Being Present

We stood at the turning point
– From Chapter 5 of the Big Book of Alcoholics Anonymous

Staying sober requires we develop skills that further long-term abstinence. While there are many ways to achieve recovery, I would like to discuss an idea which has been invaluable to me and a host of clients I’ve worked with over the last 32 years.

Being Present is related to the practice of focusing your attention and awareness based on the concept of mindfulness in Buddhist meditation. While Being Present is a relatively new approach to addiction recovery I have found this concept to have merit. I quit using alcohol and drugs over 36 years ago and have found success by incorporating this idea into my recovery and my life.

In 1985 I read a book entitled Chop Wood, Carry Water. The book bills itself as a spiritual treatise, a guide for dealing with the distress and chaos of daily life. I didn’t resonate with the spiritual aspects of the book, however, the title has remained with me and has reminded me of a simple truth: if you can’t chop wood, carry water. It’s the notion of playing to your strengths. Playing to your strengths is one of the keys to developing resilience and a major component in Being Present.

Contrary to popular belief, human beings cannot multitask. Rather, we are capable of handling a number of tasks in rapid succession. It’s akin to mixing automatic and conscious tasks and being mindful we can only do one thing at a time, no matter how much we wish for this to be different.

How do we remain present?

We remember some simple facts: most of our time is spent in the past or the future. By focusing on either of these we certainly miss the here and now. Perhaps you can consider that the past and the future do not belong to you. You are merely a witness for the present moment.

There are certainly distractions to the present moment. There are bills to pay, doctor appointments, books to read, kids to attend to, and all kinds of other things which vie for your attention. When we are distracted by everything else that has our attention it’s not difficult to understand why being present is so difficult.

When I am feeling distressed and wish to be present I simply close my eyes and think about why I am feeling uncomfortable. I run through my day and mentally hold each event in my hand. When a thought or event feels “charged” I can get a sense of what is taking me out of the present moment. When I have a sense of what is distressing to me I can problem solve and find solutions to take me back to the present moment.

Many years ago when I started my practice of the martial arts I had a teacher who introduced me to a concept I would like to share with you. My teacher encouraged me to think about what was distressing to me, envision the thought on the floor and gently sweep it away. If sweeping them away didn’t work for me I could see the thoughts on a cloud floating away from me, or I could visualize the thought in the back of a car saying goodbye, much like you see a child in the back seat of a car waving goodbye as you drive past.

When you start this practice you’ll notice you have all sorts of intrusive thoughts which compete for your attention. It’s easy to get frustrated and feel like this won’t work. Getting frustrated and focusing on what isn’t working is the opposite of this skill. Simply redirect your attention to your distress and gently try to sweep away your distress. Over time I suspect you will find success with this approach.

Being present isn’t denial, it isn’t being dismissive of your present situation, nor is it the practice of convincing yourself everything is okay. Rather, it is the awareness that humans have developed complex ways of interacting with the world and at times these adaptations don’t serve us well. While we cannot control what happens to us, we have a choice in how we behave when we are distressed and want to return to a present moment of peace and calm.

Whatever you decide to do, good luck on your path.

Dealing with Myths and Stigma in Recovery

Arming yourself with information about the way myths and stigmas affect addicts and how people respond to them, can go a long way in supporting people to find recovery. Effective treatment for substance use disorders requires an understanding of the myths and stigmas of addiction. I’d like examine a few myths that surround addiction and foster a misunderstanding of how to best support people to find recovery.

1. Everyone needs to reach bottom before quitting.
Early in my career I worked with adolescents. One of the clients on my caseload was a 17 year-old girl who had a long history of prostitution, a significant legal history, and a span of alcohol and drug use that began when she was five. During treatment she spent time talking about her alcohol and drug history and how that affected the decisions in her life. She had various opportunities to quit using chemicals but she reasoned that she wasn’t ready. While she came to a place where she was able to give up her chemical use, she never escaped her history of prostitution. She was able to develop a motto that supported her to quit using alcohol and drugs: your bottom is when you stop digging.

This client reinforces the notion that there is little evidence that the level of consequence a person accumulates before seeking help is related to their chances of succeeding in recovery. It is always better to get help early than to hold out for the perfect desperate moment. The idea that waiting until you hit bottom comes from the notion that you are more likely to pay attention if you experience a greater degree of pain in your life. This is simply not true.

Many times I will hear someone in recovery suggest that “only an addict or alcoholic can understand another addict or alcoholic.” I don’t think this is the case and is essentially an urban myth. When I think of addiction I think of people feeling helpless, powerless, and being held captive by their dark side. My sense is that we don’t need to be brilliant to understand the mind of an addict, just human.

2. The best way to get sober is by attending 12-step meetings.
While this was thought to be true at one time when there was a lack of resources and available treatment approaches, the reality is that one size doesn’t work for everyone. If you need support and don’t resonate with 12-step meetings don’t fret. I invite you to explore Cognitive Behavioral Therapy, Rational Emotive Therapy, Stages-of-change, motivational interviewing, anti-craving meds, natural recovery, spontaneous remission, or bibliotherapy. It is important to remember that recovery looks different for everybody.

3. A proper diagnosis is important to help people recover.
Having worked with many homeless clients who come with a variety of mental health diagnosis’ I can let you know that independent of the diagnosis, clients engage in dysfunctional behavior, don’t follow through with provider appointments, or continue to use despite the consequences they continue to experience. Within the psychiatric community a diagnosis or label can be helpful to convey client experience, it can be fun to engage in psychiatric lingo, can be used for the purposes of billing, but ultimately a label or diagnosis is less than helpful. When you label someone not only do they have to overcome the affliction, they also have to overcome the label.

4. Addicts and alcoholics drink because they’re addicts.
This is a myth that tends to be rampant in the self-help and addiction communities. It ultimately suggests that people are destined not to move beyond the confines of their past. Is it addict behavior to want to use alcohol or drugs to change the way you feel or is it merely human to want to feel relief?

Arming yourself with information about the way myths and stigmas affect addicts and how people respond to them, can go a long way in supporting people to find recovery. Whatever you decide to do, good luck on your path.

