My Addictions Recovery Self-Evaluation Checklist

To what extent do I agree that I have taken action this week on each recovery-supporting item below?

I use the following scale to rate my agreement with each statement. If the statement does not apply to me – for example, I don’t use tobacco products – I write “N/A” (not applicable) on the line.

Illustration by Anne

5 – Strongly agree
4 – Agree
3 – Neutral
2 – Disagree
1 – Strongly Disagree

_____ I have taken prescribed medications at the correct time(s) each day and in the correct dose(s).

_____ I have attended medical appointments, scheduled a medical appointment, or checked my calendar to remind myself of upcoming medical appointments.

_____ I have been aware of my basic needs and have done what I can to help get my needs met. I am working on self-care.

_____ I have attended individual and/or group counseling sessions.

_____ I have practiced sleep hygiene and I am working on establishing a regular sleep pattern for myself.

_____ I have engaged in daily physical movement and/or physical activity.

_____ I have centered my diet around nutrient-rich, recovery-supporting foods and eaten on a regular schedule.

_____ I have monitored my consumption of caffeine and have reduced or eliminated it.

_____ I have monitored my use of tobacco products and have cut back when I could.

_____ I have become aware of my physical sensations, feelings, thoughts. and actions without judging or criticizing myself or my experience. I am learning mindfulness.

_____ I have listened for negative self-talk. I can separate helpful thoughts from unhelpful thoughts. I have replaced my negative thoughts with supportive thoughts.

_____ I have become conscious of when I am experiencing strong states of emotion or strong sensory states. I have used supportive self-talk and other tools to calm myself enough to be able to think before taking action. I am learning distress tolerance and emotion regulation.

_____ I have met with, talked on the phone with, or texted people who support my recovery.

_____ I have worked on building social support, social connections, a social network, and community membership by attending support groups such as SMART Recovery, Alcoholics Anonymous, Narcotics Anonymous, and others. I have joined community groups and common interest groups, volunteer organizations, sports teams and/or engaged in other group activities. I am learning new interpersonal skills.

_____ I am exploring and discovering my preferences and personal interests. I am trying different activities, pastimes and hobbies to see which ones engage me.

_____ I am working on believing in my worth and learning my strengths. I acknowledge myself when I believe I can do something, say I will do it, and do it. I am learning to support my sense of self-efficacy.

_____ I am discovering purpose and meaning through self-reflection, self-discovery, and interactions with others. I am taking action on my purpose through paid work, volunteer work, and/or education.

_____ MY TOTAL. I can choose to create a total or not based on what I deem helpful to me as I discover the addictions recovery path that is uniquely beneficial to me. I can change the wording of the items on this list, as well as add and subtract items as my understanding evolves. I can use this list or not. If it seems helpful to me, I can track my totals over time.

It’s my life. Don’t you forget.
It’s My Life, Talk Talk

. . . . .

How am I doing? How do I know?

What helps most people most of the time? Current data indicates that up to 98% of people with substance use disorders (SUDs) have co-occurring mental illnesses and significant numbers have experienced trauma in their lifetimes.

The list of recovery-supporting actions above is based on my best efforts to distill current knowledge of evidenced-based practices, in priority order, that may assist many people much of the time with these challenges. At this time, no addictions treatment works for all people all the time.

I did not link the text above because every word could be highlighted and linked to multiple, readily-accessible sources. Where we couldn’t find research summaries, we created them. These links might be useful:

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

The Science of Addiction Is In

As a person recovering from alcohol use disorder for 3 and 1/3 years, I acknowledge that, early on, I made the mistake of believing my personal experience with what was helpful could and should be replicated. I realized that my sample size of one is absolutely not sufficient data from which to draw inferences about a larger population, especially given the complexity and variability of addiction.

Unbroken Brain by Maia SzalavitzAs Maia Szalavitz expresses this fallacy in logic in her article on Prince’s death, “I thought that simply having experienced addiction qualified me as an expert and incorrectly relied on anecdote, not data.” To correct my own error, I have relentlessly studied the research on addiction to grow evidence-based expertise.

That’s been a miserably difficult task. I’ve written extensively on my blog about my inability to find consensus in the literature about what addiction is and what effectively treats it. What I have found often plunges me into despair.

According to the definition used in addictions treatment from the American Society of Addiction Medicine (ASAM), addiction has “characteristic bio-psycho-socio-spiritual manifestations.”

