Archive for September, 2014

Wealthy, famous, powerful, and addicted – Part IV

Sep. 29th 2014

Barriers to recovery: resentment and envy

Wealthism, perceived or real, hinders our recovery.

“If I had your money, I would never be an alcoholic.”

 

Our fourth topic has a different twist to it in that we are talking about how others react to us as a barrier to our recovery. This is a sensitive subject few speak up about, as we are generally afraid to expose wealthism. However, discussing how it impacts us when we seek help is necessary. Unlike other barriers to recovery, which impede our commitment to change, this one impacts those of us who actually want to quit and sober up. But when we run up against prejudice, we lose our enthusiasm, become defensive, and try to “just get by” until our discharge date.

 

The genius of the 12-step movement is that people with a common problem learn from each other in order to stop self-destructive behavior.

  • We recover in groups, not alone.
  • Recovery is about the ability to tell our truth to other addicts and be accepted for who we are, flaws and all.
  • It’s also about reflecting on, identifying, and delving into what’s driving our addiction.

Without a doubt, wealthism, or prejudice against the privileged, runs rampant in the treatment and recovery communities. It’s a huge hindrance in overcoming alcohol and drug use, because unless we feel safe and free to tell our truth, it’s difficult to even contemplate stopping. And it’s nearly impossible if staff resents us, stands in awe, or caters to us due to our VIP status. A common reaction is to internalize the negativity, resulting in self-hatred that becomes even more corrosive when compounded with the shame of addiction.

Our reality

Resentment and envy can make it difficult for us to connect with other alcoholics/addicts and participate in recovery programs:

  • We’re stressed over hiding who we are really are in conversations with others and the fear of being discovered. By keeping our wealth private or hidden from others in recovery, we are essentially living a lie.
  • We don’t connect with other alcoholics and addicts through the sharing of our stories because we don’t feel we can speak freely. We edit or suppress important parts for fear that the telling will lead to negative reactions. Thus, we never complete the first step – we never rejoin the human race.
  • We withdraw from others, which results in not being present on an emotional level. Our peers in treatment and recovery sense something is missing, but what is it? We listen, but we don’t reciprocate.
  • We feel guilty because we also believe that money could “buy happiness” and feel like we have failed. This guilt prevents us from expressing our needs. Do we deserve to recover, when we blew it?
  • We try to manage or adjust the situation to minimize or offset anticipated or actual envy and hostility. This is another way of not connecting or surrendering – we are attempting to exercise control.
  • We lose contact with reality by avoiding the mainstream recovery community. Without regular contact with ordinary people, our personal issues can spiral into major emotional crisis. In reality, our problems are often trivial when compared to those facing ordinary people.
  • We’re reluctant to ask for feedback. We may not want to hear some truths about ourselves, especially truths related to our wealth, fame, or status.
  • We are perceived as objects or stereotypes instead of real people with a disease that is killing us.
  • We fear people will take advantage of us (i.e., gossip about us, sell our stories to the media, ask us for money, etc.).

Above all, it’s hard for us to feel good about ourselves when we repeatedly hear negative messages. We become mired in self-loathing and can’t summon the strength needed to engage in treatment.

Wealthism: what we experience

These wealth- and fame- related issues that crop up in recovery are byproducts of wealthism in the recovery community. Simply put, wealthism is prejudice toward people with money, simply because they have money. It includes actions or attitudes that dehumanize and objectify us. Expressions include resentment, envy, and awe.

  1. Resentment is a form of hostility or anger.
  2. Envy is a covert form of anger. Envy is based on the idea that anybody can be rich, well-known, or powerful. So why is it you and not me?
  3. Awe is the (apparent) experience of being overwhelmed by the beauty or extent of the riches or by vicarious enjoyment of our experiences as moneyed or well-known people. Awe is an indirect form of envy. Concern for our feelings is overwhelmed by the excitement generated by wealth. We are simply conduits for the assumed “magic” in our lives.

Thanks to Joannie Brofman for her dissertation on the experience of inherited wealth, for coining “wealthism,” and for her forthrightness in defining the problem.

Wealthism: what it sounds like

As children, we tend to hear the direct words, while as adults we experience indirect variations like patronizing behavior, false friendships, exploitative business, or charitable proposals. But in treatment, the juvenile directness returns:

  • “Your father is so wonderful. You are so lucky! Can I touch you?”
  • “Listen, if you got problems with your beautiful wife, let me have her, I know how to make her happy.”
  • “Our unit voted and decided with $20 million, you will never recover.”
  • “How can you have problems? You are so beautiful, you can have any man you want!”
  • “Oh look, here is your picture in Elle.”
  • “You got it easy. Why are you working so hard in treatment? Your life is handed to you on a silver platter.”
  • “What’s it like to work with Brad Pitt?.”
  • “You are so lucky, I wish I had what you had.”
  • “Can I have your autograph?”
  • “Oh no, you are one of those people, I can’t sit with you.”
  • “With his kind of money, put up with the abuse.”
  • “Will you lend me money?”

Constant comments like these make it hard to want to fit in, and even more so without the support of staff, who fall back on stereotypes, like “trust fund baby” or “arm candy” for a successful spouse.

Blaming the victim

It’s no wonder many of us are labeled “treatment resistant,” uncooperative, or reluctant to participate in group activities. Who wouldn’t be when faced with outright hostility from peers and the failure on the part of treatment staff to intervene on our behalf? A prime example of blaming the victim, when in fact it is treatment that failed.