Maintaining Boundaries – Working with Clients: Guest Post by Andrew C

I work for a state crisis line for addiction. I won’t say what state, and will keep all other details confidential due to HIPAA regulations. What I can say is that it is a free-service that is funded by the state. Anyone can call in looking for help.

It is a challenging position, and also rewarding. On one hand, I get to do good work for people who really need it. The hope is that they get pointed on the road to recovery from substance abuse. On the other hand, it can be heartbreaking to hear the struggles that callers go through.

Due to the nature of the work, I’m often put in a position where I want to tell the clients “hey, I understand, I’ve been there.” Nearly all of them face circumstances that I can relate to, or else have experienced firsthand, or have known many others who experienced them.

This of course, brings up an ethical dilemma. If you have ever attended, belonged to, or visited a 12 step program such as AA, NA, or GA, then it is easy to see how members use their experience to benefit others. The principle of one person talking to another so they can self-identify is one of the core reasons that such fellowships have proven so effective.

However, in working with clients on a professional level, there is a different relationship. It is not just two friends talking over coffee, or leaning on one another for support. It is also not a sponsor>sponsee relationship that is typical for 12 step programs, where one person with more experience offers guidance to someone who is inexperienced. Professional work with clients is, indeed, a business relationship.

Although you may share common characteristics and experiences, you are not a clients’ friend. You may want to do all you can to help them, and you may want to share your own life story when you think it will help, but there are boundary lines that should not be crossed. This is especially true if the clients are paying for services.

Why is this the case?

Well, mental health work and substance disorder work isn’t designed as therapy for me. It isn’t about discussing my issues. It is about getting the client to honestly look at their own issues and address them. After all, they are the one calling and asking for support. The person who is offering the support shouldn’t get caught up in a client’s issues, even if the client asks “have you ever used drugs or had a drinking problem?” They may ask this because they distrust professional services. Or, they may want to relate to someone. I can suggest with confidence that you can gain their trust and help them relate without the need for self-identification or self-disclosure.

Another consideration is that self-disclosure can be harmful for professionals. It can lead clients to believe that you are more than a professional providing a service. It can make them feel as if they are your friend, or even mislead them into thinking there is a romantic interest. This can open up a world of trouble, including loss of license, or court-related problems for any mental health professional.

In addition to his other work, Andy is a blogger for Step One Rehab. Through his writing, he attempts to raise awareness about addiction, substance abuse, and mental health issues. The goal of Step One Rehab is to match premium addiction treatment facilities with the needs of clients. Andy writes daily articles for Step One’s blog. To learn more, visit their website or check them out on Facebook, or Twitter.

Prescription Drug Addiction Among the Elderly – Guest Post by Helen Gent

Are you an older adult struggling with prescription addiction? If you’ve been given medication by your doctor but you’re finding it difficult to stop taking it or you need ever increasing amounts to get the same benefit, you’re not alone. Prescription addiction is now so common that overdoses and deaths from drugs the doctor ordered swamp those caused by classical street drugs like heroin. Every year, 36,000 Americans die due to prescription drug overdose – most of those deaths are the result of medicines, not the highly publicized illicit substances that are heard about in the media.

Contrary to popular belief, addictions are not mainly the domain of experimenting teenagers – they can affect people of any age and from every walk of life. Older people can be more at risk of developing dependence on medicinals because advancing age brings with it health problems and so they are likely to be exposed to more medications than the young. Despite the fact that people over the age of 65 only comprise 13% of the total population, yet they take one third of the prescriptions for outpatient medications.
Increased susceptibility to various illnesses and prescribing of multiple drugs by physicians (known as polypharmacy) make dependence and other adverse outcomes more likely.

Elderly on Cocktail of Drugs

57% of older women and 44% of older men aged 65 plus are taking five or more medications every week. 12% of both women and men take 10 or more medications. Physicians may not check for interactions between various drugs, leading to more symptoms for the patient and the use of more drugs, increasing the chance of overdose, confusion, misdiagnosis of dementia and falling accidents. Opiates are commonly used and can be extremely addictive but inappropriately prescribed. If a chronic pain condition such as osteoarthritis hasn’t been controlled properly, the patient may be tempted to take more than is recommended or to ask their doctor for a larger dose. Then they may find they cannot stop taking it. The path to prescription drug addiction is easier than than one might assume.

Be Pro-Active

Ask your doctor to check for contraindications (reasons why patients should not take medication) before you take it and make sure he checks for interactions with any other medicines or herbal remedies that you may be taking. Although doctors are supposed to do this routinely, sometimes they don’t. Make sure you read the patient information leaflet and familiarize yourself with the side-effects of your medication. If you develop new symptoms of illness it will be easier to identify whether they are the effects of the medicine and could prevent you from being given further prescriptions for drugs you don’t need.

If you have a chronic condition and medication isn’t helping, ask about alternatives such as massage therapy or hydrotherapy for back pain or surgery for hip pain.

Symptoms of Prescription Drug Addiction

Symptoms of addiction to opiates includes increased pain with higher doses, requiring the person to take more in order to achieve a therapeutic effect, drowsiness, slowed breathing, poor coordination, feeling ‘high’, constipation, nausea, mood swings, anxiety without cause or when the drug isn’t available, disruptions in sleep patterns. You may feel the need to go to multiple pharmacies or doctors to obtain more medication or tell the doctor you have lost your prescription so he orders more. In severe cases, addicted patients have been known to steal medication.
If you have noticed some of these symptoms in yourself, don’t be afraid to seek help. It is vital to speak up before your health is damaged.

Ask for a Medication Review

Make sure you ask for a review of your medication as it’s possible some of your illness symptoms may be medication side-effects. If you are taking multiple drugs, it’s important to double check that none of them interact with each other. You may be able to stop or reduce some of your prescriptions.
If you think you are addicted, your doctor can treat you by gradually decreasing the dose you take so that your body becomes accustomed to lesser amounts. Stopping gradually will avoid too many withdrawal symptoms and is safer.

Counseling

Counseling is also available to help you gain the motivation to go through the detoxification process and to give you emotional support. Your physicians office may provide a counseling service or you could also find one via your church or through your place of work, if you have not yet retired. Various charities and organizations provide detox programs or therapy for people recovering from substance abuse and dependence, for instance, Ask an Addiction Counselor.

