Author: anonymous

…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.

This is an extremely relevant and useful guest post. I have come across many different formulas for a step-wise approach to recovery, but this is the most coherent and sensible one I’ve seen. The middle step is often our downfall, and Fred helps clarify the problem.

…by Fred…

In a recent post, Marc fleshed out the idea that addicts need to shift their perception of the tradeoff between their addictive behavior and the potential consequences of that behavior.  It is well known that addicts tend to overvalue the current rewards of using, and undervalue the potential rewards that might come from staying sober.  One definition of addiction is “emotional immaturity and lack of discipline,” and it is this difficulty in seeing the big picture that trumps everything else when an addict tries to revalue the tradeoff between using and not using.

In his book “In the Realm of Hungry Ghosts”, Gabor Maté builds on the work of Jeffrey Schwartz in laying out an approach to resisting relapse called “The 5 Rs”.  When the urge to use occurs, the addict is encouraged to “Relabel” the thought (it’s just a thought, not a command), “Reattribute” the thought (it’s my old addictive pattern again – my brain’s old behavior), “Refocus” (distract and turn one’s mind to healthy activities), “Revalue” (play the tape forward and clarify all the negative consequences that could occur because of relapse), and finally “Recreate”, where the addict focuses attention on his or her dreams for a new sober life.

1. Relabel

2. Reattribute

3. Refocus

4. Revalue

5. Recreate

The 4th and 5th Rs, Revalue and Recreate, are explicitly about addressing the addict’s distorted thinking when weighing short-term payoffs against long-term chaos.  But first, the addict needs to have enough mindfulness to consciously intervene in his or her own addictive cycle (the first 2 Rs).  See the recent post by Matt Robert for more about how this works.  At that point, it’s important to give the mind something else to do — to interrupt the cycle. This is where the third R comes in — Refocus.  This is a process that combines distraction and substitution to stop the addictive thought process and ritual, and, ideally, to address the deeper needs underlying the urge to use.

Addicts use, in part, as a form of mood regulation.  The addictive ritual and behavior releases nature’s mood enhancers — endorphins, dopamine, serotonin, noradrenaline and adrenaline.  Stress, boredom, loneliness, grief, resentment and other uncomfortable feelings can all create a desire for refuge and an urge to use.  Sometimes, simply being exposed to a certain place, or image, or a particular person, can start the cycle.  Revaluing and Recreating in that scenario are probably not going to be strong enough, especially in early recovery, to interrupt the cycle and protect the addict from relapse.  That’s because the unpleasant mood state that the addict is in (which is often accompanied by negative physical sensations) is difficult to tolerate, and the future benefits of staying sober are merely conceptual.  They alone won’t shift the mood.  This is where Refocusing (i.e., distraction and substitution) is critical.  By getting away from the immediate stimulus and unsafe environment, and focusing the body and mind on a healthy substitute activity, the addict has a better chance of riding out the urge to use, and sometimes directly address the underlying stressor and associated emotions.

When confronted with stress, a young child seeks comfort in the arms of a caregiver.  The endorphins released by the loving touch and soothing presence of the attachment figure help to calm the child.  Adults also experience endorphin release as a result of intimate touch and connection with others.  But, for the addict, this source of endorphins is typically unavailable — the addiction makes safe intimate relationships impossible.  Similarly, the elevated dopamine levels that accompany craving make it difficult for the addict to focus on anything but the anticipated high, thereby ignoring everyday activities that might otherwise be rewarding and satisfying.  The addict’s artificial mood regulation strategy cuts off the ability to regulate in healthy ways — through close relationships and meaningful activities.

Refocusing not only helps the addict stay sober until the urge to use passes, it can actually start inculcating new mood regulation habits.  Instead of relapsing in response to a trigger, the addict might develop the habit of picking up the phone and calling a friend in recovery, or going to a 12-step meeting, or exercising, or reading a novel, or doing a kindness for someone in need.  These types of activities will not only provide a distraction, they will substitute a behavior that reduces stress in a healthy way and helps to alleviate negative moods.