 

In other blogs in this series, my preference has been to postpone suggestions on ways to overcome these barriers to recovery to future presentations to keep focus on the “problem.” But because resentment and envy emanates from others and so hinders our efforts to sober up, it is better to explore what to do now. Later this week, we’ll continue discussing resentment and envy, looking at what drives wealthism and what we can do about it.

Wealthy, famous, powerful, and addicted – Part III

Sep. 23rd 2014

Barriers to recovery: materialism

Materialism: Doing or having, rather than being.

 

Our third recovery barrier is materialism: putting money, possessions, lifestyle, and image ahead of self-care and recovery. It feels good to travel, spend, buy, meet celebrities, attend that special benefit, or be so philanthropic.

 

We love our new Jaguar; it just glides! Have you been to our beach house? Yes, it is a Rolex. Have you met his new wife – she must be 25 years younger. What about that endowment at Harvard or that reserve in Africa? And the investments!

 

For the wealthy, prominent, and powerful:

  • Externals matter, so we purchase a lifestyle that reflects our success. This can include relationships as well.
  • Hanging out with others like us leads to an atmosphere of comparison and competition. Who has the biggest private plane? Gives away the most? Is closer to GW, BC, or BA?
  • Since we can buy the best, why not have the best? Schools, second homes – whatever it is we value takes on meaning, rather than focusing on the quality of our relationships.
  • We learn immediate gratification because we get what we want when we want it.

In addition to a materialistic focus, many of us also buy into the notion that money, prominence, and power should make us happy. And when it does not, we turn to “more” as the solution, falling further into this trap. Alcohol and drugs help fuel and medicate this ride. Addiction is essentially the ultimate “consumer good,” in the sense that having a drink or a pill always alters our mood.

The transformation dilemma

Recovery is founded on transformation, an awakening or desire for a different life. But it’s really tough to let go of our self-identification and attachment to status, position, money, and possessions. Whether positive or negative, these feelings intensify when addiction strikes.

 

After detox, the hard, core question is:

 

Who am I without my money, name, power, or fame?

 

This is another “dark night of the soul,” stomach-wrenching question that many of us don’t want to face because we realize that when all else is stripped away, we are left only with our addiction. We’re just like every other drunk or druggie.

Our reality

  • We are used to buying what we want or our way out of trouble, so we try to buy recovery. This does not work for alcoholism/addiction.
  • We believe our own press/bank account and give lip service to our counselors. How much do they make? How do they dress?
  • Success in the material world leads us to conclude we know how to recover.
  • Money is more important than our own health or recovery.
  • We buy our way out of life’s experiences, like treatment. How much more do I need to pay for a private room?
  • We have a limited life view. Example: Trying to figure how to fly first-class on the way home from treatment without succumbing to the offers of free drinks. Flying coach is outside the realm of considered options.
  • We tell ourselves that attending to career, social, and extended-family needs takes priority over treatment recommendations.
  • We call upon outside advocates or helpers to influence treatment professionals.

In treatment, it is so easy to focus on what we lost and want to regain by abstaining: trust fund disbursements, cars, houses, jobs, assets, position, stardom, etc. These seem to be the only way we can identify ourselves to others or feel secure in a new environment without a substance to fall back on. Above all, we comply and lie, in hopes of retaining a measure of what we think is self-worth or identity, rather than commit to recovery.

  • I am here for winter vacation from graduate school. If I go to a half-way house, I can’t get my degree on time.
  • If I don’t do the publicity tour, I won’t be hired for another film.
  • I must go to my family’s annual summer gathering or they won’t give me money.
  • Don’t tell anyone my job is a sham, I don’t want to lose my position.

When these and other core attitudes and behaviors surface, it’s a crossroads moment: We can decide to stay in our addiction or try a life without drugs.

 

On one level, this is about being unwilling to take a leap of faith and trust treatment professionals or our affluent friends in recovery. But on a deeper level, it’s a struggle to let go of attachment to the “material” and make recovery our first priority.

 

The realization

Some of us are lucky enough to have a light bulb moment where we realize that money and our other special attributes and resources are fueling the fires of our addiction. Others discover through self-reflection or interactions with others in treatment how money is a negative rather than a positive in our lives:

 

  • We experience an underlying sense of unease when we take a good look at the world around us.
  • We’re objectified by others we meet in treatment, our “peers” and counselors. (“If I had your money, I would never become an addict.”)
  • Some feel bitter and disillusioned, wanting to get rid of the trust fund, get out of town, and change our name.
  • We question if we really deserve all this when we’re given every advantage or have exploited, tricked, or screwed our way to the top.
  • We substitute money and material possessions for love, self-worth, or achievement – leading us to feel alone and like failures in our personal lives.
  • Money interferes with genuine relationships. Our friends and mates become dependent on us rather than establishing genuine relationships. As a result, no one says “no” to us – and if they do, we get rid of them or avoid them.
  • We struggle to relate to others. Our toys, prerogatives, and privileges act as a barrier to forming meaningful relationships because we never go deeper than surface-level.

When these thoughts come upon us, we can feel very isolated. We are migrating beyond our comfort zone into uncharted territory. Few counselors really understand how hard it is to reframe and sometimes disconnect from the lifestyle that we begin to recognize is destroying us.