References

Prescription Drug Abuse, Older Adults, National Institute on Drug Abuse, accessed July 5, 2016.

Prescription Drugs are More Deadly than Street Drugs, Psychology Today, accessed July 5, 2016.

Preventing Polypharmacy in Older Adults, Medscape, accessed July 5, 2016.

Patients are Taking too Many Medications; It’s time to Fix That, Kevin MD, accessed July 5, 2016.

Prescription Drug Abuse, Mayo Clinic, accessed July 5, 2016.

How to Stop Cravings, 7 Tips From an Expert, Recovery, accessed July 5, 2016.

Some thoughts about my mom and her mental illness

My mom was a single mother. I don’t necessarily think this was a bad thing. I was born in the 60’s, and while it appeared my mom was pretty self-sufficient, where I lived in the working-class neighborhood of Brooklyn it was considered a faux pas to give birth to a child out of wedlock. My mom knew this and she found a guy who was willing to be listed as the father on my birth certificate. I didn’t know this at the time, but my mom had been married two times before I was born. During her life she was married a total of nine times. Nope, that’s not a misprint. Nine times.

My mom was also a consummate artist. She was also profoundly mentally ill. Her mental illness informed her art and her art informed her mental illness. Knowing my mom as well as I did it makes sense that she used art as a distraction. It also makes sense that she was married nine times. As her internal world was so chaotic I sense she was looking for outside stimuli to quell the madness she felt on the inside as well as receive some kind of validation that she was okay. During the time my mom was a professional artist her work appeared in over 200 shows. She worked in various mediums (plaster, ceramics, sculpture, pottery, pen and ink, etc) but her best work was done in either oil or acrylic. Today, artists would mount their work between two pieces of clear Lexan of Lucite. My mother’s work was mounted between two large pieces of glass, held together by large machine bolts/screws. Felt washers were used on ether side of the washer and bolt and in-between the pieces of glass. The pieces of glass came shipped to our Brownstone pre-drilled. My mom tried various methods to mount her work, but she seemed to be fond of threading the holes in the glass with climbing rope and using a fisherman’s knot connected to some bolts mounted on the ceiling. Not only was she a consummate artist, she prided herself on making sure her art was mounted in a way that could keep her work safe. People would come from across the globe to attend her shows and buy her work. I was proud of my mom and I never tired of people telling me that my mom was amazing.

As a kid I remember hoping that the constant adulation my mom received about her art would be sufficient to quell the near-constant distress she felt with her various mental health issues. As a kid I remember feeling powerless to help my mom. When my mother took her medication she was at ease in the world: her world made sense, and there was a sense of order in the Universe. When my mom took her medication I felt connected to her. When she kept to her medication schedule my friend’s weren’t scared of her. My mother was also trained as a mental health therapist. When she took her medication she had amazing clinical insight. When she didn’t take her meds, the police were always there. I’m not sure exactly how many times I visited her in the hospital. The diagnosis was always the same:

– Paranoid Schizophrenia with depressed features
– Narcissistic Personality Disorder
– Borderline Personality Disorder
– Sociopathic personality Disturbance, or what is known today as Antisocial Personality Disorder

My grandmother was a social worker and my mom was a therapist. It’s not surprising that I was drawn to working in the mental health field. After reviewing my mom’s hospital records I’m not sure that the last three mental health diagnoses were accurate, however, I am absolutely convinced she suffered from Paranoid Schizophrenia. She had command hallucinations which convinced her I was the spawn of Satan and that the only way to save the world was to end my life. During her last hospital stay the entire team met with me and my grandparents and they disclosed my mother’s plans to end my life. There were enough clues along the way but nothing extreme enough had happened which prompted the state or my grandparents to remove me from my mother’s care. I came to live with my grandparents but was extremely sad as I felt like I was abandoning my mom.

Have you seen A Beautiful Mind ? It’s an amazing film that does a wonderful job of illustrating mental illness, specifically paranoid schizophrenia and delusional episodes. While I have never met John Nash nor do I know anyone who knows him, I can relate to how his wife felt living with someone who was profoundly mentally ill. Unlike John Nash, my mom was never compelled to create a room full of chaos. She kept most of her delusions in well over 600 scrapbooks. My mom was obsessed with numbers, colors, shapes and abstract information. If she saw the number 5 on TV, she would collect five objects that represented that number. If the numbers on TV were a certain color, she would collect pieces of paper in that color: the word ‘White’ would become part of her delusion and she would collect a large number of objects that were white. As ‘White’ has five letters she would fixate on the number five. Much like someone with OCD engages in the compulsion to relieve the distress, my mom was compelled to focus on her delusions to feel safe. After I was sent to live with my grandparents I inherited all of my mom’s scrapbooks. I tried looking through them to see if I could gain any insight as to how my mom lived her life and navigated her world. After paging through many of the scrapbooks my grandmother sat beside me, placed her hand on mine and encouraged me to stop. “Todd, even your mom doesn’t understand why she does what she does”. My grandmother was right. I was simply trying to find a way to be closer to my mom. I wanted to help her. I felt powerless.

Growing up with my mom and living with grandparents that survived a genocide certainly shaped how I view mental illness and the work with my patients.

I’m not a huge fan of labels. My experience is that when you label something not only do you need to overcome the affliction, you also need to overcome the label. I certainly understand why a label or a DSM code is applied in a mental health setting: they create a sense of commonality with other clinicians, they act a gateway for billing practices, they offer a common language when writing reports or letters, and when clients do not behave in a clinical setting the clinician can blame the patient versus take responsibility for their inability to make any progress with their client. Unfortunately, labels also tend to marginalize clients, especially people who are poor or low-income. People with greater financial resources tend to have less social problems. Clients without the aid of financial support tend to be at the behest of agencies which are overloaded and they often are only willing to apply a label to make quick work of a new admit. As I’ve worked as a clinician in a variety of agencies and with clients on either side of the financial spectrum, I’m convinced this point-of-view is accurate. I’m also embarrassed to admit that early in my clinical career I was entirely too generous with the application of labels on a host of clients. I’m reminded of many assessments and letters and documents that were rife with the misapplication of whatever diagnostic assessment impressed me at the time. I’m grateful that I have grown as a clinician and have grown past the need to both marginalize and stigmatize clients seeking help.

