Understanding Addiction

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.

This is an intimate, personal account, unlike my other posts. I’ve thought for a long time about whether and how to share it with you. I decided I had to try.

Picture yourself in a large, dark circular chamber, sleeping bags and cushions arranged all around the perimeter of the room, with an interesting looking (often long-haired, colourfully dressed) man or woman seated on each of them. About 25 in all. There’s a fire crackling in the middle of the room, its smoke rising to a chimney hole in the shadows high above. The shaman sits on a stool behind a little table, covered by fabrics and totems of various sorts, somewhere behind the fire. There are candles here and there, but the chamber is mostly dark. An assistant, sitting next to the shaman, prepares the brew, stirring a large flask of brown liquid. The shaman pours a certain amount in a cup, then beckons the next person to come and drink.

One by one, each of us goes forward and sits down on a small stool just in front of the shaman’s table. Now it’s my turn. The silence rushes in. I can barely see the man’s face, but I sense his smile, the twinkle in his eye as he looks directly at me. He hands me an earthenware mug, and I drink the nasty tasting liquid in two gulps. I thank him by touching his hand. Then I sit back down, and the next person takes my place.

By the time the last person is done, the ones who went first are beginning to make noises. Little sighs, or gasps, perhaps a low chuckle…or a fart.  The person I came with (I’ll just say “my companion”) is on the sleeping bag next to mine. Nobody is going home tonight. We will lie down and sleep when the time comes. For now, we look at each other and raise our hands in a “cheers” gesture, smiling. Happy landing.

The wave of sounds makes its way around the chamber until — I feel the changes starting to happen in my own body and in the implicit motion and blending edges that begin to distort my field of vision. It’s been about 40 minutes since my drink. I’m excited, hugely intrigued, and terrified.

Then everything starts to change very rapidly: my perception, my thinking process, and my bodily awareness. The patterns on the prints on the far wall start to extend out into the room. Soon it’s difficult to tell which lines and whorls are painted on fabric and which are insinuating themselves in the air all around me. Tiny noises are magnified; sounds ricochet through an echo chamber.

Magic rushes in from all sides. Visual perception becomes vastly distorted: space fills with interlocking mosaics, people’s faces mutate, shifting identities, growing halos. The candle beams are fiber optic cables fraying like cotton scorched by flame. And so on and so on. I’ve tried to put the psychedelic experience into words several times. See my “Memoirs” for example. It’s not easy, but you can find many attempts at such descriptions on the net. So let’s cut to the chase.

This stuff is coming on very much like LSD. But it’s stronger. It’s happening too fast. I am overwhelmed. I wish I could turn the volume down but it keeps going up. The visual hallucinations are now so thick that I can barely see what’s actual. The wall is an arbitrary layer in a thicket of planes. As to the doors, I simply can’t find them.

This becomes a real problem when I have to go to the toilet. I’m now lying on the floor, on my side, and I can’t get up. I have no sense of balance. And I have to shit. And suddenly I realize that the urgency of the shitting, about which I’ve been warned, is right here, right now, and I have no clue what to do about it. I can’t ask for help, because I can’t find anyone in this fog of patterns. And I don’t think I can speak. I know I can’t stand up. And I don’t know which direction to crawl in.

So here comes the shit. It’s relentless, and there’s not a thing I can do about it.

Now I’m lying on the floor, somewhere, and there’s shit in my pants. I can’t figure out how much shit, but it feels like a giant mound. I imagine it has already covered the sleeping bag of one of my neighbours, though this turned out not to be true. There’s a very clear voice in my head. It’s my voice, and it’s remarkably sharp, considering my predicament. The voice says: this is an engineering problem. I have all this shit in my pants and I can’t get up or move.

I found out later that I had lain on the floor saying “oh fuck, oh fuck” several times a minute. For several hours! But what I experienced subjectively was different. I experienced PURE HELPLESSNESS. Yet there was a calmness in it. This helplessness was the ground floor of an architecture I’d lived in all my life. I can’t give you a clearer sense of what I mean except by repeating these words: paralyzed, shit, can’t see, can’t walk, can’t ask for help…and then I started getting cold. Really really cold. But there was nothing I could do about that either, since any movement (e.g., creeping toward the fire) had become much too challenging.

We were all instructed not to interfere with each other’s “trips” unless we deemed that someone was in great distress or in actual danger. (And in those cases, the assistants always seemed to get there quickly.) It was thought best to let people go through their suffering and learn what they needed to learn from it — without interruption. So, for three or four hours, I lay there and considered what pure helplessness was like. I had not experienced it since (presumably) my infancy. There was a lot to catch up on. I felt the helplessness through every part of my body and mind. I prodded it from every mental angle. I thought about it. I felt it. And I remembered it.