We long for something more

Ultimately, there is a persistent, underlying emptiness – a void that we previously filled with drugs and alcohol. In treatment, we hear that spiritualism stands in contrast to materialism and wonder if we can live with the contradiction and what that means. How do we sober up without losing everything and maintaining our abundance, however we define it?

 

These are excellent questions to consider in later blogs. But for now, the focus is how wealth, fame, and power are actually distractions from recovery, easily diverting attention from real issues, like keeping one’s sobriety and being just a first name.

Alternatives to leverage

Sep. 17th 2014

Other models to encourage change when facing addiction

 

As anyone who has turned to the Web and typed in “addiction treatment” knows, there is an ever-growing number of options that promise a cure. These range from doing nothing, to medication management, to insight therapy. The wide variety of methods may puzzle the reader who wonders why there are no “best practices” or a commonly agreed-upon professional approach to treating addiction.

 

The reasons for this lack of standards are threefold:

  • Unlike other areas of medicine, claims for success are completely unregulated by the FDA, FRC, or health department. So it’s a buyer-beware, anything-goes market.
  • No established criteria exist for evaluating treating outcomes.
  • Most addicts do not want to stop and so go to treatment that lacks rigor or effective protocols, despite marketing claims to the contrary.

In fact, there is a best-practices model, and that’s the therapeutic leverage approach (modeled after the physicians’ program), which we described in last week’s blog.

 

That blog also briefly reviewed the accepted medical view that addiction is, in part, a disorder of the autonomic nervous system where the urge to use occurs at the unconscious, limbic level. That’s the “loss of control” addicts experience over how much and when to drink or take a pill. We also discussed the lack of motivation to seek help and remain treatment-compliant for the many months needed to achieve stable sobriety.

 

So in thinking about other approaches, consider how they address these hallmarks of addiction:

  • lack of control at the unconscious level, and
  • lack of perception and motivation to seek help and comply with treatment recommendations.

Then evaluate how each one manages these concerns in comparison to the leverage model.

Doing nothing

Waiting until the addict wants help

Many families prefer not to use coercion (leverage) because they fear a negative response from the addict or want recovery to be the addict’s “choice.” However, because the addict’s disease results in the compulsive and harmful use of alcohol or drugs (see above), you will be waiting a long time for this “choice.”

 

Here is what a leading authority has to say:

 

A myth is that the addict must be motivated to quit – that, as it is often put, “You have to do it yourself.” Not so. Volumes of data attest to the power of coercion in shaping behavior. With a threat hanging over their heads, patients often test clean.

Sally Satel, M.D. “For Addicts, Firm Hand Can Be the Best Medicine.” The New York Times, Aug. 15, 2006.

 

Even after explaining how we apply the physician model to other groups and their success rates, some parents are reluctant to use pressure, saying,

 

“My son/daughter will be so mad, s/he will never talk to us again.”

 

Anger and rejection are transitory threats made by the addict to preserve the status quo. A good counselor will help you manage these responses (and take some of the heat).

 

Without leverage, all the love in the world will not sustain recovery. (By the way, we do advise using leverage or the implied threat of leverage in a respectful and loving manner.) But doing nothing and waiting for a serious enough consequence is not an option. The risks are too great.

 

‘Letting go’

Common practice from Al-Anon, therapists, and counselors is to tell family members and their advisors to “let go” and not try to affect or “control” an addict’s use or recovery. This is not a successful recovery model because the addict is often suffering serious economic, emotional, and physical harm, with the attendant damage to family members, particularly children.

 

For the affluent, dangerous use can go on unabated, with few consequences, until late-stage alcoholism, overdoses, or nonstop use.

 

In our view, letting go or waiting for the addict to choose to enter treatment is, in fact, neglect because addiction – by definition – is loss of control over the decision to drink or drug.

 

Letting go does not honor autonomy because, at some point, the autonomic, unconscious part of the brain will override any vows to stop.

 

As one beneficiary said to me, “How come nobody tried to help me when they could see I was way out of control?”, after 20 years of hard use. 

Medication management

Craving-reduction medication

Naltrexone is an anti-craving drug designed to help alcoholics reduce their alcohol use and to prevent relapse. It can be helpful, but only as part of a comprehensive recovery program; it is not sufficient on its own to lead to stable recovery. If used, it needs to be combined with effective treatment.

 

Substituting one drug for another

Several well-advertised treatment programs substitute benzodiazepines (e.g., Xanax and Klonopin) for alcohol and hard drug use. These prescription medications are known as “alcohol in a pill” and users are simply swapping one addictive substance for another.

 

Similar considerations apply to “herbal remedies,” such as ayahuasca and rue seed, which are touted to cure addiction but affect the same areas of the brain as other hard drugs.

 

Suboxone is given as an alternative to opioids, such as OxyContin, because it results in a lesser high and stays in the body longer. Similarly, methadone is prescribed as a substitute for heroin. The problem is that users are just as dependent on the substitute drugs and will usually return to their former drugs when available. Another huge concern is that there is a large resale market for the substitute drugs because prescriptions are loosely monitored.

 

Anti-use medication

Drugs such as Antabuse have been used since 1951 to help people stop drinking by making you sick to your stomach if you have a drink. If you know you can’t drink, then you won’t think about drinking as much. This is an example of an external control designed to remain in place until the person develops sufficient internal motivation to achieve recovery. The problem is that many people on Anatabuse stop taking it or drink while on it and never reach the next phase.