I have suffered with depression for most of my life. Meds don’t seem to work. I am sure that if meds worked I’d still be taking them. The only thing that seems to help is therapy and exercise. I think of mental illness as being on a spectrum, and I’m certain that if most people peeked at the DSM 5 they could probably identify with some of the characteristics of any of the diagnostic criteria. Chronic mental illness is a bit different. I think of chronic mental illness like a radio station: most people who are not mentally ill have the ability to tune into one station; my mother lacked this ability. Attendant to illness of Schizophrenia belies disorganized thoughts. I’m not sure my mom ever felt normal or had the ability to have coherent and cogent thoughts. Most literature suggests that symptoms of Schizophrenia manifests before the age of 19. While I never had the opportunity to meet any of her family, I have heard enough of her background to determine that my mom suffered from early-onset Schizophrenia. She likely heard voices and suffered with hallunications and delusions while she was in Kindergarten.

As hard as it was for me to accept my mom’s mental illness, I am absolutely certain it was just as hard for her to accept that her brain did not function as a normal human being, whatever normal is. I saw a great bumper sticker that said normal is a setting on a washing machine. I think that is pretty spot-on. My mom represented two extremes of a great mind: a tormented human being in her own thought prison and a fantastically talented artist with the capacity to produce great, original work in various mediums which were lauded by art critics throughout the US and the rest of the world. The people who knew my mom suggested she was a great artist and a consummate therapist. I think they were right.

When I was a kid I used to believe that my mom ruined my childhood. I blamed her for creating so much chaos in my life. I assumed she did this intentionally. I grew up in an environment of catastrophic violence. Whenever I had a hard time I’d point to my mom: I never developed the coping skills needed for a decent life, I developed PTSD because of my mom and her poor choices, I attracted women who weren’t good for me as I had a poor role model. While this could be great fodder for a therapy visit, it’s also a fantastic way to stay ‘stuck’.

Here’s what I know and believe to be true: my mom did the best she could with what she had. She was incapacitated and couldn’t have functioned any other way. She was living with a disease that affected the way she behaved and thought about people and the world at large. While my mom was sufficiently impacted with mental illness, she had some sense that she couldn’t care for me and let my grandparents raise me. In her mental fugue she had enough clarity to make a decision for my own well-being.

My mom also valued education (she possessed a few graduate degrees) and insisted I followed-through with my own education. She valued self-sufficiency and would remind me that I had the fortitude and capacity to survive. While I lived with her pain and confusion, this experience has remained a catalyst for my friends, sponsees, and clients: when people talk to me I’m not shaken by their disclosures. Being able to listen to the pain of another person without flinching is a very concrete experience that allows me to witness humanity. I’m also keenly aware that my mom had wanted to take her own life on several occasions. Had she done that I wouldn’t be here. Because of my mom I had an amazing relationship with my grandparents that would have never been possible had my mom been born without any kind of mental illness.

I was able to meet with my mom before she died. I got to visit her in Hospice. She told me to never relent, come from a place of hope, strive, to grow, evolve, and make a noise big enough that the world would take notice. I suspect that was her final gift to me.

Was I affected by my mom’s mental illness? Certainly. Do I have more work to do? Absolutely. While I can focus on what I didn’t get and be upset that there are places in my life that feel incomplete, I am left with a striking revelation: there are gifts in the darkness.

However you choose to deal with your own distress, good luck on your path.

Secular Spirituality

In a previous article I noted that I would talk about why I opted not to follow-through with my rabbinical studies. I was raised in a fairly orthodox Jewish household by grandparents that survived the Holocaust. I attended shul on a weekly basis, spent hours studying with various rabbis, and was fully invested in learning Hebrew, Aramaic, and Yiddish. I fasted before Shabbat, and was absolutely focused on being a Mensch and not dating a Goyim. I assumed that as my grandmother was a Shadchan she would find me a nice Jewish girl to marry. Jewish life seemed full and complete, and I certainly felt connected to the Jewish community in the Brooklyn neighborhood where I was raised.

Towards the end of my rabbinical studies I was asked to meet with the rabbis. I was impressed with my progress and assumed that something good would come out of the meeting. Rabbi “L” was one of my mentors and someone who listened to the first 5th step I completed without judgment. My grandmother spoke highly of him and I felt safe talking to him and trusted his judgment. Before he taught at my Rabbinical school, he was a professor of Engineering at a college in upstate NY. When I met with the Rabbis, Rabbi “L” said that the way I asked questions and the way I responded to questions the entire faculty was pretty convinced I was an atheist. This very kind man who I trusted without reservation told me something I knew one some level, but didn’t want to admit. Rabbi “L” told me I needed to tell my grandparents as a form of making amends.

I needed to find a distraction, any distraction. I returned to temple, AA meetings, martial arts practice, and studying the languages of the Jews. I was embarrassed at how I lied to my grandparents and lived a life of deception. I’m Jewish and assumed my Jewish life would support my faith. While I was devout in my practice, something seemed to be missing. I came to understand that while I wanted to believe, I wasn’t hardwired to believe in a supernatural deity. After a few months I approached my grandparents and made my grand confession. My grandmother smiled and told me that both she and grandfather had known for some time that I was an atheist. They thanked me for following through on their requests to attend Rabbinical school, participate in the Jewish culture, and study the language. My grandmother said that while I no longer needed to attend to the activities of the Jewish culture, she said that both she and grandfather required that I continue with AA meetings and martial arts practice. So as I wouldn’t be complicit in any more deception I honored the wishes of my grandparents and admitted to them that I had also eaten pork when I wasn’t at home. I felt a tremendous sense of relief and came to understand what the AA literature discussed when it mentions “freedom from bondage of self”.

I realized what had been missing from my life. I understood that being consistent meant that I would need to live my own truth.

