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.

Engaging Compassion in Addiction Recovery

It’s been suggested that you can improve the quality of your life by cultivating compassion. Compassion has been described as 1) a feeling of deep sympathy for another person, 2) to suffer together, or 3) concern for the misfortune of others.

Not only is compassion praised as a desired human quality, studies suggest that engaging compassion can increase the hormone DHEA and reduce cortisol, the hormone responsible for managing stress. It’s also been suggested that people who live with a high degree of compassion tend to be happier and be actively engaged in service and volunteer work.

When people live a compassionate life they tend to be admired by friends and family. This sense of compassion tends to spill over into their relationships.

I’d like to suggest five ways to engage compassion:

>Follow-through with service work. Volunteering is helpful as you are engaged in an activity that’s not about you. Oftentimes when we have a desire to use or drink we’re focused on us, our situation, or a problem that has to do with us. Volunteering creates emotional space to give you a chance to make better decisions.

>Random acts of kindness. Doing something for someone without any expectation of something in return.

>One of the most powerful tools for developing compassion is loving kindness meditation. This involves the practice of deliberately engaging kindness by focusing on internal images of different people and directing compassion towards those individuals. This also involves sending loving thoughts to people you care about.

>Develop a ritual which includes meditation time in the morning or before you retire for the night. Focus on statements that allow you to engage ways that allow you to engage loving kindness towards others.

>Practice Commonalities. One favorite exercise comes from a great article from Ode Magazine — it’s a five-step exercise to try when you meet friends and strangers. Do it discreetly and try to do all the steps with the same person. With your attention geared to the other person, tell yourself:
Step 1: “Just like me, this person is seeking happiness in his/her life.”
Step 2: “Just like me, this person is trying to avoid suffering in his/her life.”
Step 3: “Just like me, this person has known sadness, loneliness and despair.”
Step 4: “Just like me, this person is seeking to fulfill his/her needs.”
Step 5: “Just like me, this person is learning about life.”

Good luck on your path.

Increasing Self-Esteem in Recovery

If I spend time thinking about the various issues specific to addicted clients I come up with a few central themes. Many people need to find a sense of purpose, some need to find a sober place to live, and others need to find a way to earn income or repair family relationships. However, what is needed to follow-through on any of these tasks is a sense of self-esteem, or what I like to call ‘Emotional Competence’ or EC. I think of of EC in this way: are you up to the task at hand? Do you have the ability and wherewithal to follow-through? It seems to me that if you don’t like who you are and you can’t take ownership of the successes in your life then it’s very likely you’ll never like who you are. I am convinced that there is a direct relationship between poor self-esteem and giving away all of the credit in your life to a higher power.

While there are many causes of poor self-esteem, I am not convinced it is necessary that you need to know why you dislike yourself. All of the reasons we dislike who we are tend to manifest in the same way and the end result is the same: poor self-esteem, diminished self-confidence, and a poor self-concept. Rather than focus on changing the past (which is generally impossible) let’s use this time to focus on how we can feel better about our place in the world. I want to posit seven ideas for change. It’s important to try and change how you feel about yourself as poor self-esteem can lead to relapse.

1) Sentence completions: on a piece of paper start with a sentence that says “I like myself because” and complete the sentence as many times as you are able. If you feel blocked you can try “I could like myself if…..” and complete several sentences. Note any patterns and share what you learned with a trusted friend or mentor and ask for feedback.

2) Affirmations: I could spend hours writing about affirmations so I will simply encourage you to look online for ways to create affirmations. When you complete affirmations just remember: they need to be said in the present, they need to be realistic, and they need to include a level of risk. When I say ‘level of risk’ I am simply suggesting that you can read them aloud, read them to yourself in a mirror, write them on a piece of paper, read them into a tape recorder and play them back, or you can go for the highest level of risk and read them to another person.

3) Forgiveness: I suspect we all have done things which are less than flattering to our ego. It will be likely that many times the stupid thing you have done will simply work itself out and people will see that you made a mistake and will be able to let go of their annoyance about you and your actions, so take heart in that. Other times the act perpetrated against us is so great that forgiveness seems like too huge a leap – perhaps we can begin by remembering that forgiveness is about forgiving the person and not the act. Seek more support if this is a block to you.

4) Volunteer work: My grandmother would tell you that if you want to raise your self-esteem you need to do esteemable things. I am a GIANT fan of volunteer work and have done all kinds of volunteer and service work in my life. When you have a “dark night of the spirit” and you feel bad and you have done volunteer work, no one can take away how you have helped another human being lessen their burden or suffering. Your behavior is in black and white. Never forget that. Two of my favorite websites include: Serviceleader and Volunteermatch.

5) Meditation: My idea of meditation is to simply focus on one thing at a time. I like the idea of sitting on the bed in the morning when we get up and before we retire. Focus on something that makes you feel joy and breathe in through your nose and out your mouth – try this for at least two minutes each session and I suspect the long-term benefit of this practice will surprise you. If this doesn’t resonate with you, I want to invite you to explore the online resources available to you.

6) Therapy: Having a trained listening ear is important for accountability and support. We tend to experience distress when our perceptions don’t match reality. It is important to have someone provide feedback that can tell you where you might be stuck. I have been very fortunate to have worked with some very excellent clinicians in my time and these people have been invaluable to me.

7) Start something new or do something you love. If you like working with older adults, chances are that the people you work with also love that you’re willing to step up and volunteer your time. Perhaps you like walking someone’s dog or you are jazzed about writing to homebound seniors. Have a desire to connect with folks? You could begin a blog or a get involved in a letter writing campaign. My sense is that when I push myself past my comfort zones the rewards are huge.

