Faith is given in sufficient quantities to communities

I recently listened to an interview with Nadia Bolz-Weber. There were a lot of keepers in the interview (even for a non-believer). She’s described as a recovering drug addict. Her recovery shines through in this, “fake it till you make it” discussion:

Ms. Tippett: So a sermon of yours I wish I could have heard is “Loving Our Enemies Even If We Don’t Mean It.”

(laughter)

Ms. Nadia Bolz-Weber: Yeah, I think meaning it is overrated. I mean, I think …

Ms. Tippett: I think this is profound. I really do.

Ms. Nadia Bolz-Weber: No, I’m serious. Like, my gosh, if God’s going to wait till I mean it, that’s going to be a while, right? So I think that the key is praying for them, not like feeling warm feelings towards people who’ve hurt you or towards your enemy. I don’t think it’s about feelings. I think it’s about an action.

That was kind of neat, but what she said next really leapt out to me. [emphasis mine]

…I think that’s what the sort of love your enemies and pray for those who persecute you means. I will actually ask other people to do it for me sometimes, like it doesn’t always have to be us. And so it’s like this thing like I don’t think faith is given in sufficient quantity to individuals necessarily. I think it’s given in sufficient quantity to communities.

Wow. It reminds me of my persistent despair many months into my recovery and Dave H. telling me, “It’s okay if you don’t believe it’s going to get better, just believe that I believe it’s going to get better for you.”

This reminds me of an aha moment I had when listening to Bill White describe the recovery coaches of Project SAFE. I remember listening to him and thinking of the clients in those stories as having no protective factors–none!–only risk factors. He went on to describe the assertive support and engagement that these workers provided. I realized that these workers were becoming and creating protective factors in the lives of these women.

It also reminds me something my friend Ben often says, “Too often I fail to notice how much of the time I’m carried by others.”

What a gift it is for our profession to have access to a recovering community that, a group and one-to-one level, provides so much hope, faith and tangible support.

The adjacent possible and hope

I heard a radio show this morning about where ideas come from.

They interviewed a guy who wrote a book and gave a TED talk on the topic.

During the interview he discussed the concept of the adjacent possible and it’s importance in forming new ideas. During the interview, he described it as the building blocks of new ideas. Without the right building blocks, any innovation is not possible. He described it another way in a WSJ article:

The adjacent possible is a kind of shadow future, hovering on the edges of the present state of things, a map of all the ways in which the present can reinvent itself.

The strange and beautiful truth about the adjacent possible is that its boundaries grow as you explore them. Each new combination opens up the possibility of other new combinations. Think of it as a house that magically expands with each door you open. You begin in a room with four doors, each leading to a new room that you haven’t visited yet. Once you open one of those doors and stroll into that room, three new doors appear, each leading to a brand-new room that you couldn’t have reached from your original starting point. Keep opening new doors and eventually you’ll have built a palace.

During the interview, he pointed out that it doesn’t matter how smart one is, it was not possible to invent a microwave in 1650, because the building blocks, the adjacent possible, just wasn’t there.

One factor is that the physical building blocks did not exist. The other factor is that the imaginative/inspiration building blocks did not exist.

This reminded me of a metaphor Bill White once used when talking about hope-engendering relationships offering kindling for hope.

I think this helps explain the resistance some recovery advocates have to interventions focused on something other than drug-free recovery. There’s a sense of how precious this adjacent possible is, and how easy it is to imagine a world where drug-free recovery is not possible because the adjacent possible has been lost.

Book Review: The Recovering Body

Jennifer Matesa’s The Recovering Body: Physical and Spiritual Fitness for Living Clean and Sober seeks to provide “a roadmap to creating our own unique approach to physical recovery” and frames “physical fitness as a living amends to self–a transformative gift analogous to the “spiritual fitness” practices worked on in recovery.”

She focuses on five areas, blending her own experiences, other recovering people, empirical research and practical to-do lists. The five areas are:

• exercise and activity
• sleep and rest
• nutrition and fuel
• sexuality and pleasure
• meditation and awareness

I see two reasons this book is an important contribution to recovery literature.

First, it’s the first book I’ve seen (not that I’m well read in the area) that places such emphasis on physical wellness and self-care as an important element of recovery within traditional 12 step recovery paths. I’ve seen it addressed as an aside, and I’ve seen it offered as an alternative path, but not as an important element within traditional recovery paths.

As researchers and clinicians search for every tool to give addicts any possible edge as they initiate and maintain their recovery, we’d be wise to take notice. There is a growing body of evidence to support Matesa’s assertions that these are important elements of recovery rather than frivolous and indulgent accessories to treatment and recovery programs.