Wikipedia defines spirituality as how one seeks meaning.

Did I become addicted to alcohol because my method of seeking meaning has been flawed?! Half a century of “Know thyself“and “The unexamined life is not worth living” and it was all wrong?! According to ASAM, it must have been. Because there I was, unable to stop drinking. The sorrow, the grief, the shame – unbearable! And now here I am, wishing I could drink.

Criticizing the ASAM definition, Maia Szalavitz writes in Why the “Disease Model” Fails to Convince Americans That Addiction Is a Health Issue, “The ‘spiritual’ part is something no other medical specialty feels compelled to mention in its official documents.”

What world have I fallen into? Why doesn’t anyone know what’s happening and what to do about it? Melted Dali clocks are everywhere. I’ve never been more frightened, more uncertain, more disoriented. How am I to save myself from addiction if no one knows what to do? What does the science say?

The science is in – comprehensively reported in the just-released book by Maia Szalavitz, Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Finally, someone understands what abstinence has been like for me: “I felt utterly stripped of safety and love…what tormented me most wasn’t the nausea and chills but the recurring fear that I’d never have lasting comfort or joy again.” (34)

I cried with relief when I read that. And I cried a few more times, but primarily felt my spirits and hope rise as I read Unbroken Brain. Szalavitz braids together her personal narrative, the science of addiction, and a call to action to replace experience-based and belief-based treatment with evidence-based treatment. Whew, yes, let’s do that.

Whatever term one uses for addiction – disease, disorder, illness – I didn’t make this happen to myself through moral or “spiritual” failing. I’m released from the fruitless, desperate search to figure out what I did wrong so I don’t do it again and return to drinking. My job is to keep figuring out what helps me stay abstinent from alcohol – the treatment I need, not the one for all.

. . . . .

I am part of a local community group in the Blacksburg, Virginia area reading Maia Szalavitz’s Unbroken Brain: A Revolutionary New Way of Understanding Addiction. We’re compiling a list of her recent publications and interviews here. If you would like to join us, please contact me and I’ll invite you to our discussion meetings.

What I Learned About Myself from Creating a Podcast

I thrive when I have many, many ways to create.

Anne recording a podcast episodeI wrote a post for our company’s blog on how I discovered having “podcaster’s block.” I’ve gotten through “writer’s block” many times since the 5th grade when I declared myself a writer. Why was I having trouble speaking into the mic?

Like with so many of life’s challenges, I found that help helps.

Laurel Sindewald, our podcast producer, transformed my podcaster’s block into building blocks with her kind words. I share them with her permission.

Would you like to try doing your podcast recording together? We could feel our way forward on podcast content one bit at a time, recording together and working together on what you might want to say. Perhaps dialogue is an easy way for you to hit upon your truths.
Laurel Sindewald

Laurel is simply lovely.

The post – So People Can Hear, Too – elaborates on other lessons I learned about the logistics of podcasting – and the exhilaration that comes from having one’s own podcast show!

My observations and insights from starting a podcast channel:

  • Podcasting feels like I’m going to a creative gym, like I’ve found a novel way to exercise my inner life and discover what I think and feel and can express.
  • I feel like I’ve been given a new sense of hearing! I’m listening to every sound, wondering if it would make a good ding or bump in a podcast episode.
  • I’m listening to people more intently. I’ve been listening to their words for meaning. I am now more consciously listening to the sound of their meaning.
  • It feels like I’m doing my written work a good turn by reading it aloud.
  • I experience a kind of self-appreciation. I feel respect for myself and my efforts as I hear my words.
  • I think it will help me grow as a writer.
  • It feels like a present I’m giving myself.
  • I feel like I’m being of service. Some people have trouble reading. But they can hear.

Look at all the creative possibilities for podcast! I can’t wait to record my next episode!

I’m listening to sounds – and to my inner voice.

. . . . .

In this podcast episode from my podcast channel, I’m reading aloud my blog post, Letter to Myself at Three Years Sober.

The recording was edited and mastered by Laurel Sindewald and produced by Handshake Media, Incorporated.


Unclosed

“What if nothing’s wrong with you?”
– My father

In a short story I read as a teenager, aliens performed vivisection on an abducted human man and reconstructed his brain, nerves, muscles and bones so that every thought and every movement created pain. Then they dropped him back off at home.

