The spirituality of addiction treatment

English: A woman walking a prayer labyrinth
English: A woman walking a prayer labyrinth (Photo credit: Wikipedia)

I was listening to On Being this morning and was struck by this one quote. I think this could be paraphrased into something that fits perfectly with why we have such great staff who put so much ourselves into our work here:

For me, thinking about living in a city like Chicago where you just — honestly, in a society like the one that we’re in and the world that we’re in with such extraordinary disparities between those who, you know, if you’re in a block in Chicago, you’re born in one ZIP code, you are, you know, destined for a school that has over 50 percent dropout rate, you’re destined to be four times more likely to be incarcerated, three more times to be, you know, unemployed. So I think, for me, this work is in part a way to deal with the anxiety, the spiritual anxiety, of those disparities that I can’t feel religiously comfortable in simply accepting that type of division in the way we live our lives.

 How would it sound for Dawn Farm? Here’s a stab at it:

For us, thinking about being an addict in a society like the one that we’re in and the world that we’re in with such extraordinary disparities between the kinds of help that addicts get, you know, if you aren’t from a wealthy family you’re destined to be referred to a crappy once a week public outpatient office (if you’re lucky) that has no hope, no love for addicts and no connection to the recovering community, or, if you’re opiate addicted, referred to a methadone program based on the assumption that you’re not capable of full, drug-free recovery. Even if you are from a wealthy family, it can be dumb luck whether you end up in a hopeful, compassionate treatment setting or a program that takes $25,000 for you and does little more than pump you full of Suboxone. So I think, for us, this work is in part a way to deal with the anxiety, the spiritual anxiety, of those disparities that I can’t feel spiritually comfortable in simply accepting that type of division in the way addicts live their lives and receive help.

Some people say…

weasel_words_propagandaUgh. A pretty visible blogger resorts to the some people say tactic to advance a pet theory that slanders 12-step groups. 

It’s worth noting that he’s acknowledged elsewhere that he’s had next to zero direct exposure to 12-step groups. His knowledge of 12-step groups and theory are based on internet comments. Ugh. Ugh. 

The 12-step approach has been said (by some ex-members) to put a freeze on emotional development. For those who believe that people can develop out of addiction (like me, for one), this is not an optimal solution. Twelve-step groups are notorious for convincing members that, even if they’ve been clean for a while, their addiction is out there waiting for them, waiting to sneak up on them in moments of weakness. So they have to remain constantly vigilant: Any slip, even one drink or one pill, will be the first step on a journey that inevitably leads to full-scale relapse. Twelve-step groups want you to keep coming back, to help gird your loins against the hazards of relapse, and they encourage you to define yourself as an addict – for life. In other words, not only the way you govern your life but your whole self-image is frozen in place. This is what you are, and if any change occurs, be warned: it’s going to be a change backward – back to being out of control.

A reader of my other blog suggested that the net effect of the scare tactics used in some 12-step groups is to induce a kind of PTSD (Post-Traumatic Stress Disorder). People with PTSD live with continuous anxiety, denial and avoidance mechanisms, intrusive thoughts, and more, about what happened to them, whether it was a serious accident, a mugging, physical or sexual abuse, rape, or getting wounded in a war. PTSD is in some ways an adaptive emotional response to trauma. It’s one way to stay clear of danger. After getting mugged or raped, you won’t go strolling through city parks at night, you’ll stay inside when the parade comes by, you’ll avoid people of a certain type, you might avoid eye-contact with strangers altogether, but you’ll continue to see yourself as a victim or a loser. This is a static state; obviously it’s also an unhealthy state, at least compared to normal, flexible, spontaneous functioning. It maintains anxiety rather than relieving it.

According to him, millions of us are voluntarily submitting ourselves to and “unhealthy state” of frozen emotional development, chronic manufactured anxiety, PTSD and a life time of seeing ourselves “as a victim or a loser.” He adds that 12-step groups are a poor choice for “those who do have the capacity to continue growing.”

Hate to say it, but tossing in that this describes “many (surely not all) 12-step programs” does not get you off the hook.

Quitting Smoking and Anxiety

A 21 mg dose Nicoderm CQ patch applied to the ...
(Photo credit: Wikipedia)

 

A recent study finds that quitting smoking reduces anxiety:

 

The study followed 491 smokers attending NHS smoking cessation clinics in England. All participants were given a nicotine patch and attended eight weekly appointments.

Of the sample, 21.6% (106 people) had a diagnosed mental health problem, primarily mood and anxiety disorders.

All participants were assessed for their anxiety levels at the start of the research, and were also asked whether their motives for smoking were ‘mainly for pleasure’, ‘mainly to cope’ or ‘about equal’.

Six months after the start of the trial, 68 of the smokers (14%) had managed to quit smoking – 10 of these had a current psychiatric disorder. The researchers found a significant difference in anxiety between those who had successfully quit and those who had relapsed.

All of those who had quit smoking showed a decrease in anxiety. People who had previously smoked to cope showed a more significant decrease in anxiety compared to those who had previously smoked for pleasure.