Faced with pain from life, our addictions temporarily soothe us, but they leave us more alone, and even more vulnerable to pain.  It’s suicide on the installment plan.  In recovery, faced with pain from life, we replace the mood-regulation strategy of addiction with caring for ourselves and connecting with others.  Consoled, we begin to believe in, and create, a future free from addiction and filled with the blessings of a life worth living.

This guest post is by Peter Sheath, another good friend, who, like Matt, I’ve only met in the flesh for a few hours. Peter knows a great deal about addiction and rehab. Here’s what he’s got to say about power and powerlessness…

I have been student of addiction for many years. Much of it involving the personal and, sometimes, painful elements of self-experimentation. I’ve talked to thousands of people and I’ve experienced the privilege, honour and genuine unfettered pride that comes when a person decides to trust me and invites me to share some of their journey. There is something very special that inhabits almost everyone I have come across who struggles with addiction. I see it in their art, I feel it in their performance. Read anything by Hemingway, The Old Man and the Sea in particular, or watch a Tennessee Williams play. Watch Philip Seymour Hoffman as he steals the show. Working with addicts, when you are really with them, is much the same. It’s almost as if they have a magnifying glass attached to them that blows up every little human characteristic to an almost unbearable level of magnitude. Beyond all the ego, bravado, and defiance are, almost always, frightened children. Who have lost their way and come to rely on the predictability of substances. Until they’re ready to move on.

To try to work with these people I firmly believe that I have a professional responsibility to work with myself. I need to be able to see beyond the narcissism of self and meet them exactly where they’re at without wanting to control them. In a line from a song, Willie Mason says, “It’s a hard hand to hold that’s looking for control.” That reinforces the idea that, if I do not have the presence to meet someone and accept them as they are, I shouldn’t bother meeting them in the first place. I have found, through bitter experience, that if I’m not with them it becomes my space that I’m working in. A space often populated by my dark side: a space I need to control.

Unfortunately many of the people working in treatment do not see any need for self-reflection and continued self-development. They have come to believe that they simply don’t have time. I’ve travelled all across the UK, delivering training, coaching and consultation, and it’s the same everywhere. Blame, intimidation, threats and arrogance become the tools of rehab, the vehicles of control. It’s just easier that way.

During a training session I was delivering a couple of weeks ago, one of the delegates said that the training was great but how was she supposed to do it when she had 70 people on her caseload? She was genuinely upset and was expressing her sense of being overwhelmed by the situation. I invited her to just take a step back, consider the situation as an observer, and try to see the 70 people as 70 individual opportunities for change. I said that each of those 70 people had the propensity to take responsibility for their own lives, begin to address the risks they were currently involved with, make some decisions and commit to actions to help with their wellbeing. Not rocket science, but it really did help her to see the situation differently, and  to realise that, by approaching her work in a different way, by handing over responsibility, she may have a lot less to carry on her own shoulders.

Unfortunately, and here’s the rub: when we have absorbed the ideology that addiction is a disease and we need to sort it out or cure it, we are unknowingly removing from the person the very thing that is going to get them well. By assuming the “expert” status we are telling people that they are sick and, as such, unable to take responsibility for their recovery. Walk into any treatment centre anywhere and suddenly you become completely incapable. You can’t even fill in a form yourself and you certainly have no capacity or competence to manage your medication. Even if you begin to take responsibility by getting honest and telling the workers you have used again, they will need to take a confirmatory drug test to prove it! “You will need to undergo an assessment, looking at everything that’s wrong with you…” Using a form filled out by a worker, because you can’t do it yourself. The process is repeated by any further “expert” you may need to see. Any initiative on your part will be viewed the same way: as an obstruction. If you don’t want a script or you want to go straight to detox, you will be met with, “you’re not ready for that yet”, or the classic, “people die doing it that way.”

In fairness, it is beginning to change, but I believe that change needs to begin with the workforce. It needs to begin with an admission that we’ve got it wrong. Then recovery can become a team process that includes the person doing the recovering.

