How to Care for Yourself After a Shock

If something happened that shocked you, you can help yourself with it.

First, assess whether or not you are currently at risk or may be at risk within the next few minutes. If your situation is unsafe, get yourself to safety as quickly and efficiently as you can.

If you are in a safe enough place for now, hug yourself. Hug yourself hard.

Now. When we’re upset, even for the most legitimate, justifiable reasons, we can’t think. So our job is to “un-upset” ourselves enough to be able to balance feeling and thought so we can use our full powers to discern what would be effective action – or what would be effective inaction – on behalf of ourselves and others.

Using my inner volume control to calm myself

So. Here we go.

  • Acknowledge to yourself that you have had a shock.
  • Pause to become aware of your inner experience of the shock. What are you feeling, what are you thinking, what physical sensations are you having?
  • Imagine a volume control knob representing the intensity of your inner experience, the totality of your feelings, thoughts, and bodily sensations. On the “minimum” to “maximum” scale, note where the knob registers at this moment.
  • Become aware of your breath. Note anything that draws your attention to your breath. Is your breathing rapid or slow? Deep or shallow? Simply notice this.
  • Can you deepen, elongate or slow your breath? Even just a bit? If so, you are engaging in an already-in-place, mind-body hack that can begin the “un-upsetting.”
  • Now become aware of your thoughts. When you become aware of a thought, imagine the volume control knob and observe what happens when you think the thought.
  • If the thought increases the intensity of your inner experience, acknowledge it as a thought to consider later, but for now, for just a few moments, it is not helpful to you as you attempt to shift your inner volume. Disengage your attention from the unhelpful thought and engage your attention with the next thought.
  • Simply note the effect of a thought on your inner volume control. Avoid attaching goodness or badness, rightness or wrongness to thoughts. Simply note their effect on you and disengage attention from the unhelpful ones.
  • Continue to sort your thoughts, based on their impact on your inner volume control.
  • While you’re sorting your thoughts, also monitor your inner volume control.
  • Become intentional about using your mind to bring down the volume on your inner experience. There’s no particular how-to on this. How you do this will be unique to you.
  • Note that thoughts that are self-judging, other-judging, replay what happened, anticipate future trouble, result in a sense of helplessness, or result in a feeling of outrage or alarm tend to increase the volume on one’s inner experience.
  • Appreciate yourself for your fine mind and powerful thinking skills and then shift your attention from these thoughts back to sorting.
  • Note your breath. See if you can inhale on a count that works for you, then exhale on the same count.
  • Continue to sort thoughts and observe your inner volume control.

Become aware of when you experience the presence of your feelings, thoughts and bodily sensations falling within a manageable range. Then note when your inner volume is moving into an unhelpful range, whether too high or too low, and immediately shift your attention back to sorting unhelpful from helpful thoughts. Use your mind, in your own way, to shift your inner volume to a level that feels manageable to you.

The ability to manage your inner volume frees your inner wisdom – a wise, synergistic blend of both your rationality and emotionality – to help you decide what would be effective, helpful and beneficial for you to do in this moment and the next, no matter what has just happened – or what might or might not.

. . . . .

Maia Szalavitz introduced the idea of using the metaphor of a “volume knob” to represent regulating one’s inner experience in Unbroken Brain: A Revolutionary New Way of Understanding Addiction, published in April, 2016.

I, Actually, Am Not Tormented

. . . . .

Hee!

Thank you, Lynda Barry, for reminding me.

 

Looking Up After Nearly 4 Years of Abstinence from Alcohol

In a moment of vulnerability, just a few years before she died, I said to my mother, “I’ve tried my whole life to please you.”

“No you haven’t,” she replied.

Having alcoholism has felt like having an unpleasable parent.

Last Saturday, I woke up well-rested. I wrote excitedly and with growing confidence that my new discovery of recently published research on the neuroscience of addiction might be the eureka cure for addiction. I mixed and kneaded dough for bread, worked out with my trainer, had a nap, baked bread, bathed with lavender-scented bubble bath, then headed to a church event to which I had been invited by a friend. I arrived early and checked in with the church ladies. The one seated nearest the fellowship hall waved her arm invitingly toward the entrance, smiled warmly at me, and said, “The bar is open!”

