Hope and Recovery

Pat Deegan reflects on her own experience an shares about the need for hope in recovery:

He said, I should retire from life and avoid stress. I have come to call my psychiatrist’s pronouncement a “prognosis of doom”. He was condemning me to a life of handicaptivity wherein I was expected to take high dose neuroleptics, avoid stress, retire from life and I was not even 18 years old! My psychiatrist did not understand that boredom is stressful! A life devoid of meaning and purpose is stressful! A vegetative life is stressful. A life in handicaptivity, lived out within the confines of the human services landscape, where the only people who spend time with you, are people who are paid to be with you – that is stressful! Living on disability checks from the government is stressful.

When I was diagnosed I needed hopeful messages and role models. I needed to hear that there were pathways into a better future for me. I needed to connect with others who had been diagnosed with schizophrenia and who had recovered lives of meaning and purpose. I needed to find others who had completed college and who had jobs and who got married and had families, and had an apartment and a car.

Why is hope important to recovery? Because hope is the root of life’s energy. In order to recover, I had to turn away from the wish that psychiatrists could fix me. I had to turn away from the myth that psychiatric treatments could cure me. Instead, I had to mobilize all of the energy I had. I had to become an active partner in my recovery. I had to learn to work collaboratively with my treatment team and to draw strength from the wisdom of my peers. I had to begin striving for my goals, not when I was “all better”, but from day one. I had to believe that there was a life for me beyond the confines of the mental health system. That is hope. Hope is the tenacious pursuit of pathways to a better life, despite the odds. Without hope, there is no recovery.

Amen. Please go and read the whole post at her blog and spend some time poking around her posts.

What are teens hoping to feel when they self-harm?

Self Harm Scars III
Self Harm Scars III (Photo credit: LauraLewis23)

 

This isn’t about addiction, but self-harm is not unusual in the addicts we serve.

 

A common motivation teenagers give is that non-suicidal self-harm provides a way to escape unpleasant thoughts and emotions. Another motive, little explored before now, is that self-harm is a way to deliberately provoke a particular desired feeling or sensation. A new paper from US researchers has explored this aspect of self-harm, known as “automatic positive reinforcement” (APR).

Edward Selby and his colleagues gave 30 teenagers who self-harm (average age 17; 87 per cent were female) a digital device to carry around for two weeks. Twice a day, the device beeped and the teens were asked to record their recent thoughts of self-harm, any episodes of self-harm, their motives, their actual experiences of what it felt like, as well as answering other questions.

Just over half the sample reported engaging in at least one instance of self-harm that was motivated by wanting to experience a particular sensation (and 35 per cent of all self-harm behaviours had this motive). The most common sensation the teenagers sought was “satisfaction” (45 per cent of them), followed by “stimulation” (31 per cent) and “pain” (24 per cent). Those were the hoped for sensations. In fact, pain was experienced more often than it was sought; stimulation was experienced as often as it was sought; and satisfaction was experienced less often than the teenagers wanted.

There were differences between the teenagers who self-harmed in order to produce a particular feeling and those who didn’t have this motive. The former group self-harmed more often during the study (and in the past) and they thought about self-harm more often and for longer. Those seeking a particular feeling from self-harm also engaged in more other risky behaviours including using alcohol, binge eating and impulsive spending. Zooming in on the different sensation motives, those teens seeking pain and stimulation tended to self harm more than those who sought satisfaction.

 

via BPS Research Digest: What are teens hoping to feel when they self-harm?.

 

Precovery

Bill White introduces a new concept, precovery:

Precovery involves several simultaneous processes:  physical depletion of the drug’s once esteemed value, cognitive disillusionment with the using lifestyle (a “crystallization of discontent” resulting from a pro/con analysis of “the life”), growing emotional distress and self-repugnance, spiritual hunger for greater meaning and purpose in life, breakthroughs in perception of self and world, and (perhaps most catalytic in terms of reaching the recovery initiation tipping point) exposure to recovery carriers–people who offer living proof of the potential for a meaningful life in long-term recovery.  These precovery processes reflect a combustive collision between pain and hope.

Unfortunately, it can often take decades for these processes to unfold naturally.  If there is a conceptual breakthrough of note in addictions field in recent years, it is that such processes can be strategically stimulated and accelerated.  Today, enormous efforts are being expended to accelerate precovery processes for cancer, heart disease, diabetes, asthma, and other chronic disorders.  We as a culture are not waiting for people to seek help at the latest stages of these disorders at a time their painful and potentially fatal consequences can no longer be ignored.  We are identifying these disorders early, engaging those with these disorders in assertive treatment and sustained recovery monitoring and support processes.  Isn’t it time we did the same for addiction?