We know (intellectually) that we come from helplessness in infancy and return to it in old age or on our death-beds if we don’t live that long. But how can we actually live with that knowledge? How can we just be here, knowing that we could lose everything at any time? And someday we will? How can we endure this condition? And then…what other condition is there? With the plant soothing and guiding me at the deepest level, I experienced (vividly, like I was there) what it was like for my ancestors, tens and hundreds of thousands of years ago, to not be able to get warm. To be freezing cold, with no fire anywhere. I felt the ultimate fragility of all animate beings. I experienced helplessness as pure reality.

And I kept asking myself, and asking the plant who seemed a living presence, who could endure this? And the answer came when I listened to my breathing and asked (as I often still do in meditation) who is doing this breathing? This body. That’s who.

I remembered what it was like to be a small child and depend entirely on someone else to help me out of problems I could not solve. And with that came the most brutal and most enlightening realization: tonight, every time I considered calling out for help, I stopped myself, because I didn’t want to bother anyone, and because I was ashamed. I heard my voice coil into these self-effacing, euphemistic pleas: if it wouldn’t be too much trouble…if you wouldn’t mind… In fact I could not imagine that someone (like a parent) might just want to help me. I could not trust.

Which neatly explained the two years of bullying and despair I’d forced myself to endure at boarding school as a teenager (before I got seriously into drugs). I could have asked my parents to get me the hell out of there. But I didn’t. Now, for the first time, I understood why.

All these insights came with a kind of intense grace or beauty despite their awfulness. The ayahuasca was unsparing, determined, but also somehow generous and loving, like a planetary caregiver.

Help came, finally, when the hallucinations abated enough for me to recognize familiar faces. Like the face of my companion and the shaman — both looking concerned. I called to them. They hoisted me up, gently, pretty much carried me to the washroom, and hosed me down in the shower. There was no warm water. I was colder than I’d ever imagined being. But they got me clean. And I had brought clean clothes. They helped me stagger back to my spot, and before too long I was almost okay. I lay down on my sleeping bag and, once the whispers faded, finally slept.

That recognition of pure helplessness hasn’t gone away completely, and it’s been a few years now. Sometimes it’s distant, sometimes (for example when meditating), it’s right there, a cosmic slap in the face. And at each of these times, during each of these replays of that first dreadful realization, I understand something about myself I’d never understood before that night. Even after ten years of twice-a-week psychotherapy in my thirties. I understand that (until quite recently) I have lived my life in denial of my helplessness — and in denial of the lack of trust that makes it so sad. My thinking skills, my determination, my obsessiveness, my drive to succeed (20+ years as a professor is no picnic) — all were weapons against helplessness. In the service of self-control.

And so was my drug-taking — because drugs are a way to deny helplessness. Drugs allow you to change things, to change how you feel. Drugs were a way to take control of my mood — my anxiety, depression, shame, fear…to vanquish them. If only for a while.

My conclusion is simple: Can taking psychedelics help us understand our addictions? Yes, but it might not be an easy ride.

My four subsequent ayahuasca trips (three in South America) weren’t nearly as difficult as that first one. And I was able to make it to the toilet each time — though sometimes at a run. Why did I ever take it again? Because I wanted to experience other facets of this strange substance and the tradition it came from. And I did. I experienced cohesion, love for those around me, beauty so intense that it made me cry, and something else I’d never felt before: pure, unfettered gratitude, gushing outward into the universe. Gratitude for something I can’t explain. I mention this because I don’t want to leave you with the impression that psychedelics can only be valuable for the pain they release. They can also be valuable for connecting us with the goodness inside and outside ourselves.

That might be another important way to help people move beyond their addictions. But more on that another time.

I have been thinking a lot about craving lately. What is craving, really? What’s it all about?

Craving seems to amount to a fundamental sense of being incomplete. When we crave, we want something to fill us up. We want to fill a hole, by taking something out there in the world and putting it into ourselves.

We’ve talked about ego fatigue and delay discounting lately. These are phenomena that strengthen the impulsive urge to take something – now! But where does that urge come from? What’s its origin, and what form does it take in our inner worlds?

I’ve long thought that most people who become addicted to something have been badly hurt or scarred while growing up. This view is shared by many others, including Gabor Maté, our Canadian addiction specialist. So we’ve been shamed or rejected by parents or close friends, punished when we didn’t expect it or understand it, bullied, raped, or abandoned, or maybe we’ve lost someone dear to us, maybe more than once.

