Category Archives: Addiction Recovery

Removing the Shame and Stigma Associated with Addiction Treatment

There are many hurdles to accessing help. With more than 23 million people in need of treatment and less than 2 million receiving any level of care, there is something in the way. There are many theories out there about why this is. Of all the hurdles, to negotiate, there is likely none higher than shame. Consistently, people cite stigma as a major reason that prevented them from reaching out for help. In the midst of a fever pitch crisis, losing 160 people a day to overdose, there is a moral imperative to remove the shame and stigma.

Check out this new film featuring Joe Schrank in the subject of reversing the stigma:
“Reversing the Stigma“.

Recovery Rangers

It’s national recovery month, you must have seen the news coverage. You didn’t? That’s because there isn’t any. For a condition that has plagued man since forever, that has destroyed families and communities, and spawned an us winnable drug war, we as a culture, don’t pay much attention to the reverse side of the addiction coin. Recovery. Consider that the NFL wears pink cleats for breast cancer, and well they should, but where is the support for the issue of addiction and recovery? In a small but very important way, it’s alive and well in the Texas Rangers clubhouse.
Recovery Rangers
I have long regarded the Texas Rangers as the top sports franchise for recovery. While I have tried to ask why, I haven’t had much luck with a sit down with team head honcho, Nolan Ryan. Some years back, the Rangers manager, Ron Washington, tested positive for cocaine in a routine drug screening. He promptly issued a statement and gave his resignation to the Rangers. It was then that the Rangers demonstrated their understanding of addiction. Nolan Ryan rejected the resignation of Washington and opted to work with him. It was a bold statement of compassion and understanding of how addiction works and how recovery can work.

Supporting Team Members During Addiction Recovery

The Rangers won the AL West and it was met with the usual dog-pile merriment. It’s a major accomplishment, it might be one of the hardest things in sports to accomplish. Among the Rangers current roster are Jeremy Jeffress and Matt Bush, two young guys who are recovering alcoholics. In a bold move and departure from the usual callus disenfranchisement of alcoholics, the Rangers went the opposite way buy supporting Bush and Jeffress and their recovery. Instead of spraying champagne, the Rangers opted for ginger ale, a small but important gesture. There are two outcomes if the Rangers didn’t support these two, relapse or isolation. Bush and Jeffress would have either been swept up into the group norm of drinking or they would have sat isolated from the rest of the team.

Sports is a powerful system. It has the power to shift the culture in many directions. The recent media frenzy over Colin Kaepernick shows just what a loud voice sports has in American life. The sports world is rife with is sure regarding alcohol and other drug use, it’s a daily occurrence if one looks. Seldom, if ever, do we see the victories and that’s too bad. Additionally, we don’t see nearly enough of good drug and alcohol policy that can genuinely help people. MLB has pink bats for breast cancer, they are major participants in “stand up to cancer”, almost every night at an MLB stadium has some kind of advocacy attached to it. I have been to “dog day” at the Mets home Citi field to raise money for shelters, autism speaks, special olympics, veterans causes, all noble and worthy endeavors, but what about recovery? Why isn’t there a night for recovery month at any MLB park?

While they may not know, the Texas Rangers are the top team in all of sports for dealing with issues of addiction and recovery. They have shown they support people who are actively using and those who are in recovery and want to stay there. When a public system like a professional sports franchise is faced with issues and recovery, often times they spin the issue until it dies a news death. That needs to stop and the Texas Rangers are leading the way. Well done to Bush and Jeffress and well done to the Rangers. Should they win the World Series I hope they make a very big deal out of showering each other with ginger ale instead of champagne.

Quitting Drinking Found to Extend Life and Ability to Dispense Unsolicited Advice

Quit Drinking

Success in AA Includes Ability to Dispense Advice to Virtually Everyone About Virtually Anything

AA is an organization that is riddled with holes and contradictions. It happens to work for me. The steps are something I found to be very useful as a focal point of effort and ideals for which to strive. The fellowship of mutual help and peers was critical to my success in sobriety. I am lucky. Very lucky. The first time I walked into an AA meeting and thought “these guys look like guys I could have known at USC” it was life altering, more than anything, it made being sober ok and as a young man, I needed that permission. That era of my life was fun. I had friends, we had a robust life exploring Manhattan in a pack with few limitations other than not getting drunk. While I have great gratitude for AA and the people who helped me, I understand it’s not a fit for everyone. What’s the big deal? Isn’t that why they make chocolate and vanilla?