This made me think of Debra Jay and her efforts to continue refining, improving and expanding the role of family interventions.

Sentences to ponder

by karola riegler photography
by karola riegler photography

Nearly one-third of U.S. veterans who are given psychiatric medications by their doctors do not have a diagnosed mental health problem

Many vets given psychiatric drugs without diagnosis | Reuters

NIMH acknowledges that antipsychotics worsen prospects for long term recovery

Mad in America
Mad in America (Photo credit: Wikipedia)

Thomas Insel, the Director of the National Institute on Mental Health comments on a recent study of the long term effects of antipsychotic maintenance for schizophrenics. The study looked at patients who discontinued antipsychotics compared to those who were maintained on antipsychotics.

…by seven years, the discontinuation group had achieved twice the functional recovery rate: 40.4 percent vs. only 17.6 percent among the medication maintenance group.

…antipsychotic medication, which seemed so important in the early phase of psychosis, appeared to worsen prospects for recovery over the long-term. … At least for these patients, tapering off medication early seemed to be associated with better long-term outcomes.

…It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness.

Mad in America reports that this information has been around for years and the establishment has willfully ignored it. He adds that there’s also a better way to respond to psychosis.

The Open Dialogue therapy protocol delays the use of antipsychotics in first-episode patients, instead utilizing psychosocial support and selective use of anxiety-reducing benzodiazepines (e.g. Ativan, Klonopin,Valium) with the hope that patients can “chill out,” and get through their first crisis without ever going on antipsychotic medications. And if patients need to go on antipsychotics, the Open Dialogue protocol allows for them to subsequently try to taper from the drugs.

The results? “With this selective use of antipsychotics,” Whitaker reports, “Open Dialogue has produced the best long-term outcomes in the developed world. At the end of five years, 67% of their first-episode patients have never been exposed to antipsychotics, and only 20% are maintained regularly on the drugs. With this drug protocol, 80% of first episode patients do fairly well over the long-term without antipsychotics.”

This begs a critical question. If antipsychotics are impede the recovery of many schizophrenics, what do they do to the millions of non-psychotic adults and children that are prescribed them?

One other observation. This notion of “functional recovery rate” sounds a lot like quality of life. Interesting that this is the kind of measurement exposed this pharmacological treatment as harmful for many patients and some prominent advocates of a pharmacological treatments have dismissed quality of life as an outcome measurement.

UPDATE: This is precisely why so many of us have been so concerned about mergers between mental health and addiction treatment systems. Many of these mergers are really the mental health system taking over addiction treatment systems.

Recover from ==> Recovery to

wellness_wheelCommenter Web Servant responded to the a recent “Sentence to Ponder” from Bill White about the need to expand the scope of treatment and recovery services that create pathways to natural community supports and adopt a wellness model. His comments seem worthy of a post of their own.

The place of treatment in recovery is to help people stop using (ie “recovery from”), the place of mental health and primary care in recovery is to address other issues which may undermine recovery and the place of community in recovery is to help people stay stopped and help sustain and maintain the full change in lifestyle and thinking that is needed “recovery too” – and can only only take place within the community.

I responded:

I like this. And, I’m thinking that this is probably true for any chronic illness where the most effective treatments are behavioral. The chronic disease burden threatens to crush the American health care system. Maybe the biggest factor is not better pills, procedures and systems, but it’s the absence of communities of recovery to support those behavioral changes.

Web Servant responds back:

Your right, nothing about this approach is specific to addiction – it applies equally to mental health, diabetes, obesity, disability maybe even ageing. So many of the struggles we have with these health conditions in the West risen from the professionalization of health care. While professional health care is essential and has had led to great achievements, it has stepped way outside of its rightful place. Especially the notion that professionals have a monopoly on human healing – a notion that has radically undermined and dis-empowered individuals and their communities from what they used to do for themselves.

This phenomenon is beautifully documented in the book The Careless Society: Community and Its Counterfeits by John McKnight where describes how the best efforts of experts to rebuild and revitalize communities can in fact destroying them through the four “counterfeiting” aspects of society: professionalism, medicine, human service systems, and the criminal justice system.

“These systems do too much, intervene where they are ineffective, and try to substitute service for irreplaceable care. Instead of more or better services, the book demonstrates that the community capacity of the local citizens is the basis for resolving many of America’s social problems.”

Bill White has talked about the need to differentiate treatment and recovery. If we fail to make this distinction, we’re more likely to drift into treatment-oriented treatment rather than recovery-oriented treatment. After watching the video below, I’ve often wondered what American health would look like if the health care system invested a little less heavily in stents and more heavily in supporting creating community/social pathways for patients to integrate more physical activity into their lives.

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.