Insight-based therapy vs. stopping the addiction first

Some therapists and treatment centers believe the addict needs to resolve the underlying conditions (i.e., the mental health, social, or other factors) leading to addiction before recovery can take place.

 

This belief is completely incorrect, not supported by research, and views addiction as a disease secondary to the underlying issues.

 

Addiction is a primary disease that needs to be addressed first, in that the addict needs to be detoxified and in the first stages of recovery before delving into the “drivers of addiction.”

 

I know addicts who see their psychiatrists two or three times a week for years and never stop using drugs. (Nothing better than an addict with money to keep on paying for therapy!) Addicts will give 100 reasons why it’s hard for them to stop and claim that if they can just get them resolved or gain more insight, the problem will be solved. This is all part of their smokescreen to keep on using.

Moderation management

This approach is designed to help people reduce their drinking (or drugging) to a manageable level where they are no longer binging. The goal is to still enjoy a beverage or a pill without the hangover or negative impact on work or relationships and to socialize without the stigma of being a non-drinker or – God forbid – an alcoholic.

 

If a person truly has a substance use disorder and the attendant brain change, it’s nearly impossible to exercise the control needed to maintain reduced use. This means at some point, there will be a return to prior use levels and that can be very dangerous, depending on when and where it happens.

 

Let’s face it: People drink to get a buzz on. So it’s no fun only to have a drink a day. (Or maybe it is, depending on the size of the drink.) Many “restrictors” are unpleasant to be around because their bodies “thirst” for that next drink, and the amount of willpower needed to stop at one makes them angry and bitter (i.e., “Why did God take away the only pleasure I had in life?”).

Assessment/evaluation model

This model is based on the idea that there is unsettling conduct, behaviors, or emotions on the part of the loved one, but uncertainty as to what may be the cause. So the person of concern is asked to obtain an evaluation or assessment – either outpatient or inpatient – to get a better picture of what is going on. Great idea, but your loved one has to agree, and then there is the debate about the type of evaluation, where it should be held, and who will be sent the results.

 

This segues into another phenomena: the addict who goes to treatment intending to stay awhile and then being “discharged” before completion, either due to disruptive behavior or leaving AMA. The addict is changing the attitude of his/her parents by ostensibly complying with their wishes but really is only going through the motions, with no intention of doing the internal, emotional work that recovery requires.

Drug testing

The success of all of these models is dependent on addicts being truthful about their use. As addicts lie, the only way to know what drugs are being taken is through drug testing with a competent service. Most users these days are taking multiple drugs but may only admit to one or two less-serious ones – alcohol and pot, for example – when they are also on benzos and ecstasy. Drug testing is a change technique in that it provides information about what is really going on, so the family and the user are on the same page. Also, drug testing, when combined with these various models, should lead to better results – either showing the need to intensify efforts or move to a more leveraged approach.

None as successful as leverage

None of these strategies is as successful as the leverage-based physicians model. Without the help of family and friends, the addict will continue to suffer as the disease progresses.

 

For families, the options are not leverage or choice – they are leverage or neglect.

 

Your addict needs encouragement to seek help, and this requires working with a qualified counselor to strategize and create a plan to address and manage the disease over the long term.

 

Our next blog will detail the benefits and fine points of using leverage.

Wealthy, famous, powerful, and addicted – Part II

Sep. 15th 2014

Barriers to recovery: lack of consequences

Lack of consequences: Using resources to shield us from the effects of drinking and drugging.

What problem? Call my lawyer!

 

We continue our exploration on the connection between wealth, fame, power, addiction and family dysfunction in today’s blog with a discussion of lack of consequences – perhaps the Death Star of barriers to recovery.

 

Most people seek treatment when they “hit bottom.” Whether they are arrested or lose their jobs, relationships, and money – life has become so unbearable there is little choice but to do so. Those of us with resources and influence avoid these problems. We are insulated from the effects of our drinking and drugging – what I call the Featherbed Syndrome. We snuggle up in our cocoon of delusion with little or no sense of how we hurt others or even ourselves, and therefore, with few incentives to change.

Our reality:

Buying our way out of trouble

When arrested for a DUI or drug possession, we can use high-priced attorneys, friends of the family, or our position to avoid jail.

 

Substitute child care

We can avoid our responsibilities at home by hiring others to do our work for us; so we can drug, drink, and party.

 

Not needing to work

We may work, but work is not essential for our existence. It is often a cover. Losing employment may be an annoyance that needs to be explained away but creates few incentives to stop. When we are our own boss, there is no one to insist on performance standards.

 

Media madness

For some, relapse may make us a marketable commodity for a show needing a ratings boost. At a minimum, it’s good for a few hits on our website, where we describe how we use our renewed strength to stay on the straight and narrow.

 

Home or work environment supports use

When those around us are dependent on us for their well-being, our addictions will be tolerated, if not encouraged. “The drug lady and her briefcase come at 11:00.” When fearful things will change if we sober up, our habits will be encouraged. We get rid of or avoid anyone who objects.

 

Self-made – not self-aware

For the self-made, the reach of our empires smooth’s over any flaws or warts that might bring ordinary men and women to their knees.

 

The code of silence

Above all, there is a code of silence, where those in positions of authority like to do us or our family members favors, and drinking or drugging are viewed as private matters to be tolerated and expected without much comment.

Rules don’t apply

Most of us were raised in a lifestyle where we grew accustomed to not experiencing significant consequences of poor behavior. Nothing happens to us when caught in anti-social behavior as children. It is ignored, covered up, or spent away. We also see our parents or older siblings avoid trouble through the use of high-paid help or influential relationships (although we may not be aware of what is really going on).