 

However, some people who tried to quit and failed became more anxious:

 

Among the smokers who relapsed, those smoking for enjoyment showed no change in anxiety, but those who smoked to cope and those with a diagnosed mental health problem showed an increase in anxiety

 

I wonder if another study looking at the natural history of attempts to quit smoking may offer a little insight into that increase in anxiety:

 

Within the month of the study, 32% of smokers had multiple episodes of intentions to not smoke, and 64% transitioned among smoking as usual, abstinence, and reduction status on multiple occasions. When participants reported that they intended not to smoke the next day, 56% of the time they did not make a quit attempt the next day. Just under half (44%) of quit attempts occurred on days with no intentions to quit the night before. Most quit attempts (69%) lasted less than a day. Reduction in cigs/day was as common as abstinence.

 

It’s striking how fluid motivation and attempts to quit are. Relapses don’t mean I’m a smoker. Quitting is a process. Many smokers probably constantly evaluate their status in that process.

 

 

Coming of Age on Zoloft

An interesting take on anti-depressants from a writer who has benefited from them:

The mainstreaming of medication has bred confusion about what’s normal. In some sectors, we’ve grown so vigilant about the possibility of having a mental disorder that this vigilance becomes counterproductive, a source of anxiety in itself. Every negative emotion becomes a potential sign or symptom. I think people, particularly adults, should use medication if they wish, but I am concerned about the changing goalposts of what’s considered pathological. It’s nice to know that medication is available, but it’s also important not to lose sight of the comfort that can come from talking openly with each other, realizing that not every instance of feeling sad, or overwhelmed, or disappointed, or anxious, is a sign of something medically wrong.

With youth, I feel that a conservative approach to medication is best.

Partly that’s because of the way that getting a mental-health diagnosis can intersect with the adolescent search for self. Being diagnosed and using medication confers an identity, that of someone with a mental disorder. To an adolescent who is preoccupied with constructing an identity anyway, and looking for clues to who she is, that can be a big deal. Some adolescents feel that having a diagnostic label is clarifying and that it helps them. But others wrestle with it. They ruminate about what it means to be sick. They take that identity deep inside, and sometimes magnify it way out of proportion. A diagnosis event can have lasting, rippling consequences, and I think adults should be very cautious and careful before they impose a diagnostic label, or let a young person self-impose such a label, on what may be ordinary developmental struggles.

More thoughts on the use of antidepressants with kids. Here, she’s commenting on a piece in The Atlantic that discussed her book.

I think one thing that piece illustrated nicely is the potential difference between starting antidepressants as an adult and starting them young.

Kelly was saying, ‘Look, antidepressants help people; they helped me; they’re this wonderful thing, and I don’t understand why you people are trying to shoot holes in them.’ Kelly has a story that was similar to that of a lot of adults who start antidepressants: she was in therapy for years; therapy was helpful but notthat helpful; she went into crisis and finally overcame whatever inner resistance she had about trying antidepressants, and they were great — she wished she’d tried them sooner.

I very much respect that story, and many others have one like it. Part of what I’m on about in the book is that for people who start medication as teens, or even younger, the story is different. For them, using medication is often not their choice or not their idea. They don’t have the experience of trying other remedies for years and then reaching a point where they say, ‘You know what, these things aren’t working, this problem isn’t going away, and I’m going to take it seriously now and try something new.’ They haven’t necessarily had a chance to sort out what’s the turmoil of growing up and what might be deeper or longer lasting. Sometimes it’s very obvious that an adolescent is dealing with a real mental problem that goes way outside the realm of teen angst. But in other cases it isn’t always so clear. So for some of the people who start young, the narrative ends up not being one like Maura Kelly’s, of, ‘I had a problem, and then I used my own agency to find a solution, and it was wonderful.’ It’s more like, ‘Someone thought I had a problem, and this thing was given to me, and maybe it helped me or maybe it didn’t, sometimes it’s hard to tell, and if I stayed on it for years then I’ll never be quite sure, either what was the matter in the first place, or how I would have developed if I hadn’t taken this drug.’ It’s a singular experience, but it’s becoming more and more a hallmark of our time. That’s what I was trying to capture in the book.

One trend I find interesting is this. There was a time when anecdotes were used to attack antidepressants. The reaction of researchers and other advocates was that evidence should guide practice. Now, as the evidence has softened, we see many of these advocates using anecdotes to make their case. I’m not one to dismiss experiential knowledge, so this is just an observation.

a thousand pasts and no future

“Choose [your memories] carefully. Memories are all we end up with … You’ll have a thousand pasts and no future.” –The Secret Behind Their Eyes (film)

forget about the sunshine by whatmegsaid

A friend shared this On Point episode with me and made a connection between it and resentments.

This matter of appropriate, helpful, deliberate forgetting is very fascinating.

We’ve talked before about role of the brain’s memory circuits. I’ve also been very interested in the similarities between PTSD and addiction. Both are characterized by intrusive, powerful, multi-sensory, involuntary memories.

The On Point episode discusses that the capacity this helpful forgetting relies on executive function which we’ve discussed is impaired AND depleted.

So…addicts may have limited capacity for this kind of helpful forgetting. Maybe this explains and supports 12 step recovery’s emphasis on letting go of resentments.

Further, the idea in the quote above may help explain the emphasis on gratitude and the power of gratitude lists. Aren’t gratitude lists really an attempt to choose what to remember?