For many, the AA experience can be misery. A lack of connection, not finding the right peers, it can feel like it’s little more than deprivation punctuated by really lousy coffee. This is the life for which I am supposed to stay sober? When I went to graduate school in a Midwestern land grant rural community, AA was a much different thing. Mostly older men, many were cold and unwelcoming to students, the access was restrictive. The mitigating factor was hardly the gossip about the price of corn. Had that been my introduction to AA, my story could have been dramatically different.

AA Slogans for Recovery

AA is nothing if not full of slogans, many that make no sense, some compounded with rhyme as an added layer of mystique and aggravation. Here is a list of some of the more blaring examples, along with the often forgotten component of their meaning.

  1. “You’re as sick as your secrets”. Yet, you’re not supposed to tell anyone about AA, thereby being asked to be part of a secret society. Never mind that it’s not a secret, the pods of people smoking in front of a church is really the cat out of the bag.
  2. “If you’re taking inventories, take yours”. Great advice, seldom heeded. There seems to be a caveat that if YOU were successful you have the right to critique others, endlessly as well as assume role of soothsayer, doctor, clergy and just about any other discipline one might need.
  3. “We know but a little”. This is written in the AA big book but often cast aside for apparently knowing everything that people should do without knowing them.
  4. “Live and let live” but first inform that by not living as we live, you will die. Live on!
  5. “This is a selfish program”. Accurate to be sure. So selfish, in fact, it leaves no room for an individual to self determine.
  6. “Be part of the solution, not the problem”. The problem is complex, deep, wide, and individual. Pontification that you have the solution is a big part of the problem. So be a part of our solution of which we approve or else you will die.
  7. “E.G.O. Edging God out.” For a program that has a minimal requirement of a “desire to stop drinking”, there is an awful lot that must be believed. While the rhetoric is “you’re higher power could be the doorknob” the truth is, you will be an outsider, judged, subtly and not so subtly coerced, patronized and preached to if you in fact dismiss God to the level of a doorknob, never mind if you are a person of questing faith or no faith.
  8. “Be nice to newcomers, one day they may be your sponsor”. Really? For an organization that is so invested in a hierarchy of time, deifying members for being around longer than others, this seems contradictory.
  9. “An attitude of gratitude”. Yes. The rhyme. If ever there were a group of ungrateful people it’s in AA. Humans are not what we say, we are what we do. While other diseases have enjoyed the fruits of community organization and hard work, alcoholism hovers at the same dismal rates of recovery it has for generations. Grateful people work to help the process. Compare alcoholism to breast cancer: Research, walks, fundraisers, pink ribbons, MLB using pink bats to raise awareness and funds. Alcoholism, “hey man, I set up chairs at my meeting”.
  10. “We’re not a glum lot”. Let’s see if this blog gets any eyeballs, then judge for yourself by the comments the level of “glum”.

AA is a great organization to be certain. It is part of Americana that has helped millions of families and individuals. What it isn’t is perfection and something for all who need to address their drinking issue. The truth is, most people “fail” in AA and that has a big by-product of shame. Alcoholism is a complex illness, and not everybody does well in AA, most don’t. I am unique in the AA world being both grateful to it and critical of it. My message is clear, AA works, if it works for you. I have clients who have done well with it and others who abhor it; both groups have achieved and maintained sobriety and both groups haven’t. As always, there are never easy answers. There is no wrong way to get or be sober, don’t let the fear of AA stop you from trying or exploring options.

My Sponsor, the Plumber, Says I Have to Stop Taking Suboxone

Stop Taking Suboxone
Few things kick the hornets nest like a discussion of medication assisted recovery. It’s a stake your claim issue that stirs the pot in the recovery universe like no other. On the purist side are those who say addiction is a spiritual problem and only a spiritual solution can be used to solve it. The other side argues that science has progressed to the point where medication can help people stay sober for longer when they are medicated properly. So who wins? Nobody really but we know who looses, those seeking recovery. The infighting creates an even deeper level of complexity when one is finding their way out of the woods.