 

Those of us with special talents or favored appearances learn early on that same rules do not apply to us. It starts with school excuses, postponed work, going home instead of to jail, trading a smile or a look for a warning – all playing on the need of others to be connected to us in some way, even if we know we don’t mean it. When addiction strikes, the distortions become exaggerated:

 

Mirror, mirror on the wall, I know best and that is all.

The lack of corrective feedback as teenagers and young adults makes it difficult to accept information about our behavior that does not fit with our desires or view.

 

The sound of one hand clapping.

When everyone seems so happy to be around us, we buy into the idea that they must be right (and you, counselor, are wrong).

 

The avoidance of consequences by family leaders creates a culture negatively impacting successive generations where children are afraid to speak up for fear of being cut out of the will. Spouses can be influential, but many of us would rather find a new one than continue to hear about our excesses.

Lack of visible consequences

Many of us experience internal consequences from our use, such as emotional and mental degradation and loss of spirit. Unfortunately, we tend to see these as resulting from the actions of others or events outside our control. This “projection” makes it bearable for us to continue in our use. The lack of visible consequences can impact recovery in many ways: 

 

We believe we don’t have a problem.

We are often able to deny the problem and point to positives in our lives as proof that the problem does not exist. This is particularly true in comparisons to others: “I can’t be an alcoholic, I’ve never been in a car accident or missed a day’s work.” (What is that you do, exactly?)

 

Without consequences, we stay in delusion.

Because our addiction lies below our level of consciousness in the primitive mid-brain, we are not consciously aware of our self-deception or that your perception of our behavior is more accurate than our own perception. In essence, our unconscious, primitive mid-brain tells us we must use or we will not survive. We buy into this message hook, line, and sinker and will continue to do so until we die.

 

Multiple/delayed treatments.

The result can be multiple treatments to please others. Only when the consequences of our use become severe enough or others confront us with sufficient leverage so as to break through our “must use or die” internal bind, do we admit we might have a problem we need to look at.

 

Enforced abstinence seldom succeeds without the lifestyle connection.

Many times we are able to experience periods of abstinence only when access to money, prominence and power are restricted by others or our own severe physical consequences. Unfortunately, during these opportunities to gain insight, little support is provided so we can see how our resources help get us to the spot we’re in.

 

Without consequences – without feeling the impact of our addiction – it’s unlikely we will stop using alcohol or drugs.

Make the disease real

When sitting in evening lecture, night after night hearing speakers say we had to lose everything in order to recover, I began thinking of ways to make the disease real. Asking myself, how can we recover without losing everything? This is a topic to explore in later blogs, but I will say that it has lot to do with our being accountable by developing recovery agreements and relapse plans. In other words, offsetting the Featherbed Syndrome by creating external consequences and prioritizing recovery activities.

 

In the next installment of this series, we will discuss how materialism and the pursuit of money and possessions stifle self-care and recovery.

When addicts say no

Sep. 11th 2014

Using therapeutic leverage to encourage change and promote recovery

 

When alcohol and drugs assume a life of their own and begin to influence and, at times, take control of the behavior of the user, family members and advisors wonder how best to respond. The simple answer might be, “Why not ask them to stop?”

 

But anyone familiar with a substance user knows this request is very likely to be ignored or objected to (sometimes vehemently). The concerned person who is rebuffed or too afraid to ask the question faces three major challenges:

 

  • Understanding what is going on in your loved one’s brain.
  • Lack of motivation to change his/her behavior.
  • In the face of resistance, deciding on the most effective option to encourage the addict to seek help and be successful in recovery.

 

This blog will briefly discuss these challenges with an emphasis on why we much prefer “therapeutic leverage” to encourage addicts to seek help, versus other commonly-used approaches. As one parent wrote about her young adult child:

 

And the truth is without mom and dad forcing change, as some point either the law will force change, or tragically life will.[i]

 

This the stone cold truth – it is reality in world of addiction. And the purpose here and in the next few blogs is to talk about leverage and compare it to other, less-effective approaches.

Understanding the disease concept.

The first thing those dealing with a substance user need to remember is this:

  • It’s not your loved that is rebuffing you, it’s the disease.

With brain scans, we now understand addiction as an “automatism” – a disorder of the central nervous system partially located in the limbic system – the fight-or-flight area of the so-called primitive brain, which tells itself “I need this substance to survive.”

 

The intensity of the reaction to any request to stop is directly related to the limbic system’s commitment to the drug or drink.

 

This commitment to use can be for several hours a day, on weekends only, or two-to-three days a month. It’s not the frequency of use – it’s what happens as result that matters.

 

In order for the limbic system to become less reactive, an addict must abstain from mood-altering substances and learn new responses to the desire to use. This means in discussing change strategies, the idea is to look at the model(s) that provides the best opportunity to achieve abstinence in the long run. (If you, the reader, do not buy into the disease concept, you have an obligation to present credible alternative scientific evidence to support your view.)

Lack of awareness on the part of the addict.

One major hurdle is what we call the “self-perception” problem. A high percentage of people who need treatment do not believe they need it. They do not perceive themselves as having a problem with alcohol or drug use and are resistant to being told they need help or to seeking treatment. For example:

 

Of the young adults who needed but did not receive substance use treatment in a specialty facility in the past year, 96 percent did not perceive a need for treatment. Of the 4 percent of the young adults who did perceive the need for treatment, less than one-third made an attempt to get treatment.