Untitled by Trish Shelor White

That has been my conception of having alcoholism. My first drink was my own doing. But after that, something was done to me against my wishes, against my will, and I ended up unlike anyone I’ve ever known. On the comforting bell curve of the human condition where I treasured my place as one of many because everyone fits somewhere, I felt thrown to the edge of the paper.

After three years of abstinence from alcohol, some cognitive functioning is returning. I am remembering who I used to be a decade ago before I started drinking. But who is this aching, pale entity inhabiting my body? Something’s been altered, distorted, changed. O, how I miss you, my former self! And the merciless pain. How did this come to pass?

. . . . .

I’ve been studying the work of Pauline Boss, particularly this book, and her conception of ambiguous loss – “an unclear loss that defies closure.” A researcher and therapist, she began working with families of soldiers missing in action during the Vietnam War, then continued with those who had a person in their lives physically missing but present in thought, and then with those who had a person physically present but psychologically absent through a cognitive impairment. In people with both losses, she discovered a complex grief and chronic sadness. How is a person to handle both presence and absence, the push-pull of hope for having, plus the doubt of never having again?

“Hold on and let go.”
– Pauline Boss

What if, as my father asked me, nothing is wrong with me? Boss writes, “Ambiguous loss is a relational disorder and not an individual pathology.” I had a colleague tell me about 35 years ago, “You’re the loneliest person I’ve ever met.” What if I’m not an outlier, but experiencing a deep, unclosed, on-going grief? What if I’ve just been very sad for a very long time?

. . . . .

We timed it perfectly. I was a teacher and if my husband and I waited until fall to conceive a child, I would have the summer off with our newborn. In October, 1986, I would stop using birth control. Delight in each other began us in September but I didn’t conceive that month so our plan was safe. We picked out names for a girl and a boy and I began to buy baby clothes – a pastel green onesy, a darling twosy with orange duckies. I began to love that girl and that boy.

I never did conceive. I see by the display on the corner of this computer screen that I have been missing my babies for 40 years.

. . . . .

Part of what I lost when I couldn’t have children was my identity. I thought I was a full-blooded, fertile woman. I became a wisp of hay, neutral, neither female nor male.

The corpus of who I want to be and think I am keeps getting carved away.

I was a married woman; when my marriage ended, I was a spinster.

I was a master teacher, a champion of ideas; when the student shoved me in my classroom, the trauma felled me. I was a cowering victim.

I was a person with a sacred sanctuary within; when I developed alcoholism, I lost what makes me a self. Nora Vokow writes, “People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.”

With the help  of others, I became abstinent from alcohol. I am not free or safe but continuously besieged from within.

The pain is unbearable.

And yet I long to live.

If I showed my “me and not-me” list to Pauline Boss, I believe she would say my thoughts are understandable, but they are examples of “either-or” thinking – it’s either all good or it’s all bad – and a source of anguished suffering. She urges people living in the presence of absence to cultivate “both-and” thinking. I have to step farther back, open my arms wide, live deep, and accept what happened then and this happening now. I have to accept that I both was and am. I must grow my heart and mind to be present for the whole of it.

Pauline Boss counsels, “To stay in control, differentiate what you can control from what you cannot. When you’ve tried everything, and there’s nothing else you can do, go with the flow. Embrace the ambiguity. Know that the world isn’t always fair – that things don’t always go your way and that this isn’t your fault. You’re doing the best you can.”

Yes. With the both-and, push-pull of me and not-me, I am doing the best I can.

Image: Untitled by Trish Shelor White, a founder of Choices Recovery Center

Catch That Thought, Hold That Feeling

After three years of abstinence from alcohol, on an existential scale of 1 to 10, where 1 is “I am nothing,” 5 is “I am enough most of the time,” and 10 is “I am everything,” I’m settling into 5ish. I know I’m not more powerful than gravity or death. I know I’m powerful enough, in this moment, to pretty much do what I intend to do, with the understanding that the tidal wave of the human condition may gather in a torrent and wash me and my good intentions away.

With one exception. My intention to not drink is of questionable power.

A thought just on the edge of awareness

A thought just on the edge of awareness

For me, alcoholism doesn’t feel like part of the “human condition.” Yes, I am human and it happened to me, but what I consider my most precious, fundamental power as a human, as a person, as Anne – the ability to do what I will and want – vanished.

