversees one’s thoughts and feelings, judges them, and dishes out guilt when it finds that they centre on wishes for sex and murder. Fast-forward to the middle of the century and you’ve got object relations theory, where the superego is just as harsh but a lot more observant. It’s not only sex and aggression that you’re guilty of; it’s also greed and envy. A couple of decades later came “transactional analysis,” a lay-person’s guide to an internal parent in ongoing dialogue with a child-self, with an adult self hopefully emerging in between. Since then? There’ve been all sorts of offshoots, but mainly a more optimistic approach, including the current emphasis on self-compassion, in psychotherapy programs like ACT, mindfulness/meditation, and positive psychology in general.

Addicts don’t need a history lesson when it comes to the internal critic. Just being an addict is enough to earn you a degree in self-judgment, self-contempt, self-hatred, and all their variants. Self-criticism is often (and rightfully) felt to be highly destructive. It arises from the addictive pursuit of drugs, drink, sex, or food (and all the nasty things we do in preparation or in the aftermath) and it feeds back to our addiction. Because feelings of shame and guilt, which are the key weapons of the internal critic, are so painful that they magnify the need for pain relief. And we know how to get that.

Why is the internal critic so focused on our addictive activities? Maybe because they demonstrate a complete loss of self-control, and being in control of oneself is a cardinal virtue from early childhood (you’d better hold it until you get to the toilet!) onward. Or maybe because addiction seems inordinately selfish. Maybe because gorging on drugs or booze strikes us as the epitome of greed, and greed is another sin we are scolded for as children. Or maybe because we fail ourselves, we fail others, we lie to ourselves and others, we hurt ourselves and others, we use up the last shreds of self-respect or “authenticity” by indulging yet again when we have promised ourselves to resist temptation.

Peterson reminds us that self-criticism isn’t all bad. And that’s kind of refreshing. He says: “the self-denigrating voice…weaves a devastating tale…Don’t listen to its exaggerated claims that you’re completely worthless. But don’t ignore it either.” Why not? Because self-criticism is the leading edge of self-improvement. We often have no idea how to improve ourselves except by listening to an internal critic. Or an external critic. Some of you may remember the Bob Newhart skit in which the client tells the psychologist about her irrational fears and then about her dismay and guilt at being bulimic (and other addictive tendencies). Newhart, the psychologist, offers the perfect cure. Check it out.

The trouble is that the scorn and contempt we (addicts) level at ourselves reaches levels of intensity so high that, as I said, the psychological pain makes us desperate for relief or — and this may be just as familiar — we want to punish ourselves for being bad. We know that more drugging or drinking will bring more suffering, so we can combine immediate pain relief with a well-deserved licking, thereby playing the bad kid and the righteous parent at the very same time.

For many people in addiction, self-contempt  is so constant that we assume it’s unavoidable — the brutish background noise of life. But that’s not the case; we can overcome it. When I do psychotherapy with clients in addiction, I try to get the internal dialogue onto the table, and I try to help my clients talk with their internal critic, to participate in the dialogue rather than just taking the abuse.

If I had to specify a model recipe for taming the internal dialogue, here’s what I’d say:

Become conscious of the internal dialogue. Listen to the words (e.g., there you go again, you’re such a loser, such an asshole) and if the words aren’t accessible (because sometimes the critic’s voice doesn’t quite form words) then focus on the tone, the disdain, the contempt, the lip-curling hatred or disgust. Next, try to home in on who’s doing the criticizing. Does it sound like a parent? It often does. We can almost see that glaring, judging, scolding eye watching us. The judgment and scorn are palpable. Who but a parent (or older sibling or teacher) would judge and condemn us like that?

But that doesn’t mean your parent (or sib or anyone else) ever actually spoke to you like that. We have an extraordinary capacity to embellish, distort, and amplify whatever critical messages we might have received as children or adolescents — for being bad, dirty, thoughtless, aggressive, selfish, greedy…all those nasty qualities we’re brandishing again…in our addiction. In fact, the internal parent is NOT a copy or revision of an actual parent. The internal parent is part of ourselves.

So, listen in. Don’t blot out the voice. Get to know it consciously. Then, as I see it, you’ve got four choices.

1. Argue back, wholeheartedly and truthfully. Tell the critic that you aren’t really that bad. Given what you’ve been through, given the challenges you’ve had to face, you’re actually kind of brave. At least you’re trying, and you’re not giving up. And your addiction isn’t all of you. You’ve got a lot of good features (generosity? honesty? perseverance?) as well. Then access the dialogue at least several times a day. Engage in it as a participant. Defend yourself. That can feel liberating.

2. Let the internal criticism pass through you, like cosmic rays passing through matter. This approach has most to do with mindfulness/meditation, or Buddhist detachment. The thoughts you’re thinking and the feelings you’re feeling (e.g., shame and guilt) are just thoughts and feelings. Let them come (don’t duck and pretend) and then let them go. There are many guided meditation apps around (e.g., Insight Timer, Buddhify) that can help you learn to let thoughts and feelings come in the front door and leave by the back.

3. And then…if a space opens up, try to fill it with a sense of affection for yourself. Or do that even if you don’t sense a space. There’s no secret formula for this. To paraphrase Bob Newhart, just do it. Perhaps give yourself a squeeze…literally. Put your right hand around your left shoulder and your left hand around your right shoulder and hug yourself. It’s not as silly as it sounds. There are many methods for trying to increase self-compassion. Google them. But also just try to be kind to yourself. Recall what you’ve been through, recall your good points — as in #1 above. Add a dash of humour. It’s not as hard as you may think.