 

This holds true even if there is a crisis that outside observers consider to be overwhelming dependence on alcohol or drugs: DUI, low grades or dismissal from school, car accidents, failed relationships, or a consistent pattern of binge drinking.

 

The addict’s inability to see the need to change is one of the core conditions that an effective approach to encourage the person to seek help must take into account. Addicts are not merely in denial, they are delusional because of lack of awareness regarding behavior or attitudes. Therefore, any change strategy must focus on chipping away at the self-perception problem – the delusion that the addict is fine as-is and you are the problem.

 

This can take weeks and continues on even after entering treatment. For example, merely because someone agrees to seek help does not mean they fully understand what they need to do to recover – the “learning process” is ongoing. Addictions are different from other illnesses in that the degree of effort is greater for recovery, and it requires a unyielding determination to remain abstinent no matter what.

Choosing a change model.

While there are a number of different approaches used in the treatment field, we firmly believe in the leverage model used by medical boards for substance-dependent physicians because its results are spectacular when compared to other approaches. Let’s look at the numbers:

 

“The research showed that 78 percent of 904 doctors in the studied programs completed an average of 7.2 years of monitoring without relapse. …

Those are just over-the-top numbers for a chronic, progressive disease that kills people.” – Dr. David Carr, Director, Mississippi Physicians Health Program

 

Seventy-eight percent rate of continuous abstinence at seven years!

 

These results are much better than those for other programs. (And the data is reliable because it is based on regular drug testing overseen by medical boards, rather than self-reporting or very small, restrictive samples, as is the case for success rates reported by other programs.)

 

One reason for their very good outcomes is that medical boards use the license to practice medicine as leverage or pressure to assure that physicians comply with treatment recommendations, including post-treatment plans and reliable drug testing for two or more years.

 

“A skeptical argument often goes that physicians are a special case because the threat of losing a lucrative profession they have worked so long to pursue gives them extra motivation to stay sober.

 

But Carr believes most everyone has something similar in their life that they value, and that is what the treatment system must identify and tap into.

 

The plumber has a good job and doesn’t want to lose it,’ he says. ‘Or he’s got a great wife.’

 

Carr says the field needs to analyze what it is providing to groups such as physicians and airline pilots but not to others. Then it can determine how to overcome barriers to a more widespread application of a treatment model that is based on accountability.”

 

Our goal, then is to identify and tap into what the addict values and does not want to lose.

 

Finding and using leverage points.

Parents, family leaders, trustees, and business owners need to find pressure points to encourage their addicts to enter treatment and comply with post-treatment recommendations, via either explicit or non-explicit leverage.

 

  • Explicit leverage includes using continued employment, access to funds, and professional licenses as incentives for compliance.
  • Examples of non-explicit leverage include requests to seek help, embarrassing social incidents, and school or employment failure.

 

Non-explicit leverage is far less effective because it does not provide enough pressure for the addict to engage in recovery activities long enough to sustain stable abstinence.

 

Using leverage to encourage compliance with treatment recommendations over many months helps make the disease “real.” People with few external consequences – especially those with wealth, status, and power, who are immune to the Average Joe’s “rock bottom” – begin to recognize they do have a problem, particularly when there is accountability and drug testing.

 

Why leverage works

The primary goal of applying leverage is to modify behavior by encouraging the addict to seek effective treatment and follow post-treatment recommendations. The pilot and physician model is, in essence, forced behavior modification in which the addict is required to engage in recovery activities until they internalize the desire to remain sober.

 

Internal motivation is a more powerful predictor of recovery than external motivation. Moving from external motivation to internal motivation is a long process. Therefore it is critical for external pressure to continue until this transition is fully underway, if not complete. The failure to follow this advice is a major cause of relapse. (Paraphrased from report.)

Susan Merle Gordon. Relapse and Recovery: Behavioral Strategies for Change. Caron Foundation Report. 2003: p. 18.

 

As noted in a New York Times article, “The Secret of Effective Motivation,” internal reasons for remaining sober are far more conducive to success. Therefore helping people focus on the meaning and impact of their new life without drugs or alcohol is one of the primary goals of treatment, beginning with initial detoxification and continuing on as a life-long process. We cannot stress enough how important it is to maintain pressure until the addict is motivated to recover for the sake of recovery, and not for the benefits of doing so – or the punishments for failing.

 

Leverage is a strategy to obtain compliance – it is not treatment.

Leverage is not treatment. It is a technique to get the addict to enter treatment and stay in recovery. So you have to find treatment centers who support your use of leverage and has an abstinence-, 12-step-based program that respects and treats the individual clinical needs of your loved ones.

 

In upcoming blogs, we’ll discuss other aspects of leverage as well as other approaches to treatment and recovery and why we believe these fall short of the therapeutic leverage model.

 

[i] Lynn Benson, Star Tribune 8.6.11

Wealthy, famous, powerful, and addicted – Part I

Sep. 9th 2014

Barriers to recovery: being special

Being special: Feeling unique, different, and superior.

Are we too special to recover?

 

In a previous blog, we discussed the connection between wealth, fame, power, and addiction and family dysfunction. We said:

 

The advantages and privileges of money, fame, or power support and feed our use of alcohol and drugs. When using, the very resources distinguishing us from others are in fact part of our disease and in essence killing us.”