12 step programs have a long history in American life. They are largely viewed as a sacred cow institution. Through their history, they have helped millions of individuals, families, and communities improve and rebuild broken lives. There is little question about the potential value of 12 step programs. The issue gets sticky when well meaning people tap into being zealots and evangelicals, closed off to the possibility of other roads to recovery. The issue is further complicated by the deeply held belief that the program itself is infallible. If it isn’t working, there is a flaw in the individual who is attempting to make it work. That doesn’t stand up to any research or science. While nobody really knows, the estimate of 12 step membership is said to be a few million but 20 million Americans report themselves as “in recovery” but little is known about the process they used to get to that destination. Still, many experience 12 step life as cultish, coercive, shame based and intolerable. The truth is, they get to have their own experience. Like evangelical Christians and tea party goers, the belief is “without Jesus, you’re looking at eternal damnation, science notwithstanding.” It sounds a lot like a very common message heard in NA/AA “join us or face jail, institution or death”.

At some point, man figured out how to cultivate intoxicants. Chaos has ensued for some ever since. America has a long history of dealing with the problem. The “Whiskey Rebellion” almost unraveled a new country when George Washington attempted to levy a tax on alcohol to pay down the war debt. It came to gunfire. Prohibition was a nightmare entanglement of violence and crime as well as classism that did little to curb the flow of alcohol. From our very origins the enticement to train farmers to use a musket to fight tyranny was “free beer”. So what has been tried? Prayer is a big one. A problem so deeply saturated in our bones only an act of providence will solve it. Americans love believing God will take care of us because we are always right. We have tried criminalization. So far we have filled prisons while the DEA themselves admits “no meaningful or measurable change in the availability of drugs or drug use on the streets of America”. The “health issue” rhetoric has always circulated in the discourse about drug use but words have seldom matched actions. There is no other health issue that is treated with prayer and incarceration.

Medication Assisted Recovery

Just a few years ago, if one was hopelessly late and stuck in traffic the options weren’t great. Worried people waiting or pull over and find a pay phone. Today, a simple voice activated text will do the trick. Think about dentistry and how much easier and more effective it is now compared to even a decade ago. Even a stripped down economy car has a camera that assists the driver in backing up. So why is addiction still treated with prayer and incarceration? The truth is, it doesn’t have to be. There are more and more medical advancements made that can help people move away from addiction and into recovery and one of the ways is medication. The trouble is the paradoxical need to understand, the solution for some to the drug problem, might be drugs. If not the solution a big leg up in the problem.

Medication assisted recovery is without a doubt a viable intervention for some people. It should be available without shame or hurdles. The idea of withholding all options to drug addled people because of an individually held belief is simply wrong. In my view, it’s malpractice. I have reached a point where the selection of treatment must include centers that will work with medication. Treatment centers “forbidding” medication are obsolete and ineffective. The spirituality argument is a falsehood. Scientific inquiry and discovery are God given gifts and don’t exclude spiritual practice or so say and live the Jesuits and I buy it. If we are on one side of a river and need to get to the other, absolutely pray…but row like hell.

If we truly believe that addiction is a health problem then medication must be considered by the individual seeking help and work out the best plan with their doctor. Medication may or may not be the right path for you but if you have diabetes, another chronic health issue, you wouldn’t just consider prayer or a 12 step program, though peer support may help. Like all chronic health issues, addiction requires change. Change in lifestyle, peers, sleep, diet, and yes, medication. Not examining the possibility of the need for and benefits of medication is wrong. Addiction is complex, tricky, and needs every possible advantage to stabilize the wound. Parents who refuse medication for prayer when they have a sick child are arrested. Don’t make that mistake.

Is AA the Only Way?

Finding Other Alcohol Recovery Options
This is an age old question and certainly depends on who you ask. AA old timers will say “yes, without God and AA, there is no hope”. While that may be true of their anecdotal experience, it certainly isn’t true from a scientific perspective. The truth is, AA doesn’t allow for any kind of scholarly research, that violates the tradition of “primary purpose is to stay sober and help others achieve sobriety” so nobody empirically knows what AA does or doesn’t do. AA has become a cultural sacred cow, a pillar of health, wellness, hope and healing–and it is but only if that is your individual experience with it. For every person who has become a zealot laden member of the converted there are untold numbers of people who AA just didn’t help. The AA literature will label them “unwilling to go to any length”. So what is the real answer? Like many things regarding addiction and recovery, nobody really knows. There are many self ordained gurus who will claim they know but their sample size is usually 1, themselves. Consider the perspective of SAMHSA,(substance abuse and mental health service agency) the largest research body available on the topic of addiction and recovery. Samhsa reports that “more than 20 million Americans identify as being in recovery” (samhsa.gov). AA reports a fraction of that as global membership. So, who are these other people and what was their road?

