Category: Connect

Now that the shock of it has passed, I’m left with a fog of sadness and anxiety, a sense of things being wrong in the world — more wrong than usual. Everyone loved Robin Williams. He gave so much of himself in his films and on-stage that we felt we knew him intimately. He was easy to connect with. He became part of our personal worlds.

A few people have asked me what I think happened. Was his addiction to alcohol the problem, was it the inadequacy of his AA and other treatment choices, was it the shame he still carried during his dry periods, or his yearning to go back to booze and coke?

I think these are the wrong places to look for an explanation. In a somewhat bizarre interview with Decca Aitkenhead at The Guardian, published four years ago, Robin shifted the flow of dialogue directly to his personal problems.

After 20 years of abstinence, Robin started drinking again while shooting a film in Alaska in 2003. Here’s what he said about that moment in his life, quoted from the Guardian article:

“I was in a small town where it’s not the edge of the world, but you can see it from there, and then I thought: drinking. I just thought, hey, maybe drinking will help. Because I felt alone and afraid. It was that thing of working so much, and going fuck, maybe that will help. And it was the worst thing in the world.”

So why did he start drinking again?

[From the same article:] Some have suggested it was Reeve’s death that turned him back to drink. “No,” he says quietly, “it’s more selfish than that. It’s just literally being afraid. And you think, oh, this will ease the fear. And it doesn’t.” What was he afraid of? “Everything. It’s just a general all-round arggghhh. It’s fearfulness and anxiety.”

He continued drinking for about three years, then stopped. A residential rehab seemed to have helped, and he attended AA meetings about once a week since then.

He did not go back to drinking after that, as far as I know. But he must have been unable to deal with the anxiety that drove him to drink in the first place.

Those of us who’ve been through addiction know all about that fearfulness, that anxiety, that arggghhh. And the depression that is closely linked with it, and that reportedly engulfed Robin Williams in the last month of his life. Of those I’ve talked with, most have seen it up close, a jungle beast staring them eye to eye. I still feel it often. But I don’t use anymore, chiefly because that just makes things worse. Then the fear becomes concrete: this is what’s going to get me.

Otherwise, it’s just anxiety.

Just?!

We live in a dangerous world. The love and protection we got as children (whether we were smothered in it or had more occasional helpings) is gone. We realize that was a childhood gift. The world is a dangerous place. Everything is uncertain. We cannot control the threats of loneliness, loss of loved ones, the onset of disease or disability, the vice-like grip of sadness, and eventually old age (if you’re lucky) and death. We cannot even control our desperate deeds aimed at self-protection, harbingers of shame and self-loathing. At least not always.

We live in a time dominated by an existential view of reality. Few of us feel buoyed up by religion or hope of a pleasant afterlife. And yet we’re not very good at being here now. It’s not something we’re taught, and it doesn’t come naturally.

I think the fear, anxiety, the depression, the arggghh that became unbearable to Robin Williams is something we also know well. His death disturbs us so much, not only because we will miss him, not only because we feel for him, but because it reminds us of the brutality of that incessant uncertainty, that desolate isolation, which can turn into terror.

Of course we hear about the casualties. Philip Seymour Hoffman, and now Robin Williams. Yet most of us endure. We’ve learned something that Robin may have been too busy to learn. How to love ourselves a little. How to accept helplessness and keep going. How to absorb some degree of warmth and wonder from the universe, the same universe that refuses to grant us safety or permanence. Maybe battling our addictions has made us stronger, more open, more accepting.

 

I’m sorry that wasn’t true for you, Robin.

 

 

 

 

 

 

 

 

 

Well not literally. I don’t even like fishing. It’s boring and I hate eviscerating worms. But I am sort of entering holiday mode, and that’s why you haven’t heard from me for awhile. Judging by page-view statistics, many of you are in vacation mode as well. I HOPE you are having fun.

We drove for 12 hours from the Netherlands to the south of France a couple of days ago. Played an audio book for six of those hours and the boys slept through most of the rest. Now we’re staying in a very relaxing spot in Provence, the kids have a pool and other pastimes to occupy them, and I can hide away with my laptop and write write write. That is actually bliss for me. The best vacation I can imagine. I plan to finish my book, “The Biology of Desire,” within another month. Think I can do it?

We ended this season with three splendid guest posts that dealt with treatment/recovery issues. That followed my blow-by-blow account of getting off painkillers after spinal surgery. I think that was a good way to end “the season.” As with the Netherlands’ accomplishments in football, we maybe didn’t win the cup but we played well and got close. And okay, cheesy metaphor, but I really do feel that we are a team. The flurry of comments and discussions following each post were moving and intelligent, informative and productive. You wouldn’t believe how many emails I get congratulating me on the quality of this blog. A lot of that credit goes to you, my readers and co-posters.

By the way, my back is in great shape. Zero pain, which is very nice for two reasons: (1) I really don’t like pain and (2) it does have a tendency to get me thinking about painkillers. I’ve been off pain and painkillers for a couple of months now, and it’s all good. Life feels interesting, full of possibilities, and relatively content.

I may post the occasional piece in the next month or two, but probably won’t really pick up until we’re settled in California — Isabel’s sabbatical and my chance to start another book, beginning in September.

Until then, I wish you all a wonderful summer, full of peace, fun, mindfulness, relaxation, happy abstinence or moderate controlled use (whatever works for you) and — what seems to make it all happen — a healthy dose of self-forgiveness.

 

 

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.