Please note that we have a new Guest Memoir. Click the link above and check it out. Send in one of your own. These are potent, personal, and searingly honest portraits of the struggles and triumphs of addiction.

This guest post by friend, colleague, and contributor, Matt Robert has a five-star rating. Check it out…..

A meditation “practice” isn’t called a practice just because it’s something you’re supposed to do every day, like brush your teeth. It’s practice for a performance, like that of a concert pianist or a pro basketball player. What’s the performance? It’s that moment that occurs in the real world when you’re not meditating— the moment after a stressful encounter at work when you start to visualize hitting the liquor store on your way home. The performance is making a choice, a decision under stress: will you be able to not react reflexively out of fear or anger?  Mindfulness practice is training to be more open to all the possibilities a given situation presents—not just those possibilities we see from our own habitual frame of reference, with our own personal blinders on. It’s practice to take a look at what we’re telling ourselves. It’s practice to act mindfully in real life.

In the beginning, meditation is useful just to relax the mind and body. In a busy world, we seldom spend time just sitting quietly.  We’re always on the go. In meditation we bring the physical activity down, and consequently let the mind rest more in its natural state—closer to being free of judgment, opinion and the restless activity of the stories we constantly tell ourselves. This can come about just by focusing the mind on an object of attention, like the breath or a mantra, or a point in space.  It’s simple, but not easy.

The more time one spends doing it, the more thoughts and emotions become recognizable as discrete objects instead of part of an amorphous blob of cognitive gobbledygook. In CBT-based recovery approaches, one technique is to name your “addictive voice” or disturbing urge. It becomes a thing, a person, a tangible adversary—the thing that gets triggered in you and seemingly drives your car to the liquor store without your permission. Mindfulness practice helps us recognize that adversary at the early stages of its waking up and entering the room.

People in recovery meetings who engage in some kind of meditation or mindfulness practice frequently report examples of becoming more mindful of problematic behaviors and being able to sidestep them. One person got into a terrible fight with his wife that involved throwing dishes. His anger got to a level where he just put on his coat and headed for the door knowing full well where he was going. But this time his practice paid off.  At this “performance” time, he just paused for a moment and looked at what he was doing, noted his feelings, and realized it was not what he wanted to do in the long run.  He took off his coat and sat back down.

Another person was experiencing alternating episodes of fear, anger and resignation whenever she had to use her sober-lock device to start the car. Every time she had to blow into it, it reminded her how badly she had screwed up. Every now and then the device also gave her a false positive, which led to tremendous anxiety. Her anger and fear caused her to imagine going down the road to relapse on the F-it express, with a string of false positives as the catalyst. So she began meditating a few minutes before she had to start the car, took some deep breaths, and this fearful, resentful reaction began to dissipate.

Every time people can maneuver through one of these episodes, whether it is spawned by high emotion or a passing thought, another brick is laid in the foundation of their recovery.

Addendum by Marc: The neuroscientific research on meditation is a bit of a hodge-podge, but two brain changes keep showing up. There is a network of brain regions called the default mode network, which includes some posterior regions not involved in paying attention. We spend our time lazing about these regions when we are day-dreaming, fantasizing, wondering or worrying about the past or the future, imagining ourselves in different scenarios, but not paying attention to the present moment. When people meditate, and especially when they start to get good at it, the default mode network turns off more readily, and regions of the prefrontal cortex (especially the left) turn on. The left prefrontal cortex is where we go when we are paying attention. But the brain changes in another way. With meditation, there is increased communication between the prefrontal cortex and many other regions. That means that our increased focus on “now” can alter our habits, redirect our memories, and clarify perception and action — seeing and doing.

Most important to people fighting addictions, meditation increases self-control. The perspective and insight provided by the left prefrontal cortex organizes thoughts and actions, so that we can act in our own best interests because we see things more clearly. Behaviors that get us in trouble show up on the larger map of possibilities as trouble spots. That doesn’t fit! Going to that party in this mood is a recipe for disaster. Hanging out with Dave does not fit with an overall game plan to stay clean. Your left prefrontal cortex knows all this. With meditation, it develops the skills to bring that information to bear whenever you need it. We learn to bring focus together with experience and action — and that’s a powerful arsenal for people who are trying to remain safe from their demons.