Second, I am convinced that the future of treatment and recovery programs (All chronic disease management programs, really.) should emphasize a lifestyle medicine as the foundation of care. After all, “recovery as a lifestyle” epitomizes one of the things addiction treatment has gotten really right historically and something the rest of chronic disease care could learn from us.

Despite this, professionally directed treatment that discusses the idea of the “recovery of the whole person” has mostly been lip service. Matesa brings this concept to life and presents holistic recovery as a lifestyle to be cultivated, practiced and maintained. On this front, she’s far ahead of professionals and researchers. The field is not there yet and too often equates recovery with swallowing pills or passively doing what professional helpers direct them to do. Matesa bypasses professionals and speaks directly to recovering people as a peer, calling them to action and offering experiential and empirical truth. That’s radical, in the best sense of the word.

Her writing is very accessible, is not preachy, and unpretentiously conveyed a lot of deep truths that I hadn’t considered but seemed self-evident as soon as I read them.

On a personal note, as someone who only started paying attention to physical fitness after 20 years of sobriety, the book takes a lot of previously disparate pieces of information that I vaguely knew to be true and organizes them into framework that not only deepened my understanding, but offered a concrete path to continue enhancing and securing my own recovery. I highly recommend it.

Urban myths exposed

Points blog is back with a great interview with George Vaillant.

Here’s one of the questions and his response:

2. What do you think a bunch of alcohol and drug historians might find particularly interesting about your book?

The value of the Grant study to the history of alcoholism is the number of urban myths that it exposes, and for this reason it received the biennial Jellinek prize for the best research in alcoholism in the world.

The first urban myth exposed is that depression causes alcoholism. Our prospective study shows beyond a doubt that alcoholism causes depression.

Second, alcoholics have unhappy childhoods due to their parents’ alcoholism; unhappy childhoods without a history of alcoholism do not lead to alcoholism. Therefore, the relationship between childhood and alcoholism appears to be genetic.

The third urban myth exposed is that AA is only for a few alcoholics and drugs are more useful. There are no two-year or longer studies of Naltrexone, Antabuse, or Acamprosate that have been shown to be effective, nor has long-term follow-up of cognitive behavioral therapy proved to be effective. On the other hand, when we followed, over 60 years, our sample of roughly 150 alcoholics, the men who made complete recovery—that’s an average of 19 years of abstinence—as contrasted to those men who remained chronically alcoholic until they died, the men who “recovered” went to 30 times more AA meetings than the men who remained chronically ill. Like outgrowing adolescence, it takes a long time to learn to put up with AA, but when you do, it works.

Sober fun on St. Patty’s day

I teach at a local university and some years I teach on Saint Patrick’s day. It’s bad. Green beer starts flowing early, there are very drunk people wandering around all day, people passed out on the sidewalk, etc. Worst of all, it’s the default thing to do if you’re a young college student on St. Patrick’s day.

That’s why it’s so nice to see the growth of the Collegiate Recovery Program at University of Michigan. It would be cool no matter what, but it’s even cooler because they’ve been such good friends to Dawn Farm.

USA Today covered their St. Patty’s day event:

“Priority number one is to have fun,” says Molly Payton, 23, a general studies senior at Michigan, who has been sober for one year and attended the Sober Skate. “When I was in recovery, my big fear was that I wouldn’t have fun anymore … it was baffling to think I could have a life outside of drugs and alcohol.”

“For me, Fridays and Saturdays were tough,” adds Garrett Gibbons, 27, a graduate student in pathology at Michigan who is also in recovery.

“Those were nights when I knew I would party, knew I would drink. That’s why this is an important time for us.”

Hope, empowerment, capability, connection and purpose

Hopeworks Community recently listed his core beliefs related to his recovery from mental illness:

The idea was simple. There are a few core beliefs about recovery that make a difference. To the extent you are able to live them your recovery will be positively impacted.

My list of core beliefs was simple:

Life can get better.
I can help make it better.
I can learn the things I need to do to make it better.
I have support. People care about me and what I am doing.
What I do matters. It has meaning and purpose.

Or HOPE….EMPOWERMENT…CAPABILITY….CONNECTION…PURPOSE…

This rings very true for addiction recovery as well. Any practitioner or program that ignores these dimensions is inadequate. Some people will need no assistance with this kind of recovery–if we reduce their symptoms they can take care of all of this on their own without mutual aid or extended professional help. (I’m thinking of people with major depression or a problem drinker.) Others will more severe and chronic mental illness or substance use disorder will need lifelong professional and/or peer support. (Here, I’m thinking of an addict or chronic, debilitating mental illness.)