Anne's Place, Blacksburg, VA

I don’t have words for how I felt or what I thought. But I shifted quickly to, “I’ve got this. Surely after everything I’ve done and learned, I can be present for the people and enjoy what’s here.”

In not quite an hour, I was nearly running to my car. In spite of the nice event, the nice people, the nice friends who arrived and with whom I talked, in spite of me undergoing nearly every single known addiction treatment, I could do nothing to stop the abject, terrible longing to join in drinking the wine with the nice people.

I can only use one word to describe the feeling I have when alcohol is present: pain. Mental, emotional, physical, existential pain. The pain of feeling stalked, hunted, targeted. The pain of feeling under dire threat. The pain of feeling unprotected.

I have never once not gotten out of bed. But on Sunday, I went back several times. I looked up what it feels like to be tazed. I looked up Achilles heel and kryptonite. I read over and over what happened to Ulysses when he was tied to the mast and heard the sirens’ songs.

I have done everything I can to make longing to drink go away and to make distress and weakness in the presence of alcohol go away.

There is nothing more I can do.

I think, like most uninformed people, I believed fundamentally that addiction resulted from having gone bad or having done bad and that being good and doing good would make it go away. The symptoms of addiction show up as words and actions so it makes sense to target the feelings and thoughts that create those words and actions. I have undertaken complete moral, characterological, psychological, behavioral, educational, social, and relational transformations. I have scrutinized every single aspect of my feeling, thinking, behaving, and relating that is within my power to identify and confront and address. Every wrongness I could find, I have tried to right.

I have abstained from alcohol for 3 years and 10 months.

And, one more time, alcoholism pinned me like an insect to a display board and had its way with me.

I cannot make longing to drink go away. And I cannot make go away the result of that longing: writhing in the bindings of my own intent when I am in the presence of alcohol.

What is this thing that’s got me?

I’ve been asked how addiction is different from mental illnesses like depression or anxiety or from chronic physical illnesses. The difference is there is a one-to-one correspondence between a “flare-up” of this “chronic illness” and 1) harm to myself and others because I lose partial or complete control of my words and actions, 2) contempt from others, and 3) punishment. If I relapse, I will not be brought casseroles. I will be pitied or pilloried. And I may be incarcerated, whether in rehab or jail.

What’s to be done with what can’t be done?

The first thing I need to do is make conscious my unconscious beliefs about addiction. Experts are right, society is wrong. Addiction is a brain disorder. Good feelings, good thoughts, and good behaviors will not make it go away. I have exhausted myself doing things that do not make alcoholism go away.

The second thing to do is accept that I might relapse. Most people with substance use issues get better on their own. They age out, have spontaneous remission, or successfully practice harm reduction, i.e. they use in ways that allow them to function. I don’t currently fall into any of those categories. So the odds are good I will return to use. My entire life is lived as a relapse prevention plan. I need to follow up on creating a relapse response plan.

The third thing to do is accept that bouts like I had on Saturday are going to happen, no matter how well I think I’m doing. Wine happens everywhere in my town. Those bouts don’t happen often. But I need a near-relapse recovery plan for when they do.

I need to continue to play the odds in my favor. None of these treatments or practices directly affects addiction. But a lot of them help me feel good. I’m guessing, but can’t know, that the better I feel, the less likely I am to relapse. I felt great on Saturday and was nearly felled. So it’s not a guarantee. But for myself and for the people I work with, I think it’s the way to go.

I need to continue to try to find people who can help me when I’m around alcohol. I was talking with my counselor about my near-demise on Saturday and an image of a bodyguard came to me. If I could take a bodyguard with me to every drinking event, present solely to protect me from alcohol, I think I would be okay, or okayer. She, of course, wisely coached me to become my own bodyguard. I hear her! But I’m so tired. I so wish I could have a little help! But the help I need is so specific that it’s almost impossible to find. It just seems like everyone I know can’t be around alcohol or wants to drink it, too. I do hope some day to have a partner with whom I can have a “You and me! We’re going in!” team. I think if I felt less alone with all this, I’d be doing better. It’s a tough one, though.

And the most important thing for me to do is to enjoy non-alcoholism moments. For me, most moments of most days are alcoholism-free. Alcohol’s power to destroy moments terrorizes me. I never know when it’s going to hit or how bad it’s going to be. For those who don’t experience addiction this way, I am shaky with gratitude and relief for you. For myself and those who have shared with me having similar feelings, I wouldn’t wish this on anyone. Ever.