4. The last thing to try: When you focus on that critical eye or critical voice, look behind the illusion that it’s someone else criticizing you, and you may very well recognize yourself. It’s kind of a 180. The way I do it is through the pivot point of anger. Behind all that contempt and lashing out, the critic is angry, and you can feel the anger right there in your own body. That’s you scowling, judging, condemning…yourself. And why are you so angry at yourself? For all the reasons mentioned above, to be sure. But for a whole host of other reasons. You’re alone, you’re misunderstood, you’ve been abandoned or rejected, by people you wanted to be close with, people you wanted to love you. Never mind that you might have done some pretty dumb things to elicit those reactions. You’ve been blocked from accessing what you need to feel tolerable. Drugs soothe you. What right does someone have to withhold them? What right do they have to punish you?! Your anger is legitimate. In a sense it’s natural and fair. But the crazy thing is that, through some psychological sleight of hand, your anger at other people got turned on yourself. It became the hostility of the internal critic. And do you know who came up with that idea? Sigmund Freud.

If you get in touch with the anger of the internal critic, you can neutralize its destructiveness, because, after all, it’s just you freaking out and being overly strict with yourself. And what’s left, once the shittiness is subtracted, might actually be valuable. Self-improvement is possible. Finding your own self in your internal critic might help specify who you want to become while at the same time providing that lurch of pure self-awareness that makes you feel you’re already halfway there.

 

 

 

 

If you’re a regular on this blog, you probably know that Peter Sheath and Matt Robert have enough knowledge, compassion, and common sense about addiction and recovery to lead us to a far far better world. I’ve grabbed these gems from their comments to a recent post. If you’ve already read them in context, well read them again. If not, now’s your chance.

Peter Sheath:

I feel like there is an amazing amount of synchronicity going down, especially between you [Marc], Matt and li’l ol’ me. I can almost guarantee that I will have had my interests stimulated by a client, book, lecture or simply talking to someone and, a few days later it will be there in your blog and Matt will have made one of his beautifully eloquent comments on it. This may not sound so apparent at first but please bear with me.

Over the past couple of years I’ve been doing a lot of thinking, talking and research around this whole co-occurring conditions/dual diagnoses thing. I think we, organisationally, have got astonishingly good at not dealing with it. We love to have these imaginary silos that we place people into, develop manuals and protocols to either keep them there or embargo them from going there. We’ve even developed competency/accountability frameworks, skill-sets and governance systems that ensure that, supposedly, the right person is working with the right person, at the right time, in the right place.

The trouble is that it mainly creates confusion, uncertainty, apartheid and exclusivity. Only the other day I received a phone call from a friend who is managing a substance misuse team for people with complex needs. He had been asked to develop a “criteria” for the people his team would be working with. I said that I’m very sorry but I really do not believe in having criteria for people we do or don’t work with and everybody who comes to substance misuse services for help will have complex needs. Turns out that he is of exactly the same mind but has to do it because that’s what he’s been instructed to do.

Doing things in this way means that we often screen more people out than we do in and I have real difficulties understanding why we continue to do it. Jordan Peterson’s 12 rules for life, motivational interviewing, open dialogue, ACT, CBT, person-centred counselling, narrative exposure, etc. are all transdiagnostic and probably work best under the collective umbrella of the therapeutic relationship.

I’m currently working with a paying client who has had a lifetime of psychiatric diagnoses and various dependencies. He came to me because he had approached his local alcohol service looking for a community alcohol detox. The detox would need to fit around his work, because he works for himself and is the only employee. He was drinking at least a 750-ml bottle of vodka every day and was getting increasingly desperate and depressed. The service said that, because of his underlying mental health problems, levels of alcohol use and not being able to take time off work they couldn’t help him! I know it beggars belief, doesn’t it? I negotiated a course of Librium with his GP, involved his mother and his local pharmacist in the plan (open dialogue), then did some motivational interviewing type interventions to boost his confidence and ensure that getting sober was the right thing to do. We arranged a daily telephone check-in and weekly face to face, with myself, and I taught his mum and him how to do blood pressure monitoring. He agreed to call in to the pharmacy if his BP raised or reduced by 10.

Got a phone call last night to say that his detox had finished a week ago and he is now 21 days sober. He has struggled a bit because the weather over here has been lovely and he has an association with sunny days and sitting outside the pub drinking beer. He has used some psychotropic meds sparingly, because he does get worried about his anxiety levels, panic attacks and past psychoses. I’ve also been teaching him mindfulness-based meditations, relapse prevention and managing his mental health. We’ve developed a really good therapeutic relationship based on trust, autonomy, prosocial role modelling and hope. We’ve also focused on very small steps, although he is always wanting to make massive leaps. Fingers crossed.

 

Matt Robert:

Hey Peter!! It keeps coming back to this, doesn’t it? It takes a village…but a coordinated one that meets the needs of the individual as well as the tribe. Your sentence captures it all:

“We’ve developed a really good therapeutic relationship based on trust, autonomy, prosocial role modelling and hope.”

There has to be autonomy, agency… individuals need to feel in control or we don’t feel safe. I have to trust my fellow participants, the method, the goal, because I’m not going to stick with a process of arduous change if I don’t believe in it. And none of it is gonna work if I don’t feel like I’m in a sharing, connected, reciprocal relationship with the humans who are helping me. Something all effective recovery traditions have in common. All human endeavor, for that matter.

The thing about open dialogue that is so simple and compelling is that it is the same model humans have used to cooperate, help each other, and progress throughout history. It’s getting all the stakeholders, the people who care, in the same room, on the same page. It’s putting the puzzle that’s fallen apart back together.

We all know how to do this because it is a human thing, not an “addiction” thing. Addiction is a proxy for meaningful relationship.