There’s a lot of pushback on this for addiction. Just this weekend, Anne Fletcher tweeted a dismissive reaction to a Bill White post about developing geographic communities of recovery.

Recovery Landscapes by Wm White http://t.co/CuXWuruQfz A good idea or is life more than “recovery”?

— Anne M. Fletcher (@annemfletcher) March 8, 2014

Would she have the same reaction to a post about building communities of recovery for people with chronic and severe mental illness? Would she tweet a response that implies it’s overkill and these people (Who, together, are re-engaging in full family, occupational and community life.) need discover that there’s more to life and they need to get out of some growth-limiting bubble?

There’s been a whole new wave of these kinds of reactions recently. To me, they suggest a couple of beliefs:

• The failure to acknowledge the different needs of people who have less severe or time-limited problems with alcohol and other drugs versus those with severe, chronic and debilitating addictions. Their reactions often focus on the experiences of the former, framing substance use disorders as a lifestyle choice.
• The perception that recovery advocates (12 step recovery in particular) can’t tell the difference between these two groups and are bent on evangelizing every problem user into their one and only path to recovery while obstructing access to any treatment or recovery support that isn’t perfectly compatible.
• That this perceived pattern of behavior undermines the legitimacy of mutual aid groups and the empirical evidence for the their effectiveness and their mechanisms of change.

Hopeworks Community closed with a thought that sums up recovery as a way of life.

But I know recovery is never a thing to have, but a way of doing.

Interesting that there is so much resistance to lifestyle change as an approach to managing addiction while there’s no dispute that lifestyle change is critical to successful management of other chronic illnesses and that peer support is important for successfully initiating and sustaining lifestyle change.

I don’t hear any of these reactions regarding people who join a gym, spend an hour there 5 days a week, start eating healthier, integrate being physically healthy into their identity and develop new social networks around these changes, like, say, a tennis league or a biking group. Why is that? We don’t hear that push back, and we’re not even talking about people who were occupationally, socially, emotionally and familially impaired. And, if some faction of these people exhibited evangelical zeal and insisted this was the only way to be healthy and that everyone needed to do this, would we be so dismissive of scholarly work describing the development of some communities organized around this kind of wellness for really sick people?

The Doctor’s Opinion – Dawn Farm Ed Series

Research continues to shed light on the neurobiology of alcohol/other drug addiction. Modern research supports much of what was intuitively and experientially believed by the medical specialists who supported the Alcoholics Anonymous program in its earliest days.  This program will describe a physician’s view of alcoholism, as presented in the literature of Alcoholics Anonymous and updated with the modern neurobiology of addictive illness. It will include a discussion of Dr. Silkworth’s explanation of alcoholism as a twofold disease affecting mind and body, how Dr. Silkworth’s opinion relates to the modern neurobiology of addictive illness, identification of therapy for alcoholism as promoted by Alcoholics Anonymous, and the relationship of this therapy to Dr. Silkworth’s opinion.

Handouts and other goodies:

Handouts and slides:

• Doctors Opinion Handout

Related reading suggestions:

• “Doctor’s Opinion” in the AA “Big Book.”
• Articles by Dr. Silkworth.

Video

The Doctor’s Opinion on Alcoholism from Dawn Farm on Vimeo.

Slidecast:

The Doctors Opinion on Alcoholism – Revisited

View more webinars from Jason Schwartz.

About the presenter

Herbert Malinoff, MD, FACP, FASAM, is a specialist in chronic pain and addictive illness. He is the Medical Director of Pain Recovery Solutions, PC; and an attending physician at Saint Joseph Mercy Hospital in Ypsilanti, Michigan. Dr. Malinoff is a clinical faculty member of the University of Michigan Medical Center in the Department of Anesthesiology, and a consultant to Michigan Pain Specialists in Ann Arbor, Michigan. He is also a past President of the Michigan Society of Addiction Medicine. Dr. Malinoff received his M.D. degree from the University of Michigan Medical School.

Social connection as a mechanism of change

photo credit: davegray

A new blog looks at social connection as an important mechanism for facilitating recovery:

…if having plenty of quality social connections is good for the next person in the street, is it also true for people trying to recover from addictive disorders?

Mark Litt and colleagues from the University of Connecticut conducted a randomised trial on alcoholics in treatment. These patients either had case management, contingency management AND social network, or simply social network connection interventions. The ones connected to sober social networks did better than the other groups. One mind-blowing statistic coming out of this was that ‘the addition of just abstinent person to a social network increased the probability of abstinence for the next year by 27%.’ If this were causal think of the impact this would have on treatment populations. You’d think we’d all be practising this like billy-o now in treatment settings. Sadly we are not.