Still. Right here, right now, I’m sipping my last cup of tea from the pot, my plump elder cat is resting on the footstool, and I’m typing away in an office painted pink from ceiling to floor. I’m going to go work out with my trainer, have an egg and cheese on flatbread from Subway, take a nap, go from there. I’m not going to spend any time, at least today, attempting to please the unpleasable parent of figuring out what addiction is and what treats it.

My painter cleans gutters and when I first moved into this house two years ago, he suggested we wait until all the leaves fell before we did the task. We were out in the yard and I started looking on the grass at the first fallen leaves for clues and asked how we would know when that was. He looked at me with surprise and kindness.

“Look up,” he said.

Imagine, for a Moment, What It’s Like to Be an Abstinent Addict

Imagine, for a moment, that you have become among the 1 in 10 Americans unfortunate enough to develop an addiction to a substance. Given the definition of addiction, that means you will have experienced negative consequences, and probably will have done harm to yourself and others. Let’s suppose you have been through the addictions treatment system and, like a Sneetch through the Star-Off Machine, you have been removed of the substance or substances that plague you. (The addictive personality is a mythonly half of people with addiction have more than one, not including cigarettes.) Let’s imagine you are standing on a curb with your back to the latest place you have received treatment, waiting to be picked up by someone who cares deeply about you and wants the best for you.

Logic says that, freed of substances, you are now free to live life as you choose.

However, what are the realities of being you, abstinent?

Before you even developed addiction, factors such as these may have predisposed you to developing it:

Given that many of these conditions and their symptoms are treated with medication, it makes sense you might have used substances prescribed, unprescribed, legal or illegal – including alcohol, marijuana, nicotine and caffeine – to manage distressing symptoms that interfere with your quality of life and your functioning.

If you’re abstinent from the substance or substances that helped provide you relief from any of the above, those conditions are now present, partially, fully, or extremely. The problems for which you sought solutions through substances may no longer have those solutions.

As you’re standing there on the curb, waiting to begin your new life, your inner state might be alarms and sirens.

You are a person who has lived with predisposing factors to addiction and you have survived the emotional and physical hardships of addiction, plus its defining negative consequences. Those can be traumatizing.

For our purposes, trauma is defined as experiences with events and situations that leave people feeling overwhelmed and powerless.

Any of the following situations you are likely to have experienced during substance use or treatment could have resulted in additional trauma:

So, let’s see. You’ve got pre-disposing conditions, plus new trauma and new stress to handle. That’s a lot to imagine, isn’t it? Wait. There’s more. Abstinence, itself, magnifies things.

  • You experience distressing and baffling cognitive impairment. According to NIDA, “Brain-imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decisionmaking, learning, memory, and behavior control.” You want to think better and do better and are flabbergasted when you can’t or don’t.
  • You have a really, really hard time feeling better, in spite of every effort. Anhedonia, the brain’s inability to generate feelings of pleasure, is a marked trait in abstinence, sometimes lasting for years.

What are we forgetting? Oh, yes, the push-pull of addiction itself and its core, neurobiological feature: craving. The on-going, wearing anguish of wanting and not having. The largely cue-driven, highly personal, subjective experience of wanting and not wanting to want. Abstinence does not eliminate desire. Craving is a brain thing.

You’ve been imagining, just for a moment, what it’s like to be an abstinent addict. Standing on the curb, your inner experience will likely be influenced by conscious and unconscious stress, distress, discomfort and pain due to pre-existing conditions, trauma, treatment or lack of it, the side effects of abstinence, and the chronic effects of addiction.

Now, imagine the next moment. And the next.

You get to have these moments, moment after moment, perhaps in perpetuity.

How free do you feel to live the life of your choice?

How are you doing? Not so great? Yeah, it’s really hard, isn’t it? Handling all that going on, plus life, too?

That’s why relapse rates for alcoholism and other substance use disorders are high. For many people, it’s too hard.

. . . . .

I am so grateful to the hundreds of people who have shared their stories with me personally, to the thousands I have heard share in person, to the uncountable thousands who share their stories online, and to tireless researchers. I have done my best to share, as a composite and synthesis, their stories and their work.