Yet these wounds don’t explain the craving for something else. They explain why we suffer.

The thing is that suffering is part of life. Many many people in the world accept suffering as inevitable. Many who suffer do not become addicts. But for those of us who have been addicted, there seems to be a fundamental expectation that’s truly flawed: the expectation that we can be made complete by something out there in the world. What made us think that? What made us imagine that we could relieve our suffering in that way? Or does addiction reflect some crazy optimism, a hope for relief that never gets extinguished?

Addiction must start off with the very real experience of getting relief from something outside ourselves: a substance (like booze or drugs) or an act (like gambling or sex). We naturally stumble on such experiences in adolescence or young adulthood. (And note that addictive “acts” also put something into the self: a feeling of triumph or pleasure that was not otherwise available.) Then the thing that provides relief becomes a goal with greater and greater draw. Hence, we crave it when we have to go without.

Yet the conclusion that we become more complete when we have that thing…that can’t just come from a few arbitrary experiences of intoxication or pleasure. We must come prepared — predisposed — to feel that way. And then we find the key that fits the hole.

The belief that we are incomplete without that thing seems like a fundamental, bedrock assumption at the root of craving and pursuing addictive activities. What could be its origin?

More soon…but I’d like to hear your thoughts first.

…by Matt Robert, with Marc Lewis…

In this guest post, Matt, a regular contributor to this blog, takes a close look at the paradox of being in the moment. Is that a good thing — as meditation teachers counsel us? Or is it a sink-hole in time — a stagnant swamp where addiction can take root and grow? Matt’s fascinating exploration of the relation between addiction and time triggered my authorial outpourings…so I couldn’t resist adding a few sentences.

“Being in the present moment” is nowadays touted as the goal of our attitude as well as our behavior. And in fact, it’s often a very motivating state of being for people — to be fully engaged, maybe in the “flow” of being creative, active, kind, or compassionate. There is nothing there but one’s focus and the activity itself. It can take us beyond the difficulties of life to a better place — as long as it lasts — for ourselves and everyone else.

But here’s the problem with addiction. It keeps us in the present moment alright. Frozen in the present moment, locked in. We choose that route to go beyond our difficulties and move on with life, and yet we end up stuck…chained to the present moment. It’s like a funnel winnowing down our awareness to a single point, to the exclusion of everything else, and then everything else eventually falls away like chaff. And all that’s left is the next hit, the next drink, the next high…

So what is different between these two ways of being “in the moment”? In the first case, the flow of the activity connects me to the past and the future versions of myself — who I was, who I am, and who I’m striving to be. As I engage in some social or creative activity, I am connected to my different selves. This doesn’t mean that I’m thinking about the past and future at any given moment. Rather, it means there are no barriers between past, present and future. The sense of flow is a sense of being in the present but also a larger sense of moving through life, in a continuous or seamless way. In my past, there is this little person trying to please his mother, and the teenager striving to be different, and all the other persona making up my life. And in the present there is this addictions worker, facilitating recovery meetings. But there is also the person in the future, perhaps running his own program, or sailing a boat in the Carribean. This makes me a person with an impetus to go forward, even if for the moment that means getting and staying sober.

But in the other kind of “in the moment” — the ball and chain variety — there is no connection to our future self. The present is just recycling, never changing, concerned only with the immediate goal — which is to get more of whatever it is we seem to need. Whirlpools continue to “flow” in a sense. But they never get anywhere.

In the authentic kind of “in the moment,” our engagement is linked to who we are now and also who we could be. There is a continuity of experience. We might actually develop a talent for the activity we’re enjoying just now. It can move from being a hobby to being a commitment. We may become accomplished musicians, or social workers, or gardeners. This idea (which Marc also discusses) helps me incorporate my experience with my evaluation of that experience. I can become objective without losing the feeling of being subjective, in the moment. And I can do that however my process of recovery — of living my life — continues to unfold. It helps make sense of it all.

When people say “Be in the present moment” they mean that the present moment is all we have, and we need to cherish it as such. But in active addiction, it’s all we’re ever gonna have. A land of vanishing opportunity. At one point, I wanted it that way, and it was a comfort, a relief. Not to look at or worry about the future.

But that’s not me anymore, because I’ve accepted the fact that change is inevitable — and resistance is futile.

My recovery is going well. The pain is nearly gone, so all I have to do right now, besides a fair bit of physio, is get off the damn painkillers.