Here’s another guest post, and it’s a winner. Sincere thanks to Matt Robert, a  SMART Recovery facilitator I met last June in Boston….

I’ve been spending a lot of time these days going in and out of locked detox units. And it’s interesting because, in most important ways, they haven’t changed very much at all. But I’ve changed, and the reason for my going into them has changed as well. Now I go into them because I want to, and I leave because I can.  I go into them now to talk about recovery.

There is a particular flavor of desperation endemic to detoxes.  The atmosphere is rife with anger, self-loathing, guilt, shame and defeat. People seem to bounce around among acceptance, denial and hair-trigger reactivity, along with the emotions that trail behind all three. The writing is on the wall everywhere: that one is about to lose everything, and that the way to arrest this decline is clear. Yet alongside these realizations is the feeling that one cannot stop, that one must find again the solace the addiction once provided but is now decimating, one day at a time.

Into this mix come representatives from recovery programs, telling the patients definitively that they are powerless and that they have to accept that.  Or that “you are not powerless, you always have a choice.”  Both ideas, either taken together or separately, can pave the way to recovery. But when they’re presented as diametrically opposed approaches in a marketplace of recovery programs, they may do more harm than good. Especially in early recovery settings.

It’s confusing when someone who is struggling sees all this wrangling about what’s the best method.  And probably most proponents of a particular approach would admit, if pressed: not everything works for everyone.  In the wake of actor Philip Seymour Hoffman’s death of a heroin overdose, the New York Times convened a panel of experts for an Op-Ed piece entitled “What Is Addiction?” Their views: It’s a disease and needs to be treated as such. It’s a choice and legitimate options need to be made available. It’s a form of learning. It’s a lack of the spiritual development needed to build inner strength. Or…what?

The recovery enterprise is a classic example of humans being human.  “If it worked for me, it has to work for you.”  But it’s those in the early stages, in detoxes and other harsh settings, who will be most negatively affected by the unintentional arrogance of the well-meaning recovery groups whose method is the “only way” that works. And all the rhetoric about powerlessness, choice, and whether or not it’s a disease may be nothing but a distraction that serves to impede recovery, not bolster it.

In every recovery group there are hardliners who argue that their way is the only way.  But there are often others who use their chosen framework to meet people where they are.  Although some in SMART Recovery emphasize its difference from “non-scientific” methods, most recognize that everyone is an individual with a unique development, and background, and set of needs, and that the recovery that works best is the recovery that works best for ourselves–even if it’s not in SMART.  It will be different for everyone, and the journey to being free of one’s addictive behavior involves discovering the unique combination of things that work. There is no “one size fits all” in recovery.

The beauty of support groups is that they provide a safe place to work on recovery—in fact, many safe places.  There is now a great array of alternatives to choose from.  But as SMART Recovery founder Joe Gerstein said in a 2010 interview with the The Guardian, “the coercion of people into AA, SMART, or other support groups…is ethically wrong, medically wrong and psychologically wrong.” Not to mention pragmatically wrong.  And it is in early recovery where this coercion is most likely to happen.

If we could stand up on a mountain and look down at all the different recovery groups, we’d see that, although they differ in some obvious ways, they’re all aiming to do the same thing. Their objective is identical.  And that is to achieve and maintain sobriety. Period. Not to advance some treatment agenda, or get funding for research, or compete ideologically. It’s not that the exigencies of funding shortfalls are unimportant. Or that changing the attitudes of the powers that be is a trivial enterprise. Or that there is no merit in identifying a scientifically grounded road to recovery. But for the lonely person staring out a window on the locked ward of a detox, this contentious posturing is just a distraction from the dire situation at hand, and from the task of piecing together a recovery that works.