After I told my grandparents, I told the rest of the students in my class at Rabbinical school. I talked to my martial arts teacher and anyone in my life who was close to me. Some people told me they suspected that I was a non-believer while others told me I was having a crisis of faith. When I asked these folks what manifested in their life to demonstrate they believed in God and they told me, I let them know those sorts of experiences never happened to me. My friends in Rabbinical school pointed to me surviving my addiction as proof of God. I couldn’t accept this as proof as I understood that giving some deity absolute credit for saving me dismissed the role that the medical community had in saving my life. I spent 31 years of my life as a mental health counselor treating veterans with PTSD and addictive disorders. My graduate work in forensic psychology and clinical psychopharmacology relied on peer-reviewed methods. I’ve returned to graduate school and I’m currently studying theoretical physics and algebraic geometry. I am a guy that needs proof, and my former career and current graduate work is filled with what I see as proof.

Let’s define what I mean when I say proof:

– Peer-reviewed
– Repeatable
– Observable
– Demonstrable
– Verifiable
– Falsifiable

It’s probably not a leap to suggest that a belief in God would be able to meet any of this criteria. I don’t expect an answer from any deity. I know a lot of fine people who have God at the center of their life. Every single sponsor I’ve had in the program of Alcoholics Anonymous had a belief in a higher power, and when you asked them to define this higher power they would always credit God with helping them get and stay sober. Nearly all of the women I have dated believed in God. This wasn’t an issue for me as both groups of people never had a need to foist God on me nor did they have a need for me to believe. I certainly don’t have a problem with people believing in God as long as they don’t use their faith to enact law and enforce policy.

My grandparents had a quiet faith. I never heard them talk about God more than three times the entire time I knew them, and the only reason they said anything about God is because I asked their opinion. My grandmother said that talking about God was useless and that people needed to live their faith My grandparents often felt that the people who talked the loudest about their faith weren’t doing anything other than trying to convince themselves they believed.

The program of AA suggests that people need a higher power to remain sober. Some people in the program work towards finding spirituality. I like this definition of spirituality from Wikipedia which includes “a sense of connection to something bigger than ourselves, and it typically involves a search for meaning in life. As such, it is a universal human experience – something that touches us all”. In my case the “something bigger” involves feeding people that are homeless, donating clinical hours to veterans suffering with PTSD, working with people to help them stay sober, and completing graduate work in physics and math. All of these practices help me feel connected to people and none of these practices require that I believe in God. I often see the connection I had with my grandmother as my ‘higher power’. My grandparents, especially my grandmother, is my moral compass. If I’m stuck or feel disconnected I can simply think about any number of conversations I had with my grandmother about a particular issue and I’m able to get clarity. My grandparents helped me get and stay sober.

Six of the 12 steps directly reference God, so it’s not a leap to suggest the program is focused on God and it would be difficult to argue with people when they suggest AA is a religious program. I’m reminded of a recent court case filed by a prisoner who suggested that mandatory attendance in AA violated his constitutional rights. The court sided with the prisoner. The probation and parole officers involved in the case counter-sued and lost. The Ninth Circuit Court of Appeals upheld the opinion of the lower court and suggested that the dividing line between church and state is so clear that mandating AA attendance violates the First Amendment and the establishment clause of the US constitution. The court also suggested that a prisoner cannot be forced to attend 12-step meetings as a condition of his release and that probation and parole officers as well as prisons can be held liable for damages by mandating attendance at 12-step meetings. The Court’s opinion suggested “while we in no way denigrate the good work of AA and NA, attendance in their programs may not be coerced by the state”.

Reading this article you could suggest that I am wholly critical of Alcohol Anonymous. I think that would be an unfair assessment. I love AA and credit the program for saving my life and to a large degree, keeping me sober. Just as you cannot talk about Ovarian cancer without talking about women, you cannot talk about AA without considering how some people take exception with what might be seen as a religious overtone in the program of AA.

For many years Alcohol and drugs were my higher power. While getting drunk and loaded were the most important things in my life, I came to realize I was asleep on my life. I lived my life in fear and decisions were made for me. This wasn’t okay then and it’s certainly not okay now. As an extension of my evolving spirituality I have come to realize then when I focus on what isn’t working in my life my world feels really small, and when I focus on possibility I enliven my life, expand my outlook, and attract more good stuff my way.

I’m an atheist as when I honestly examined the historical, philosophical, and scientific evidence for and against the existence of a deity and came to a conclusion that for me, no such supernatural deity exists. When I came out as an atheist I wasn’t sure how the people in my life would react and I wasn’t certain I would be welcome in Alcoholics Anonymous. Both of these fears were unfounded. When I approached steps two and three with my last sponsor he simply asked me if I had a higher power that worked for me, and when I said that I did, he simply responded “I guess we’re done with those steps”.

Much like Rabbi “L”, my sponsor and grandparents, I found almost universal acceptance when people find out I do not believe in God. With the exception of several people who were absolutely convinced I would relapse unless I found God, most people are interested in my story. They want to know how I’m able to stay sober without God in my life and I continue to receive feedback that people love the stories I tell about my grandparents, the lessons they taught me, and the skills I learned from them that have enabled me to remain sober.

If you’re like me and have found that you don’t believe in God, or you lost your faith and you’re wondering if it’s possible to stay sober, I want to invite you to realize that yes, absolutely. It’s possible to create your own definition of a higher power. It’s possible to stay sober as an Atheist, and it’s possible to find your way if you have a secular approach to recovery.

Whatever you do, good luck on your path.

Commitment

Success isn’t owned, it’s leased,,,,,and rent is due every single day – JJ Watt, Defensive End, Houston Texans

I’ve been spending a fair amount of time thinking about commitment and how that manifests in my life. When I got sober I made a commitment to my grandmother that I would stay sober. Initially this commitment was made out of obligation. I was annoyed that I was asked to modify my behavior. I was young and suggested my grandparents were being unreasonable. It didn’t make any sense that someone would ask me to quit as I reasoned that my use affected no one but me. When I stepped back from my self-righteous anger, I remembered that my grandparents survived a genocide. I realized I could continue to meet my own needs or understand that not only did my grandparents spend a lot of time and money dealing with the wreckage of my use, but they also spent a lot of time worrying about me. I realized my behavior was no longer okay. I came to understand compassion meant that I needed to place their needs before mine. When my grandparents gave me feedback they were never hostile nor did they attempt to make me feel bad – they simply told me how they felt without shaming me. As I have matured I understood my grandparents were pretty evolved human beings, and I was both lucky and exceedingly fortunate to be raised by such lovely and generous people.