The post-op pain was bad for about two weeks, so, given the tolerance I’d already built up before the surgery, my dose of oxycodone was about 100 mg per day, spiced up with a side of morphine while I was still in the hospital. There wasn’t much follow-up care. Okay, I got a call from the ward doctor about a week after the operation to make sure I wasn’t paralyzed from the neck down, and I’ll see the surgeon for a check-up in another month. The health-care system here is a bit spotty when it comes to individualized care. My family doc couldn’t even remember what was wrong with me, five days after I left the hospital. It was a herniated disk, right? Um, no, wrong. It was a stenosis, which means extra bone growth impinging on the spinal cord, and the solution was to take out the trash and then fuse three verterbrae. A pretty hefty operation. So, not having a clue as to the specifics, he simply asked how much pain medication (oxycodone) I needed and gave it to me.

But now comes the delicate matter of getting off the oxys — delicate because I lived (and came close to dying a few times) for these very drugs (or their cousins) a mere 33 years ago. So where am I at now? Should I have shaken my head, with a manly chuckle, and Just Said No? A lot of ex-addicts find this decision more agonizing than the pain. Check out some of the comments to my last two posts. They ask themselves: Is the pain relief worth the chance of going back to that terrible place?

Last week my post highlighted the glories of self-programming — both as a principle and as a concrete solution to an existential problem. I still think it’s a big part of the answer. But, as some of you cautioned me, the dividers in a pillbox are not exactly bullet proof. So I sometimes found myself taking a couple of Thursday’s supply on Wednesday, and compensating by borrowing from Saturday to Friday, and so forth. Why? Because I still like the feeling. Because the line between pain relief and the soothing calmness provided by opiates is impossible (at least for me) to pinpoint. In fact it’s not a line at all. It’s a space, a zone. And my self-control is good…but it’s not perfect.

So I took self-programming a step further. My agreement with my doctor about a weekly reduction (20 mg per week — about the fastest you can go and still avoid withdrawal symptoms) was already signed and sealed. (And by the way, that plan came from me, not him.) But for the day-to-day, I handed my neatly organized pillbox to Isabel and said, please give me the daily amount, as indicated, and put the rest away somewhere. I cleverly set up a system in which I have no control, and I did it as the ultimate expression of self-control.

Suggestion: if you don’t have a partner handy, use a friend, or maybe just ask your pharmacist, if it’s someone you know and trust. If you were creative enough to be a successful addict, then this is not going to be so difficult.

But why? Why should this attraction, this conflict, come back and haunt me now — so many  years later? The answer, of course, is to be found in the brain. When I teach about addiction, whether to my university classes or on lecture tours, I repeatedly pound in the critical fact that physical addiction and psychological addiction are two different animals. And yet psychological addiction is obviously physical, in the sense that it stems from changes in bodily structures — namely, synapses — the connections between neurons. Synapses in the amygdala, the striatum (nucleus accumbens), and the cortex blossom in new places or just get stronger — more easily passing electrochemical energy from one set of neurons to another — as we become increasingly drawn to a drug (e.g., oxycodone, crack, booze), an activity (e.g., gambling, football, playing the guitar), or a person. So what happens to synapses that are left “unused” for 20 or 30 years? There are two answers to that question.

1. They are not left unused. You know those dreams you wake up from in a sweat, all those years after giving up smack or Andrea or whatever/whoever it was? Or the images in your mind when you read that article about the scourge of methamphetamine use in Kansas? You just gave those synapses a very thorough workout. And that’s what helps them grow stronger.

OR

2. Just as with PTSD, there are synapses that “contain information” that is just too emotionally loaded to ever disappear completely. Strong emotion builds strong synapses. By sending floods of dopamine, norepinephrine and other neuromodulators to brain regions at the crossroads of emotion and imagery, the initial experience (especially when repeated) provides a sort of super-fertilizer for synapse growth. Like the patch of weeds that sprang out of that spot where you accidentally spilled fertilizer last season, those synapses may be essentially indestructible.

There are other variants to these answers. But you get the general idea. Development is not a two-way street. You can’t ever go in reverse. Which is why “recovery” is not about deleting addictive impulses or images. It’s about saying “No.” And saying it often enough. And then building new synaptic pathways from that point onward — and maybe connecting those up to other pathways that went dormant for a while — pathways that are also supercharged by emotions, but, in this case, emotions about nurturing yourself and others, loving and forgiving yourself (and others), and keeping yourself out of harm’s way. That’s how you change the meaning of the addictive impulse, you change its context, you change the value that getting some has for you. But as with other developmental landmarks, you can’t just erase it.