 

We selected eight areas to explore as barriers to recovery, beginning with being special – the topic for today. As we know all too well, treatment centers and counselors that cater to the wealthy do not understand or adequately address our core issues  one reason for our high relapse rates. So if we want to achieve stable recovery, the only alternative is to start identifying and exploring them on our own.

 

There is a fine line between feeling good enough about ourselves to want to recover and too lost in ourselves and the expectations of others to keep from taking action to do so. Reflecting on being special will likely be uncomfortable for many, but we feel that unless we face some hard truths about ourselves – our reality – we will remain stuck in our addiction. So our goal is to consider some common experiences about “being special” and, if you identify with some of these traits, ways to respond positively.

Being special: a core issue

As people with wealth, status, and power, we often feel better or different than others. And why not? People want to befriend us, be near us, touch us, sleep with us, drug us… We’re the center of attention at social and professional gatherings. For some of us, the media reports our every move.

 

Where does the notion of being special come from?

  • From how other people treat us as children and adults.
  • From our search to secure love and affection.
  • From our need to wield influence over the feelings and behaviors of others.
  • From our experience growing up as children seeing how others treat our parents.
  • Being watched and courted for our imagined power, access to funds, social set, or our bodies.

It’s not the size of the town that matters – the important families in the smallest of towns experience this phenomena, particularly if they are “the town.”

 

Because other people are constantly affirming that we’re important, we begin to feel that we are entitled to special treatment. This “specialness” can directly impact our recovery in many ways:

  • We need to be special. Special treatment confirms that we are, indeed, special. Without it, we feel unsafe or unloved. So we insist on unique treatment so everyone knows we are important. This demand for special services makes it difficult for people to tell us what our real clinical needs are and limits our ability to connect with other people in recovery programs.
  • People tell us what we want to hear. Our friends, publicists, lawyers, agents, and groupies tell us we are not the problem. Our use is due to our schedule or pressures. We can’t get sober because we are going to the wrong treatment center, therapist, or program.
  • We make our own rules. We use lawyers, lobbyists, or agents to beat the system and obtain special favors. We believe that rules, including the rules of recovery, apply to other people – not us.
  • We create a public image – and live it. Often as a result of childhood abandonment and rejection, we create a false, admirable self to assure we are never alone. It is easier to buy into the image than deal with our life as it is. We start to believe this image is who we really are – we want to be recognized, sign autographs, and give gifts – even in treatment. The problem is that our addictions live in that image.
  • We fiercely protect our public image. Without our public image, we fear we will have nothing or be nothing. We live in constant fear that people will find out about the “real” us. Not only does this fear prohibit us from participating in recovery programs but it gets worse without drink or drugs.
  • We can never achieve enough. To know a wealty or famous person well is to know what cherished fantasies he has not fulfilled.”* The need to achieve more and more keeps us from being OK with the fact that we are alcoholics or addicts.
  • We are important to the world. Our careers (even if non-compensated) can put us on a treadmill that we can’t get off. We believe our donees, fans, employees, or constituents depend on us to continue working. We don’t have time for treatment.

Ultimately, these are the primary negative consequences of being special:

  • It’s hard to find personal power that is not at the expense of other people.
  • The desire for excellence to show we deserve being special leads to an inability to admit we may need help.
  • Our belief that we have valuable contributions to give to others or the world makes it difficult to hear from others or accept a program of recovery without trying to improve it.
  • Lack of empathy for or understanding of the points of view of others or their problems.
  • Overly-intense emotional reactions when things do not happen as we think they should.
  • For those related (or in the entourage), derived power and vicarious living is a great substitute for the real thing, even though one must make appointments to see the “special” relative (e.g., going through a scheduler to find time to speak with a famous parent).

Above all, are we taking the easy way out by falling for any offered “cure” other than the self-examination, behavior changes, and lifestyle adjustments necessary to recover?

           

How does it feel to be on your own, like a rolling stone?

 

Not so good – in fact, terrifying! Hand me the Xanax or that joint. What about a little Molly or a handcrafted whiskey?

Mixed emotions about being special when thinking about recovery

We have mixed emotions as to whether we want to think about this topic, let alone discuss it out loud with others. That’s partly due to feeling badly around newly-recalled memories of inappropriate (all right, obnoxious) behavior when using. And it’s also because if we start to look at the details, it will mean cutting back and changing – become less “special” in order to become clean.

 

Then there is the very real problem of finding a safe place to even begin to reflect on the topic, let alone start a conversation. Trustworthy and empathetic counselors are hard to come by, whether in or out of treatment centers. Sometimes affluent friends in recovery can be really good listeners, share similar experiences, and can be very supportive. Otherwise, try journaling and thinking about some of our ideas.

  • Accessing the shame over childhood abandonment and rejection as part of evaluating the drive for success. Where is the trauma?
  • Looking at the pros and cons of the public image. What does it do and not do for us?
  • When the public self denies the private self, the contrast creates personal fraudulence. How much of a fraud am I?
  • Evaluating fears about disengaging from our entourage, staff, or family office. What is it about being on our own with others who don’t want something from us that is so frightening?
  • Focusing on the let-down after the performance or the spending spree. Why is the “high” of the applause, exotic trip, or last purchase so difficult to sustain?
  • Reality checks with ordinary people. May be a reason to go to meetings and just listen.
  • Perform more of the basic functions of life. A “chop wood, carry water” philosophy. 