What’s the best way to improve the social networks of those seeking recovery? Answer: Introduce them to other recovering people.

Read the rest here.

The Misconceptions Go Round

Anna David vents her frustration about recent distortions of 12 step groups in coverage of Philip Seymour Hoffman’s death:

…I grow concerned about factually inaccurate information being spread in ways that are truly dangerous. That happened when I stumbled upon this io9 post which states, about 12-step, both that “the problem is that the sponsor system doesn’t fit with current scientific understandings of how addiction recovery works” and that “most NA groups frown on taking meds and forbid sponsors from doing it or advocating for it.”

I’m no expert but here’s what I understand:

• The “sponsor system” has nothing to do with “scientific understandings”
• A 12-step group doesn’t “frown on taking meds.” The literature directly states, in fact that “some A.A. members must take prescribed medication for serious medical problems.”
• Sponsors are not “forbidden” from doing anything. Sponsors are not, in fact, mentioned in the Big Book. As the literature about medication says: “No A.A. member should ‘play doctor’; all medical advice and treatment should come from a qualified physician.”

Here’s what I don’t understand:

• Why people blatantly lie when arguing against something when the facts are so clearly easy to find.

Here’s what I think helps:

• Articles that offer unbiased explanations of alternatives to standard AA, like this one from yesterday’s Times.

via The Misconceptions Go Round.

Tough love?

In a public facebook post, David Sheff rails against “tough love” advice to kick addicted loved ones out of the house:

Like so many others, he’s been indoctrinated by counselors, therapists, and people in 12 step groups. Al-Anon is wonderful –it helped me– but it doesn’t tell us to let a child or spouse or other loved one live on the street. It doesn’t tell us to give them ultimatums or cut off contact with them. Yes, in those meetings we can learn from one another’s’ experiences and we can support one another, but we in those rooms are people like us, not addiction professionals. Some may have been lucky and that sort of touch love may have worked for them. But it’s dangerous.

Over and over, in program after program, we’re told that we must kick our loved ones out in order to get them into treatment, that they must hit bottom and drag themselves into treatment if ever they’ll fully embrace recovery. This warped and dangerous definition of tough love is killing people.

. . . within the limits of our own sanity, resources, etc, we mustn’t give up on someone we love who’s ill. As I’ve said, I don’t believe in tough love. I believe in love.

Maia Szalavitz offers a few critical points.

What people are misunderstanding here is the purpose of kicking a child out or cutting them off. Parents may have to kick a child out for their own sanity or to protect other family members— that’s reality and there’s nothing wrong with that. But the reality is *also* that this is more likely to hurt the addict than it is to help them. If you want to help a person get into recovery, you need to take positive, specific steps to do so, such as using techniques like CRAFT, motivational interviewing, harm reduction, etc. You can’t take those steps if you’ve cut that person out of your life, although you can try to ensure that they have access to people who do this. Again, you may need to cut ties *for you*— the point here is don’t pretend it’s for the addict. If you do that, you risk the outcome that happened to Terry McGovern— she died drunk in a snowbank after her parents cut her off and they never forgave themselves for taking the advice to do this. Again, it’s not selfish to try to save yourself and other family members— the harm comes from pretending that leaving addicts in prison or on the street *helps addicts*.

If you reach the point where you need the addict out of your home, it’s ok. But, be clear that you’re doing it for you (and the rest of the family), not them. When done to get the addict sober, it’s really just a high stakes gamble rooted in an illusion of control over the addict’s behavior and the illness.

The lives of addicts families often drift into being organized around the chaos, crises, secrets and shame that the addiction brings. What often gets lost are the goals and values family members. Deciding to reorganize personal and family life around healthy goals and values can be traumatic and lead to difficult choices.

However, one option left out of her list is family intervention–not the hit and run tough love interventions that you see on TV. Rather an intervention that’s rooted in love and honesty.

Here’s George McGovern on the subject:

Perhaps more to the point is the manner in which the Jays’ work through the mistaken views frequently held by an addict’s family. During the years of Terry’s drinking with its frequently sad results, she did seek help in treatment, counseling, and Alcoholics Anonymous programs. But we were repeatedly told by well-meaning, supposedly informed friends, that we would have to wait until Terry really “hit bottom.” The trouble is that when she “hit bottom,” she died.

Intervention is a way of erecting a “bottom” before such a tragedy.

Jeff Jay describes family intervention here. Note that he had been out of the house and on the streets. That didn’t get him sober. A loving family intervention was the beginning of his recovery. The Love First website is full of great information and resources.