During the last day of my use I ingested large amounts of alcohol and copious amounts of stimulants. This combo landed me in the hospital and resulted in significant physical problems. I awoke surrounded by a team of doctors and nurses consulting about my condition. The attending physician began to tell me that I nearly ended my life, but I readily dismissed his comments and was able to counter every intellectual argument he offered – in the fog of withdrawal I somehow assumed that even tho I nearly died, I was intellectually superior. My grandmother came into the room, and with a disarming sense of compassion, she disabled my defenses by simply telling me she was worried I wouldn’t make it. I broke down and told my grandparents I would do whatever they asked. Both my grandmother and my grandfather told me I needed to attend AA meetings, enroll in a martial arts school, and attend to rabbinical studies. I have continued with martial arts and AA meetings, but have since ended my rabbinical studies, something I will address in a later article. What I initially assumed was a way to manipulate me (the requests of my grandparents) I came to understand was merely compassion. – my grandparents wanted me to be okay; their energy came from their concern.

I have been wearing my grandmother’s wedding ring since my 16th birthday and have never taken it off. I wear her ring every day as a reminder of the commitment they had for one another, and as a reminder of the commitment I made to them that I would stay sober. I have honored that commitment as I just celebrated 36 years of sobriety.

Focusing on commitment requires that I change my behavior. I understand that while my intentions might be in the right place, my behavior is the only thing that tells the truth. During my active addiction it became apparent that my behavior progressed in concert with my addiction. I was certain that my use didn’t impact anyone, let alone me. The truth is that I was committed to meeting my own needs and committed to ignoring the needs of my grandparents and the world at large. I pretended I was committed to changing my life. I’d give lip service to the importance of staying sober, but when I was alone I was committed to getting high. While I believed I was maintaining a bulletproof facade, on some level I knew I was lying.

After being sober for some time I learned two things: that everything I do either supports me to remain chemical free , or leads me to a place where I’ll engage in some kind of distraction (working too much, playing video games, eating too much sugar, chemical use) and doing what my grandmother used to say: you are behaving in a way that doesn’t look good on you.

Here are a few tips for developing a stronger sense of commitment:

– Remember that commitment is about being absolutely dedicated to internal and external action to bring about a desired result.
– Do not wait for people or situations to change to develop a stronger sense of commitment; start today.
– Think about what commitment would look like for you: what needs to manifest in your life to show you that you are committed to remaining sober?
– Engage your heart and mind. Read stories of commitment, talk to people in your life who have changed, and seek the counsel of people you trust.
– Be absolutely clear about what you want to change in your life. Do you have a sense of what you want to change? Why you want to stay sober?
– Surround yourself with people who are on a similar path, and who have the kind of commitment you want in your life.
– Identify any resistance you have to changing behavior, what that looks like, and what you can do to move past any resistance you might have.
– How committed are you? If you’re 50% committed to staying sober, what would it take to get you to 75% ?
– Remember, committing to sobriety or anything important is about developing passion. Developing absolute passion for staying sober will help you remain committed to recovery when recovery becomes difficult. Being mindful that recovery can be challenging can help you prepare for the times that difficulty has your attention.
– Commitment requires clarity, sacrifice, and awareness of obstacles and resources.
– Become aware of any excuses you would make and become cognizant of any temptations that would lead you astray.
– Become committed to excellence, define your vision, create a plan of action, invest in your sobriety, create powerful rituals, and a mantra to stay focused.

Here’s my mantra for staying sober: Staying sober is the single most important thing in my life, and if anything jeopardizes my recovery, it’s eliminated.

What’s your mantra?

When I think about my life I am stuck with a pressing question: is the behavior that’s currently showing up in my life demonstrating a commitment to recovery and a commitment to change? Most of the time I believe this is true. While I believe recovery looks different for everybody and there are times I fall down in my life, I am absolutely focused on engaging in behavior that supports long-term recovery. Vince Lombardi said “Winning is not a sometime thing, it’s an all the time thing”. I think the same is true of commitment. While your commitment might wane, you can certainly use some of the techniques I outlined in this article or develop your own strategies to keep you on track. It doesn’t matter what you do, as long as you DO something.

PS: To stay committed it’s important not to forget the gifts recovery can bring into your life. My mom was profoundly mentally ill and died as a result of her illness. I was able to visit her in hospice before she passed. She let me know that she was proud of me and was proud that I was able to stay sober.

My anniversary

June 12th found me celebrating 36 years of sobriety. As I approached the eve of my anniversary I am reminded of the model of recovery that has made this milestone possible. When I got sober my grandparents (both of whom survived Auschwitz) asked me to develop a mission statement that would guide my sobriety which I would like to share with you: staying sober is the single most important thing in my life, and if anything jeopardizes my recovery, it’s eliminated. This kind of commitment and absolute focus has supported me to remain sober through hardship and loss, through sadness and despair. Absolutely nothing else is as important as staying sober.

I am grateful I found a homegroup where I feel comfortable and feel like my contributions are valued. In the last two years I’ve seen an increase in membership and a significant amount of relapse. While relapse can be part of recovery, it certainly doesn’t have to be a part of your story. A casual review of the people who have relapsed in the last year demonstrates a startling pattern: every single person that relapsed gave a detailed version of their relapse, and without question they placed more importance on other aspects of their life versus the need to stay sober.

I have mentioned the following concepts in another article I wrote for this site, but I believe it’s worthy of restating them here: I attach a tremendous amount of emotional pain to the thought of using and a tremendous amount of pleasure to the thought of remaining chemical free. Not only do I stay sober because I made a commitment to my grandmother (pleasure) I do not use chemicals because it creates more problems than it solves (pain). I was able to quit as the people I knew who used drugs and alcohol had different goals than I did. I wanted more from my life than I was currently getting. I no longer saw drug use as fun, and everything I wanted in my life conflicted with using alcohol and drugs. I did not want to be asleep on my life. Anything I wanted in my life and the relationships I created are vastly more important than any chemical I would use or alcohol I would drink.