Ultimately, those of us who suffer from feeling or being special need to be willing to expose that which we are ashamed to see that others can accept us for who we are – flaws and all. This is definitely a “dark night of the soul” journey where it is easy to get lost in despair, so look for that trusted counselor or friend to join you in your travails.

 

In the next installment of this series, we will discuss how wealth, fame, and power insulate addicts from the consequences of their behavior/disease.

 

* For more on this topic see “Fame: The Power and Cost of a Fantasy,” an article in The Atlantic by Sue Erikson Bloland, daughter of Eric Erikson.

Return to reality – Now what?

Sep. 2nd 2014

Smoothing the transition from treatment to daily life

For almost all families, 28 days in treatment passes far too quickly. It seems like you’ve just breathed a sigh of relief that your loved one is safely stashed away, and bang! It’s discharge day!

 

Now the hard work of recovery begins.

 

Contrary to popular belief, 28-day inpatient treatment at a center is not a cure for addiction. In fact, it’s only the beginning of the hard work of recovery. The hardest work – and the biggest barrier to sustained sobriety – is in transitioning back to daily life. Many recovering addicts and the people who love them forget this fact – or have never been told – and assume that life will return to the way it was “pre-problem,” now that the problem is “fixed.”

 

But the worst thing you can do is act like nothing has happened. Addiction is powerful. It changes – and damages – important relationships. But recovery is equally as powerful in its capacity to transform individuals.  Life, as you once knew it, is over. Everyone involved must be prepared to support post-treatment recovery and rebuild relationships.

 

Let’s look at some of the questions and challenges our clients and their loved ones raised with us, when adjusting to the “new normal” life after treatment.

For the addict

What to say to people who know they went to rehab.

  • Anxiety and discomfort about facing their loved ones now that their chemical dependency is out in the open.
  • Not knowing how much to disclose and whom to disclose it to. There is a tendency to overshare because part of treatment is talking to peers about using behavior.

What to say to people who thought they were on vacation.

  • Anxiety and discomfort about facing their loved ones if the reason for their absence was not fully disclosed to everyone. In treatment, the addict is taught they have a disease, but almost all people have shame over both their inability to control their use and conduct while using.

Concern about being judged, stigmatized, and labeled.

  • This is real, which is why attending support groups is important because everyone there has the same problem. Support groups offer a concrete way the person in recovery can rebuild self-esteem.

An unrealistic expectation that they can immediately repair past damage to relationships.

  • A good therapist, recovery coach, or sponsor is needed for advice.

Is there a support system in place before your loved returns from treatment?

 

An unhealthy desire to hit the ground running and to prove themselves.

  • This common problem can easily lead to relapse.
  • Setting up a schedule is a good way to prevent work from becoming the new “ism.”

Concern about social and work functions that involve alcohol.

  • Support is needed to skip all non-essential functions and to take a non-drinking partner if attendance is required.

Are you prepared to refrain from drinking in front of your loved one and taking the alcohol out of your house?

 

Embarrassment about needing to prioritize recovery.  

  • These feelings reflect the addict’s shame. Be a positive supporter of putting recovery first.

For the addict’s friends and loved ones

Confusion about how to support the individual.

  • Ask! This is an ongoing and evolving concern that is often best talked out with a skilled addiction counselor or recovery coach.

Uncertainty about trusting them.

  • One advantage of regular drug testing is that it increases the confidence level for family members and helps deter use.

Who is going to “bell this cat”?  Will the treatment center, your addiction specialist, or you initiate this conversation?

 

Lingering emotional wounds or unprocessed resentments from past behavior.

  • These are not going to simply evaporate through superficial “forgiveness sessions” at a family program.
  • Wait for stable recovery to take hold before bringing these up with your loved one (preferably with a counselor present).

Reservations about including them in social functions where alcohol may be served.

  • Brain scans show environmental “cues” can trigger urges, so this concern is valid.
  • Why take unnecessary risks? Options are to give a pass, suggest you all go to an alternative activity, or if it’s a must-attend, you refrain from drinking as well.

Lack of education/understanding addiction as a disease concept.

  • You don’t know it all after a few days at the family program.
  • Ongoing education about the disease is a high priority to avoid mismatching expectations and reality.

Unrealistic expectations that the individual is cured.

  • You need a good grounding in the stages of recovery; this takes many months.

Yes, there are different markers for progress, do you know what they are and what level your loved one is at when leaving inpatient?

 

Concern about how to cope in the event of a relapse.

  • This should be addressed during inpatient treatment.

Is there a written relapse plan in place?

Picture this!

Remember seeing the ad where the high school kid with cancer has a bald head and all her friends shave off their hair to show solidarity? Well, keep that image in mind. We are all in this together.

Plan ahead!

A common theme is that this transition can be smoothed with thorough preparation and planning. Having a solid, workable, well-informed, and practical plan in place before someone returns from treatment can substantially increase the likelihood of successful reintegration.

 

The plan should address the needs and challenges of both the family and friends and the returning individual, keeping in mind that mismatched expectations are common but avoidable through clear and open communication of the issues faced by both parties.

Professional help

Above all, find a qualified addiction specialist for support – someone you can call with questions and can help you prepare a recovery plan and contract.

 

For additional information on putting a plan in place for post-treatment recovery, see the following articles:

Case Management for Families Dealing with Addiction Recovery: Dual-Track Method

Financial Managers and Dysfunctional Clients