Health and Recovery Blog

It is difficult to recover from substance abuse even under the best of circumstances. The brain and the mind (not exactly the same thing) are very powerful and sometimes unpredictable things over which we don’t have full control (as much as we would like to). In addition to the inherent difficulties in the recovery process, many have to deal with challenges and obstacles that can be quite intimidating. Some examples are fairly obvious, like lack of adequate treatment facilities, lack of properly trained treatment professionals, lack of financial resources to pay for treatment, stigma and shame associated with having an addiction problem, lack of support from family and significant others. So what else can stand in the way? I can think of internal and external factors. For example, ambivalence seems to be a big issue and can not only slow down but downright sabotage recovery. That would be an internal obstacle. External obstacles would be even simple logistical things like lack of transportation, child care issues, geographical isolation, and so on. In order to pursue recovery, it is important to get past the  “I can’t do this because of that” mentality and get into a pragmatic, problem-solving mode. Easier said than done, but well worth it.

Any other examples of obstacles and how to manage them?

Do you really want to get sober?

I ask because, many times, I wonder. I’ve seen people say the right things, but their actions say something else.  Usually, they will be crying about their most recent relapse, but they keep hanging around actively using people, using mild altering substance in lieu of their drug of choice (“I have up the Oxys but I drink because alcohol was never my thing”) or not putting any effort in recovery.

In all fairness, it is a very common scenario, as it is rare that somebody will show up to treatment 100% ready and committed and ready to hit the ground running. While the person may, at one level, want to get clean, it’s usually because they don’t want to hurt any more, not that they really want to give up their drug of choice. After all, their drug of choice did made them feel good, even if only temporarily, but the intensity of this pleasure can be very hard to give up, unless the consequences are just too painful.

It is also very hard for some to conceive that it is quite possible to experience joy and pleasure without chemicals being involved. Sometimes, that’s all they know, and it takes a lot of work to “grow new wires”, in the brain.

However, you can’t be a little bit sober any more than you can get a little bit pregnant. Either you are clean from mind altering substances or you are not. Trying to have it both ways doesn’t work very well, and will make it more likely to drop out of treatment and relapse.

So, if you are ambivalent about recovery, what would help you make up your mind? Now, THAT’S the $64,000.00 question that nobody can answer but you. It is much harder to get there if you don’t know where you want to go.

I sure hear that a lot.  Relax, I won’t force you to go to meetings (not usually, anyway, but I do make exceptions about this depending on the case).  I get it. You don’t want to mix with “those people” telling war stories. You don’t like the God/spiritual talk. Sometimes being in a meeting makes you want to use. You are too busy, too far, have no transportation, have to take care of your children/spouse/parent/dog/cat/fish  (OK, I’m exaggerating  a little bit). I get it that it’s hard and it’s complicated…but you never let any of that stuff stop you when you were using, did you?  In all fairness, some people do have legitimate reasons to not go to meetings. Like being terrified of groups, I know you probably won’t do well. If you have antisocial traits, or are disruptive, you better stay home. You may need to avoid running into somebody that could threaten your sobriety (not everybody that goes to meetings do because they want recovery, sometimes they are forced to do so by their spouse, parent, significant other, or the court and the last thing they want is to be there).

So, why go to meetings? Because you will probably meet people that have been sober longer than you have, and they have something to teach you.

Because you can meet people that are also in recovery that will support you, and hold you accountable.

Because you can get a sponsor who will guide you through the steps.

Because you could help others that are just getting started in sobriety. If you know so much that you don’t need a meeting, you would be a great asset for those that need it (playful snark).

Because when life throws you a curveball, a meeting is a better alternative than using.

You could find reasons (even legitimate ones) not to go to meetings, or you could find reasons to go to meetings. 

Ultimately, if you are so oppossed to meetings, what else can give you the same benefits? If you have good, sober, happy life without going to meetings, the more power to you. If you are struggling with sobriety and can’t get it together more than a few days/weeks/months at a time, you may want to reconsider your resistance.

God, Grant Me The Serenity To Accept The Things I Cannot Change

The Courage To Accept The Things I Can

And The Wisdom To Know The Difference

In a nutshell, this is the essence of 12 step programs. After years of practice, I see that many people seem to get stuck on the “serenity” part, thinking that they are supposed to be “serene” at all times. Much less attention is paid to the rest of the prayer, which talks about courage to change the things I can.  It seems that it is awfully hard to stay serene in a situation that requires courage. Typically, we need courage as a way to get through fear, either of outside things or of our own shortcomings. Not very conducive to serenity, but the prayer doesn’t require us to stay serene when summoning up courage. It just asks for courage when needed to change things…and the wisdom to know the difference. Just because I think I can change something doesn’t mean that I really can, and many times we all have been humbled by realizing that, despite our best efforts, some things can’t be changed. Not having the wisdom to know the difference results in lots of wasted, futile efforts that undermine our confidence and leads us to hesitate to courageously changing what we can. Essentially, the wisdom part is about self-acceptance of our limitations and strengths, therefore the acceptance of ourselves as we truly are.

Recovery, as commonly understood, implies returning to the state we were in prior to illness, disease, or injury. In the Addiction Medicine field, we understand addiction as being a disease, more specifically a chronic, relapsing brain disorder, and we are starting to get important insights on its treatment. In my experience of 10 years of practice, I have seen that recovery is a complex process that is never the same for everybody, it can be very frustrating but also quite challenging and rewarding.

I hope to use this blog for educational purposes. Because of confidentiality issues, any examples I may use are entirely hypothetical, based on combinations of situations that are commonly observed in this field, and never about any specific person (so, if you are my patient, I’m not talking about you, as your situation is not unique but probably more common than you may realize).

Because of my erratic work schedule, I’m not sure how often I’ll make the time to put up a post or read comments.  Like many other blogs, this one could wither and die, or it may become successful,  so let’s take it one day at a time. Perhaps you can suggest topics you may want me to cover, I’ll do my best to choose those where I feel better qualified and within my scope of knowlege.

Comments:  I do not appreciate vitriol, venom, insults, derogatory or similarly negative/destructive comments, these will be deleted and you may be banned. I do appreciate constructive feedback as I can’t claim to know it all, as long as we can all maintain a respectful tone.  If you happen to be a patient that wants to comment, be aware that I cannot guarantee your anonymity if you put your name, e-mail, or any information that may be traceable. I am not a tech security expert so if you make a comment, you are doing so at your own risk of self-disclosure. If you are OK with relinquishing your anonymity, you need to either that make absolutely clear or refrain from commenting in this blog.

I hope I can contribute something positive to cyberspace.

I have decided that, after being in practice for a while, I might as well experiment with blogging and see how it goes. I’m an Addiction Medicine Specialist, entering my 10th year of private practice, and perhaps this might be a good venue to share what I have learned. Obviously, this is still work in progress, so pardon the dust while I construct this site…