Oftentimes I hear people suggest they don’t like the program because all they hear is pain. I don’t see pain when I attend meetings, rather, I see possibility. I am reminded of Ivan Denisovich, the protagonist in the novel, One Day in the Life of Ivan Denisovich, a story about a prisoner in a stalinist labor camp in the 1950s. The story offers a stark parallel to an AA member trying to stay sober. Ivan does whatever he needs to do to make it through the day so he can eat. He endures hardship and trouble as he understands the reward for existing one more day. He exists because he knows that staying alive and pursuing freedom is its own reward. The protagonist in this story also draws a parallel to Viktor Frankl, a survivor of the Holocaust and the author of Man’s Search for Meaning. Frankl’ noted that we must endure, and that suffering will, with a proper attitude, bring light. He recounted that the will to survive (a man’s attitude) and not the conditions of a particular camp, generally determined if this same man survived. Frankl’ believed that possibility is the natural outgrowth of pain.

I decided to get sober as I was tired of being a parasite, and I certainly wasn’t being helpful to anyone, much less myself. My grandparents spent every day in Auschwitz not knowing if they would be alive the next day. When Auschwitz was liberated in 1945 my grandparents came through Ellis Island and made their way to Brooklyn to try and make a normal life for themselves. My grandfather was a tailor, my grandmother was a seamstress. They were consumate artists and made a nice life for themselves. However, because of my addiction, my grandparents spent a lot of time, money, and emotional energy trying to deal with the wreckage of my use. But more than any of this, my grandparents spent a lot of time worrying about me. I came to understand that I could either continue my lifestyle of meeting my own needs or quit using. I made a conscious decision to quit as treating my grandparents like crap was no longer okay.

When I graduated from Rabbinical School my grandmother gave the commencement speech. During the speech she heaped praise on me and my fellow classmates for living a life dedicated to service. She suggested that recovery need not be boring and that we needed to dedicate ourselves to what is called Tikkun Olam, a Hebrew phrase which literally translated means Repairing the World. I have come to understand that to a greater degree that is what we do when we live a life of service and practice the steps of Alcoholics Anonymous.

Recovery is its own reward. The path we forge is our own. There is a buddhist saying that suggests we gain light for ourselves when we help another and illuminate their path. Whatever you choose, I wish that the light you give to another helps you along the way. Good luck on your path.

Being of service

I haven’t posted any new material for well over a year. Apologies. My goal is to create at least two blog posts per month and strive towards two new podcasts per month. I’ve suffered from horrible writer’s block, and until today I couldn’t move past my current ‘block’

If you’ve followed me on Twitter for any length of time you know that 1) my grandparents survived Auschwitz, 2) my grandmother was my first sponsor, 3) I revere my grandparents and 4) I strive to embrace their model of recovery which includes me being both useful and kind.

I have been sober for over 35 years and have worked as a mental health and addictions counselor for over 31 years. While I have not provided direct clinical services for over a year, I have worked as a consultant with various orgs in the Seattle area the last 18 months. To earn a living and pay my bills I drive limo. I’ve been driving limo on and off for the last 30 years.

Driving limo has provided me with ample opportunity to be of service to others. I’d like to tell you about one interaction which has affected in a huge way and created an immense sense of gratitude for my passenger.

Over a year ago I picked up a woman from a local cancer center. ‘Denise’ was a lovely woman with porcelain skin, a slight build, and red hair. I’d guess she was about 55 years old. Initially I didn’t think she was a patient, rather, an executive working for the organization as her fare was paid through a company account. Seven weeks after our initial meeting, I met her again and understood she was undergoing her fourth round of Chemo. During the ride home she let me know that she had been sober for four months and was certain this was to be her last attempt at saving her life. My sense is that many times treatment for cancer often extends the quantity and not the quality of life. My thoughts about cancer seemed to comfort Denise and she came to understand that I understood her point-of-view.

I didn’t see Denise for a few months and was pleased when the call sheet for the day included transporting her from the center to her home, over two hours away. I wanted to catch up and ask her if there was anything I could do for her. I am seldom surprised by my limo clients but her request was a bit jarring. Denise let me know that she had been given a “timeline” by her doctor who suggested that she had less than five months to live. Denise asked me if I would be willing to capture her life and chronicle significant events so as to create a legacy for her family and friends. We agreed to meet in three weeks.

I met her at Denny’s on a Tuesday afternoon. I spent six hours asking her over 125 questions and gently prodding for more information when I needed clarification. When we departed I was emotionally spent and very sad that this lovely human being would succumb to what her doctors termed as ‘mangled DNA”. I let her know I would type up my notes within two weeks.

I called her as promised and we met at a copy shop. I was able to generate 18 pages of prepared copy from my notes and responses to the questions and recorded interview. Denise showed me 54 addressed and stamped manilla envelopes, addressed to family and friends. We made the copies and placed the parcels in the mail.

She cried as she she hugged me goodbye.

I haven’t see Denise since the encounter at the copy shop. I often wondered what happened to her. This afternoon I received a letter she typed that was sent to me by her daughter:

Dear Todd,

In the event of my passing I asked my daughter to send this letter to your supervisor. I wanted to thank you for your time and your willingness and your sincerity. I understood that you were a decent man when I met you and you were far more concerned with my comfort than you were with your work timetable. Thank you for stopping at Subway to buy me lunch. I hope you weren’t disappointed that I didn’t eat the whole thing- chemo you know.

I’m sorry we won’t get to be friends. I’m sorry I won’t get to learn more about your grandmother. I’m sorry that I left a friend. I’m sorry that I left my family and friends. Cancer sucks balls. FUCK YOU CANCER!

I didn’t realize that when I met you you would have 12th stepped me, but you shared your ESH (experience, strength and hope). I’m not sure you knew you helped me stay sober. But you did.

Thanks for your patience and willingness to spend so much time to ask me all of those questions. Thank you for spending your time to type up my responses in a cogent form. Thank you for helping me send on my ‘living legacy’ to my family and friends.

During one of our initial meetings you told me that you aspired to be useful and kind, something your grandmother laid at your feet when you got sober. I can assure you that without question, your grandmother would be proud of how you have handled yourself. There’s no reason to worry so much: you have been both useful and kind.

I will miss you

Denise

I attend meetings on a regular basis and would often lament that I seldom get to affect change driving limo. What I have come to understand is that how I affect change looks different than what a regular 12-step call might look like, or volunteering, or working with people in the program or acting as a sponsor. My grandmother used to say that when you want to develop a certain quality, you don’t get to decide how the lesson manifests.