While it can be likely that you can manage living your life entrenched in self-hate, it’s not fun and your life will feel really small. Do something good for yourself and work on yourself esteem – your recovery will thank you and the people in your life will notice that you have changed.

Whatever you decide to do, I want to invite you to begin today. Good luck on your path.

Approaching Change in Recovery

Over five weeks ago I was approached by one of my patients on the unit who let me know that he hated his life. He talked about the various experiences he had and he was concerned that a short stay in rehab wouldn’t offer him the opportunity to find any kind of comfort or relief. I suggested that rather than thinking about changing everything we could begin to think about small changes and that I would help him to begin to institute those changes. He was quite skeptical and as I expected he began to argue that my approach wouldn’t work – he engaged in what my grandmother called ‘arguing your limitations’. I certainly understand as I was aware that he was scared and when you’re scared your world feels really small. It makes sense to me that he was resistant: fear is all he knows and I am asking him to trust me (he doesn’t know me that well), and that I wanted him to try a different approach – while he is scared and his way doesn’t provide the kind of comfort he wants, he knows his way rather well and to some degree he feels safe. I was asking him to give up his way and try a different approach.

When I am working with family members or a patient I don’t see them as cynical, resistant, or pessimistic, I see their “stuff” as fear. Seeing their responses as fear helps me to relate, it humanizes them versus attaching a pathology to their responses, and allows me to tailor my approach to their response. When my patient was upset and I saw his ‘stuff’ as fear I could work with that and not personalize his unkind responses towards me. As I began to think about him I had a few ideas he could begin to implement:

1) I suggested that he follow-through with an appointment with one of our psych med providers on staff. It was apparent that while he had a history of addiction, his psychiatric history was impinging on his ability to navigate the day-to-day functions of the rehab schedule. I was able to arrange a time where he could meet with a psychiatrist who specialized in addiction and a history of co-morbid disorders including anxiety and depression. Three days after he began taking medication he started to feel better, he started to sleep 6-7 hours a night, and his thought process was better in that he no longer had intrusive thoughts and he didn’t feel distress. It’s not that I am a magician, rather, I know that medications can serve a purpose and the team was able to support him to find a combination of medications that worked for him.

2) He didn’t have a place to live after discharge as he burned his bridges with his family and after discharge without housing he would be homeless. I spent time considering the options for him and realized that clean and sober housing in addition to a case-manager to follow him would be the best bet over independent living. I talked with his mother and step mom and they were willing to support him financially for a period of time.

3) He had limited vocational skills that could offer him a way to support himself. In the state where I live addiction is considered a disability. There are various agencies that were able to take into consideration his health history, his mental health diagnosis, as well as his history of addiction. While he has yet to follow-through, he has the ability to pick from seven different careers that will offer him a living wage. Supporting someone with the best addiction treatment available is useless if a client doesn’t have a place to live or the ability to support themselves. The programs I located would give him an opportunity to work while offering him the ability to develop pro-social activities.

As I started to work to develop a safety net for this client and he began to see all of the paperwork he had to sign with the various appointments he had to attend he began to understand that I was on his side. His resistance diminished and he apologized for his earlier statements. I didn’t expect nor need an apology, however, his apology let me know that he began to trust that we were on his side.

4) I made several calls to various mental health providers with him present and he began to interview various people that provided mental health counseling. I suspected that he would do best with day treatment, however he surprised the team and decided that he would rather pick an individual provider and take the bus to various mental health groups and support linkages available to him. He took the initiative to develop a schedule and showed me how he was going to attend each group and what bus he needed to take to make it to his appointments on time. I was impressed with his ability to utilize the available resources and get his needs met.

5) We looked at two different volunteer sites: Service Leader and VolunteerMatch. He found four different volunteer gigs that suited him and filled out the applications and we faxed the applications to the agencies and made sure he added those dates to his calendar.

6) I knew that he needed a phone so we filled out an application for Assurance Wireless as well as a free community voicemail provider. He has a cat and he was given an application from the Humane Society as they do free pet food delivery for low-income clients. He had dental issues and we filled out an application for Donated Dental Services, an organization of volunteer dentists that provide free dental care. He needed better money management skills so we found a org that will pay his bills and send him a set amount of money every week so that he has a bit of spending money. We filled out an application for a reduced fare bus pass, and finally we made sure that his mediations were sent to him on a monthly basis.

Before he left treatment he wrote an extensive letter outlining his desire to follow-through and pointing out various things that were important to him. I am keenly aware that we spent a significant amount of time with this client and it took a herculean effort to connect with people that were even willing to take on someone with his his history. I am under no delusion that setting up all of these providers insures success, however……..I am also aware that the best counselors don’t always maintain perfect boundaries. I am sure that some people could argue that he should have probably done most of the work, but really, was he capable, especially when he was easily overwhelmed? Is it possible that he will be overwhelmed by the sheer number of appointments and that he will probably miss a provider appointment even though he has a schedule? Absolutely. What’s the alternative? It seems to me that supporting someone to find options and then teaching them that people want to help and that the world isn’t always a scary place is better than letting someone suffer. I’m okay with what we did.

Guess what? Today found me getting a letter from this client letting me know that he had been sober for 33 days…this is the first time he’s been sober for 33 days in over 20 years since his first attempt at recovery. He let me know that he started exercising and that the judge threw out two of the three legal charges. He is required to stay on probation for a year and follow-through with some kind of service work. Apparently the volunteer work he’s currently doing will count towards the court requirements.

Hmmm, yeah, I’d say this was successful.