I am hoping to portray in human terms – with links to articles and research that corroborate each point – the dire inner state of the person with addiction who abstains. I hope to call forth empathy. Abstinence may work for some, but I’m hoping it can be seen as one of many options needed by each individual from which to customize a unique addictions treatment and recovery plan.

Many people “age out” of addiction or recover from addiction on their own without treatment. This post attempts to describe what it’s like to have an acute case of substance use disorder for which one has needed and sought treatment, perhaps multiple times.

I use the term “addict” in this post for brevity, but I primarily use person-first language and refer to myself and others as “people with addiction, “people with alcoholism,” or “people with substance use disorders.” I use the term “alcoholism” as a type of “addiction,” and the terms “addiction” and “substance use disorders” interchangeably unless I’m writing about SMART Recovery which welcomes to its support groups anyone with any addiction.

I share openly that I developed addiction to alcohol at nearly 50 years of age, became abstinent in 2012 without consulting medical professionals (even though trained as an addictions counselor in 2006, I did not know that by 2011 addiction was already known to be a brain disorder), and threw myself into a world of hurt resulting from a combination of the factors above. As of this writing, I have been abstinent from alcohol 3.75 years. Only in the past year have I experienced an intermittently stable inner state comparable in my memory to the “normal” state of my pre-addiction life.

I advocate for evidence-based treatment vs. belief-based practices for people with substance use disorders.

One of the main objections to the first-order, evidence-based treatment for opioid use disordermedication-assisted treatment with buprenorphine (Suboxone/Subutex) and methadone – is the perception that “real recovery” requires abstinence. Yet, after halting the use of opioids, relapse rates run as high as 85%. Perhaps the reader now understands why that is.

I am hoping this post helps convey why abstinence-based addiction policies and practices can be cruel choices, even tragic ones, for people with substance use disorder. Abstinence-based policies can result in failed addictions treatment strategies for nations and their people.

. . . . .

Further reading:

Why Opioid Maintenance Does Not Replace One Addiction with Another

Addiction or Dependence: A Life and Death Difference

How to Get Help for a Loved One with Addiction

How to Talk with Someone About Getting Help with Addiction

Would I Date Me, a Person with Alcoholism?

Given what I know about addiction and, in my case, addiction to alcohol, would I date me?

If I didn’t have alcoholism, I would date me. I have enough strengths and enough awareness of weaknesses to be worth a try. Whether or not synergy resulted would be up to us, not just to me.

Fiend by Peter Stenson

But would I knowingly bring someone with addiction into my heart, mind and life? Into my family’s life? Into my community’s life?

Here’s how I see the context for asking and answering that question.

First, it’s still not common knowledge that alcohol is a drug, just a legal one. Whether one terms it a narcotic or a depressant, it joins other drugs in impacting brain structures related to mood and behavior. A person who dates a person with alcoholism is dating a person with drug addiction. Euphemistically separating out addiction to a legal drug as “alcoholism” from addiction to illegal drugs is a meaningless social construct.

And dating someone with addiction is dating someone who will be viewed by society, not as a person, but as “an alcoholic” or “an addict.”

Second, addiction simply doesn’t make sense. Use makes sense – feels great! – but why continue after negative consequences? Why would people continue to do what harms them and harms others? Continuing to do something that hurts oneself is anti-survival. Continuing to do something that hurts others is anti-social. Continuing, therefore, is unreasonable, irrational, illogical, unconscionable. Yet nearly 1 in 10 Americans has this tragically nonsensical condition in which they continue to do what results in costly harm to all involved.

And no one really knows what addiction is, what causes it, or how to treat or cure it. So the person with addiction has a confounding, mysterious condition that, ultimately, the person has to handle with great uncertainty on his or her own.

Third, the burden of addiction can carry additional baggage. Many people with addiction have a co-occurring mental illness. The majority of people with addiction have experienced trauma. So it’s possible the person one is dating has complex layers of personal and interpersonal challenges that will make a relationship even more challenging.

Fourth, relapse can happen. A person who is in recovery from addiction, either through abstinence or harm reduction, i.e. takes medication to manage addiction or consciously uses less harmful substances, might return to active use. While many people “age out” or quit on their own, a significant number of people have an acute case of addiction which makes return to use likely. I can’t speak for the likelihood of relapse for any one individual. But, in general, many people with acute addiction return to active use, even after a significant period of abstinence or harm reduction. So the severity of the person’s case of addiction may increase the odds of return to active use.