I so appreciate the tireless work research, medical and treatment professionals are doing to unravel the snarl of what addiction is and what will cure or mitigate it in sufferers, an estimated 5% of the world’s 7+ billion people, an estimated 10% of the U.S. population. I appreciate that President Obama is proposing spending $1 billion on addictions treatment, specifically for opioid addiction. If or when that’s approved, what to do in the future may be clearer.

But right here, right now, not in the future, I, Anne, one minuscule member of the 7+billion, want a drink.

I have trouble conveying to people who don’t have what I have the sadness that comes with that want. The only comparison that’s close: I imagine my mother, gone now four years, in her nightgown walking in a field of grass and wildflowers. I would give anything, anything to see her again. I don’t even need to talk with her, just to see her. I just want to see if she’s all right, just strolling and gazing, absorbed in her own thoughts. I step right and left, lean my head right and left, but some entity is in the way, blocking my view just as I think I catch a glimpse. The entity conveys wordlessly that if I do a deal with it, that if I say I’ll give anything to see her, then I have to give my very self. But then I will be allowed to see her. My mother taught me never, ever to give myself away. So I stand there, torn, my chest ripping open with longing.

I have spent three years trying to figure out how to make that want go away. I’ve chronicled only a few of my billion attempts in this blog. My father even hired a team of researchers to join me in studying the literature to discover best practices for addictions recovery. Some of those findings are compiled here (.pdf opens in new tab).

All of the counseling and support group attendance and the support of friends and family member and ways I’ve tried have given a wonderfully supportive context to my not having had a drink for three years.

But right here, right now, I want a drink. And it’s as if none of those three years have happened or had any meaning or value whatsoever. I’m not thinking of whom I can call or what I can do.

It’s me and my longing. We’re it. While the addictions treatment world is scrambling this very moment to find a solution to the addictions problem, I’m looking down at my chest and my breastbone is starting to rip like paper.

catch that thought

hold that feeling

I envision myself catching each thought I have – about drinking, about my mother, about her white nightgown dotted with pink roses, about what a loser I am for becoming an alcoholic – and drawing them to me, and I can feel the emotions these thoughts create in me – horror, regret, sorrow – and I hold them to me close, comforting, holding, reassuring, murmuring that it’s all going to be okay, that we can do this, that we’ve made it through this before and we’ll make it through it again.

And as I hug my caught thoughts tightly and hold my poor, sore feelings surely in my arms, the tearing in my chest stops. And then it sort of tapes itself back up again and there’s my chest again with its familiar, inwardly angled sternum and small breasts.

Somehow, once I can catch a thought and hold a feeling, I can regain the power to choose to what I give my attention. And I acknowledge the beauty of my large heart beneath that bent sternum that loves beyond death. And I give myself one last hug for having the misfortune of developing alcoholism. And I use my athletic training to muscularly move my mind. I take a deep breath, more like a sigh. I become aware I am hungry. I envision a bright, orange-yellow yolk in the center of the white in a fried egg. I get up and head to the kitchen.

I don’t take a drink.

. . . . .

Approximately two years ago, my counselor, Dr. H., recognized unrelenting suffering in me and a kind of failure to thrive syndrome in my infant recovery and switched her approach to therapy. She told me later she began to use dialectical behavior therapy (DBT) and gave me handouts from a workshop she had attended with the founder of DBT herself, Dr. Marsha Linehan. DBT scholars and practitioners have created layman’s guides to this complex therapy. I read The Dialectical Behavior Therapy Skills Workbook, I’m reading DBT Made Simple, and Dr. H. presented me with a copy of Dr. Linehan’s recently released compendium, DBT  Skills Training Handouts and Worksheets, the contents primarily only available in DBT trainings. The simplest way to describe how DBT works for me is: “Catch that thought. Hold that feeling.”

I had balls made to help me remember. They’re bright to see and soft to hold.

Catch that thought, hold that feeling

The Fix reported on the growing validity of DBT as an effective treatment for addiction/substance use disorder in June, 2015. It’s actually useful for any kind of merciless distress or sorrow or upset.

If Dr. H. hadn’t had the creativity, breadth of knowledge, courage to apply knowledge in novel ways, and the determination to help me, I believe I would have done the deal with the entity and never written this at all.

. . . . .

I’ll be attending the Montgomery County, Virginia Chamber of Commerce Women’s Leadership Conference on Tuesday, April 5, 2016. If you’d like your own “catch that thought | hold that feeling” ball, just ask me. Shirley Gillispie of Green-Eyed Designs made them for us.