Yep, useful and kind….

Performance Addiction: Our Secret Obsession: Guest Post by: Arthur P. Ciaramicoli, Ed.D., Ph.D

I remember the first evening I met with 44-year-old Mary in consultation. She entered the waiting room with hesitation and an obvious degree of discomfort. A few minutes into the interview she told me she could not get over her husband leaving her for a young colleague four years ago.

I don’t love him anymore, I just feel so inferior. He is a CEO of a successful company, graduated from an Ivy League school, always attracts women. He is charming, bright and handsome.
-MARY

As we talked further she told me her husband had frequent affairs, always increasing her feelings of inadequacy. She practically raised their three children alone yet said little about her role as a mother. She went to college to become a teacher, and emphasized it was “just a state school.” She has tried to date since her divorce but insightfully indicated she thought her lack of confidence drove men away. When I asked what gave her such feelings, she talked about her short height, her mediocre education and her meager financial stature.

Fact vs. Fiction

Early in life we write a story about ourselves, a novel if you will. It is most often a fictitious story that is being reflected back to us from those close to us – as if we were looking at ourselves in a mirror. We are evolving and learning along the way – who we are, or more importantly, who others think we are. If the mirrors you are looking into give you an inaccurate view of yourself you begin to form a fictitious idea of your capabilities and worth.

Mary grew up with an alcoholic father who spent little time with his two daughters, but nevertheless had very high expectations on how they should perform in school and athletics. Mary’s mother had a kind heart but was quite overweight. She was often on the diet of the month, frequently calling herself fat – an idea that was reinforced by her perfectionistic husband. As a result of this environment Mary developed a critical self-voice, which supported a deep belief that she was not good enough.

Performance Addiction (PA): the belief that perfecting appearance and achieving status will secure love and respect.

This common syndrome sets the stage for what I call Performance Addiction (PA): the belief that perfecting appearance and achieving status will secure love and respect. It is an irrational belief system learned from early familial experiences and reinforced by our material and appearance driven society. I recognized this disorder as I worked with people like Mary who are intelligent, compassionate, caring and attractive, yet their internal story tells them they are inferior, unattractive and unimpressive. These individuals are what I call scoreboard watchers. They are constantly evaluating how well they sound, look and appear. They idealize others, as Mary did with her husband because of his good looks and financial success, totally missing the fact that his character is quite poor and unimpressive.

They are trying desperately to look better and achieve more to have a taste of the love and respect they have longed for since early childhood.

People who suffer from PA tend to value status over character and achievement over relationships. They are often seen as preoccupied people who are always on the move, in their minds or in reality. They are trying desperately to look better and achieve more to have a taste of the love and respect they have longed for since early childhood. Our society rewards attractive people and those who perform on high levels. Once a person has bought into the unending quest of Performance Addiction they can’t relax, let go, and let life take its mysterious course. When their efforts fail, they decide to try harder, move faster, and are willing to make more sacrifices while compromising their health. This behavior pattern is the nature of an addiction.

Mary is an attractive, bright, affable woman who has needed to uncover her true worth by being open to the fact that she has been misguided in her pursuits for love and acceptance. Rather than constantly trying to correct what is wrong with her she needed to uncover what has been right about her all along. Her natural goodness had been under cover as a result of the lack of empathy she endured early in life and later in her marriage.

Changing Your Story

In order for Mary to change her story she joined one of my group therapy sessions where members are committed to providing truthful, tactful feedback with the goal of everyone changing their story from fiction to non-fiction. You cannot change your story alone; human beings are all too subjective to do so. When we have the courage to let ourselves be known by rational people who have the capacity to provide us with a realistic appraisal we begin to see the truth about others and ourselves. It is very hard to deny feedback that comes from 10 group members who have known you for some time and all agree on a certain perception of your personality.

Over a period of months Mary has been able to understand the distortions she formed of herself. Growing up in an alcoholic home with a mother who suffered from an eating disorder left her feeling alone. Without the empathy of her parents she feel into an obsession with appearance and performance. She discovered the one way to consistently garner their attention. As a result she couldn’t resist the appeal of her husband’s resume. Her familiarity with excessive alcohol consumption made her minimize the impact of her husband’s drinking, and of his demeaning way of relating to her.

Children of alcoholics often find it difficult to understand why they would choose the very type of person that has caused them such misery.

It is human nature to return to the scene of the crime; we have a degree of familiarity with what we have experienced. Our minds tell us to run away from certain individuals. Nevertheless our hearts drive us forward to see if we can re-write the story by finally gaining the love and respect from those who are incapable of giving it, recreating our familial dynamic.

Today, after several months of individual and group therapy, Mary realizes that net worth does not equal self worth and perfecting appearance does not bring love and respect but in fact creates addictive behavior.

Changing a distorted story and the negative self-voice it creates in the most impressionable times in life is very difficult but certainly possible. Always remember that anything learned can be un-learned with patience and perseverance. I have seen many miraculous transformations occur with the support of empathic, open-minded people who are committed to helping each other reach the common goal of true happiness and health.

Author:

Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. He is a member of the American Psychological Association and the Massachusetts Psychological Association. Currently in private practice, Dr. Ciaramicoli has been on the faculty of Harvard Medical School for several years, lecturer for the American Cancer Society, Chief Psychologist at Metrowest Medical Center, and Director of the Metrowest Counseling Center and of the Alternative Medicine division of Metrowest Wellness Center in Framingham, Massachusetts.

Dr. Ciaramicoli is currently in full time private practice and is the Chief Medical Officer for Soundmindz.org. He has produced an Anti-Anxiety App with Soundmindz that has been downloaded by over 25,000 users and rated by Frontline as one of the most effective and usable anxiety apps available. He has also recently released an Anti-Depression and Mental Health app for Soundmindz.

Dr. Ciaramicoli is the author of The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life, Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love, which is now published in 7 languages, and just released in China. His first book, Treatment of Abuse and Addiction, A Holistic Approach was selected as Book of the Month by The Psychotherapy Book News. He is also the coauthor of Beyond the Influence: Understanding and Defeating Alcoholism.