Somewhere long the way “recovery” and “AA” became synonymous. That’s a falsehood that permeates the entire culture. When I first launched “Thefix.com” I received numerous letters from AA asking me to stop because “it violates the tradition of anonymity”. It took them a while to get their heads around the idea that by writing about addiction and/or recovery, it wasn’t a site about AA, although there may be references to AA with regard to the traditions. The truth is, there is no wrong way to find what works for you as an individual, it may be AA. People find it a great irony that I am both critical of and a proud member of AA. As a system it’s been great for me and tremendously helpful, so is Catholicism but that doesn’t make 700 million Hindus wrong. AA works of it works for you. If it doesn’t, find something that does.

Finding Other Recovery Options

A new era in addiction treatment is offering more diversified options rather than a 30 day AA meeting. Consider the picture in this article, it’s from a era long since past and yet it’s an accurate depiction of modern 12 step life. There are many ways to go, including harm reduction. Total abstinence is one framework for recovery and it may be the best one. Just like losing 50lbs may be the best bet but losing 25 is a great start and inherently valuable in and of itself. If you’re resistant to 12 step programs, abhorred by them or just curious about options, I can certainly help with that. Don’t let “I hate AA” be the thing to keep you from getting solid help and a new life. This story originally from Salon.com offers the perspective from a leader in the 12 step alternative world.

http://www.salon.com/2012/09/03/how_should_we_recover_from_addiction/

Urine Trouble or Are You?

Urine Testing in Recovery

For many, the metric of success in recovery is the binary urine test. “What was the urine test result?” Is one of the most common question we get from families. It is true, it is an important data point but it isn’t the whole story and maybe it’s not even the most important part of the story. A “clean” test, ironic name that developed given urine is waste, is cause for celebration while a “dirty” test incites anger and feelings of forlorn defeat. So what’s the real value of a urine test? The answer, like almost everything in the recovery world is: it depends.

The first thing to keep in mind is that a urine test is only valid for a very short period of time. Fast acting drugs like adderall or cocaine could easily be out of the body in the gap between tests. So even if a test is clean, it doesn’t mean the individual isn’t or hasn’t used. After many years dealing with urine tests, it’s also important to know that the addiction will pull in individual in to amazing lengths to manipulate a test. At least with the boys. Observing urine tests is one of my least favorite chores of the job but it’s needed if we’re going to get efficacy. Believe it or not I have said on more than one occasion “huh, there seems to be a visine bottle strapped to your ‘situation’, why might that be?”. The idea being, if one fills a visine bottle full of clean urine, one can simulate the act and come up with a clean test. At one point I had a DEA agent work out a deal with a urologist. Urologist would drain DEA agents bladder, replace with clean urine, DEA agent supplied urologist with cocaine. Bartering is a lost art but in this case? Wow, really? So what do they really mean?

Think of sobriety as a pie chart, a urine test is a 20% slice of the pie. We as a culture get very hung up on “total abstinence” which is great but it may take time to get there. A result of “dirty” doesn’t quantify. So in other words, a chronic daily user may have had an episodic use. If they used daily, came into treatment at some level and used once over the last 30 days, in my view, that’s great progress, let’s keep going. The notion of that being “failure” is shaming and shame never helps, not ever. Also, in the mind of those addicted the thought is “if they think I’m using anyway, I might as well”.

The poppy seed bagel defense. At some point, someone googled if poppy seeds could produce a positive result for opiates. The answer is yes– in theory. One would have to eat poppy seeds by the spoonful for hours and hours for that to happen, and yet, we hear “I eat a poppy seed bagel every morning, that must be it” all the time. The issue isn’t poppy seeds the issue is it sets up a cat and mouse dynamic. “You’re using !” “No I’m not” and that goes nowhere. When trying to support someone in regaining their life honesty without anger is key, not always possible but important. If there isn’t a dynamic of safety to self report, very little progress is made. So urine screening is important but what else is?

The greatest indicator of someone doing well in recovery is their actions. When words match actions over time, trust is built. Showing up on time, following through with what was said or agreed upon, new friends and interests, engagement in the community, going back to school are all solid indicators that a urine test just won’t reveal. Sustained recovery is more then using or not using, though not using seems to be the ante. It’s like spring, seeing new growth on barren branches. Lifestyle change is critical or it just won’t work for very long. Plus, urine tests are gross so it’s time we devalue them to being 20% of the pie rather than the whole pie.