This is a sweet, hopeful statement from NIDA: ” Relapse rates (i.e., how often symptoms recur) for people with addiction and other substance use disorders are similar to relapse rates for other well-understood chronic medical illnesses such as diabetes [my link], hypertension, and asthma, which also have both physiological and behavioral components.”

Unlike with other chronic illnesses, however, the problem with relapse from addiction is that it manifests as problematic behavior and can include thoughtless, careless, or mean words and actions, physical illness and injury, ERs, legal problems, the works.

If I am thinking of dating me, then, I am thinking of bringing someone into my life who is ill-viewed by society, has an illness for which there is no cure and for which treatment is uncertain, who is likely to have other illnesses, and whose return to use could bring us all to our knees.

. . . . .

If I were considering dating me, I would say to me that that’s some heavy sh*t and I would want to know what the hell I’m doing about it all. (I do swear at times, a possible reason not to date me.)

I’m accountable to the entire world. I share openly and publicly on a blog, indexed by Google, that I’m in recovery from alcoholism. If having others know if I relapse is a protective factor – again we don’t know what does help, only what might help – then I have done that. The sacrifice of privacy has been a much harder hit than I expected. But people share with me that it helps so that helps me. There is no going back, however.

I think I may experience a tad less stigma because I’m “out” about having alcoholism. I’m not sure. People in my small town have to decide whether or not they’ll be seen with me in public because they might be suspected of being “one of them.” At least my situation does not need to be protected or kept secret. What a relief we can all talk openly about it!

People may not have caused all of their own problems, but they have to solve them anyway.
– Marsha Linehan, DBT Skills Training Manual

I make hundreds of decisions each day – and take action on them – to increase the likelihood that I will continue to be abstinent from alcohol. I avail myself of known evidence-based treatment options and monitor my progress constantly. I attend weekly counseling sessions for co-occurring anxiety, trauma and substance use disorder, and do about a billion other things that might be helpful to prevent myself from returning to active use.

I am ruthless in my pursuit of correct, curative treatment for addiction. I study, I read, I listen, I observe, I hypothesize, I experiment. I do not want addiction. I do not want it for the people I serve. Simply put, addiction creates a before and after in the brain that is not good for it. Developments in neuroscience are promising so I’m taking my 57 year-old brain on a wild ride to try to understand the findings well enough to derive items to add to my recovery to-do list.

Outside a neuroscience classroom at Virginia Tech

I engage in full frontal nudity about the realities of addiction. I do not avert my eyes from the primary dialectal truth of addiction: I want to AND I do not want to.

I have a relapse plan. In private, when they’re not coerced into forced confessions of personal choice and moral depravity by the courts, court-appointed treatment professionals, or fundamentalist recovery community members, everyone I know who has relapsed tells me, faces full of baffled terror, that they have no clue how it happened.

For me, if I relapse – and I also can’t know for sure – I believe it would be as a result of overwhelming environmental cues or this trajectory:

stress > distress > dissociation > return to use

Or both. Regardless, if I do relapse, I have a written document that describes what I think would be helpful and not helpful to assist me in becoming abstinent again. I haven’t yet asked particular people to be on my team and that will be next. My intention would be to return to abstinence, not to attempt to try a life that includes alcohol. I will become abstinent as soon as I can with the help for which I’ve asked. In assisting others, I have found this to be an unfortunate matter of days rather than hours, sometimes months or longer. To the best of my ability to understand the research, the longer I go without alcohol, the better are my chances to continue to go without it. I push myself each day to remain abstinent.

I shared publicly that I was advised to fall in love with my life. Now is a good time to share that I was also advised to fall in love, period. With a partner. The neuroscience of addiction says that love may, after all, be all we need.

. . . . .

So, given what I know about addiction and, in my case, addiction to alcohol, would I date me?

I actually date me all day and every day. Hard to believe but, even with alcoholism and everything else that’s gone down, I find myself remarkable company. And, if nothing else, honest and open to a fault.

But I would not be everyone’s cup of tea.

. . . . .

First photo and graphic by Nancy Brauer of me impersonating a meth zombie from Peter Stenson’s astounding novel Fiend. My review is here.

Second photo a selfie taken outside a neuroscience class at Virginia Tech.