Falling in Love with My Life: I Love What I’m Writing

I am trying to entice Maia Szalavitz, author of New York Times bestseller Unbroken Brain: A Revolutionary New Way of Understanding Addiction, into writing a sequel. I tweeted her this title: Unbroken Lives: A Revolutionary New Way of Understanding Addictions Recovery. I follow Maia’s Twitter stream avidly to learn of her new work and she’s writing about that subject and more. (We curate much of it here). Whether she writes that book or another, the title encompasses a main theme of the posts I’m writing for my personal blog, my company’s blog, and for The Fix.

I love what I’m writing.

I love to write everywhere!

I try to post my personal story on my personal blog and to publish posts that might be more widely useful on my company’s blog. But when my personal and professional experience overlap, I can be uncertain about which goes where. For example, this post about the evidence base for SMART Recovery definitely goes on my company’s blog. I made a personal plea for people to become SMART Recovery hosts on my personal blog, but I think a version of it could go on my company’s blog as well. The do-it-yourself addictions recovery series I’m writing is a personal, political act of protest – my citizen’s declaration of a state of emergency – and definitely goes on my personal blog.

Specifically, I’m writing:

  • My own personal narrative about recovery from addiction to alcohol
  • About the results of following Maia Szalavitz’s advice to fall in love with my life (first post here)
  • For the general reader, as simply as I can, with evidence to support each point, without simplifying to the point of inaccuracy, about the complexities of addiction and its treatment
  • For academic readers, about evidence-based treatment for addiction vs. entrenched belief-based practices and their sidekick, personal experience-based advice, primarily on my company’s blog but also on my personal blog
  • Posts in the form of editorials opposing misinformation about addiction and about malpractice in addictions treatment
  • How to help loved ones with addiction
  • How to help oneself with addiction
  • How to help one’s community with addiction
  • Requests to Laurel Sindewald. When I can’t find a synthesis of what the science says about what I’m writing, I outline my needs and ask Laurel if she will write a report for our company’s blog. If the topic is a fit, Laurel scrutinizes the research literature, then uses her fine mind and beautiful writing skills to author and publish reports. I then write in and around the reports, excerpting and linking. For instance, in my post about understanding one’s own case of addiction, I linked my word “trauma” to her report on addiction and trauma and my word “sleep” to her report on addiction and sleep.
  • DBT-informed exercises for people who are members of substance use disorder (SUD) therapy groups or addictions recovery support groups. Research on dialectical behavior therapy (DBT) is revealing its promise in helping people with multiple mental health issues as well as SUD.  As a former teacher, I’m an experienced distiller of large amounts of information into one-page handouts, so this is a real find of a fit for me!
  • As I gain new insights, revisions of my dating site profile. Who am I? What do I like? What do I offer? What do I seek? What have I learned from past relationships to help everyone have a better time? Pretty radical to answer these questions.
  • A book or books? I’m not sure. Could groups of these posts be brought together into books? My alcoholism recovery story? A self-help or other-help book? Falling in love with life while in recovery? I dunno.

I love writing a blog. I think it up, write it up, take a pic to go with, publish the post, done! Wake up in the morning, make tea, sit down in my pink office or stand up at my kitchen dishwasher desk, do it again!

Bliss!

Want to Help Our Community? Volunteer for SMART Recovery

I have high hopes for my hometown receiving the accolade of “Most Recovered Town in America.”

As we streamline the process of getting help for people with addictions in my locale, particularly for help with opioid use disorder, our next challenge will be the high risk of relapse from lack of daily, formal support for recovery.

Based on my professional and personal assessment, holding SMART Recovery meetings is the closest we can get to community-wide, evidence-based, group-based addictions recovery assistance using resources already in place.

Welcome to SMART Recovery!

If we can, as a community, host SMART Recovery meetings every day at different times all over the area, we can provide free, near-treatment-level assistance to our people with addiction challenges. We don’t need to form task forces, write grants, or lobby public officials. We just need community members to do the training and sign up as hosts with SMART Recovery, and for community organizations with buildings to offer spaces for meeting locations.

  • SMART Recovery discussion meetings are free and open to anyone in the community.
  • Volunteers hosts DO NOT have to be in recovery from addiction to serve. Any community member – from the mayor to the maki maker to the mechanic – can serve as a discussion meeting host.
  • While discussion meetings are not generally facilitated by experts or licensed professionals, meetings focus on learning skills termed “tools” and are guided by trained hosts, thus extending the therapeutic value beyond more sharing-oriented support group meetings.

On a personal note, I would benefit from more SMART Recovery hosts and meetings in our locale. I have sought group counseling for substance use disorder but it has been impossible, so far, to organize in my small town. I am honored to serve as a volunteer host for the SMART Recovery meeting on Sundays at 4:00 PM at our community services agency. But hosts don’t participate in discussion meetings. So if someone else would please train as a host to serve at the Sunday meeting or other meetings, I could attend and participate and not just give help, but receive it, too.

If you’d like to experience in-person what a SMART Recovery meeting is like, the meeting is open to all and you are welcome to attend:

Sundays, 4:00 PM, New River Valley Community Services, 700 University City Boulevard, Blacksburg, Virginia.

More about local SMART Recovery meetings and other local recovery support is here.

If you have any questions, feel free to contact me, Anne Giles, anne@annegiles.com, 540-808-6334. (If you email me and don’t receive a reply, please check your spam folder. If you don’t see a reply in your spam folder, please phone or text me and we’ll connect that way!)

Hope to see you at SMART Recovery!

Last updated: 9/28/16

If Someone with Heroin Addiction Asks You for Help

I have never used heroin, I have never seen heroin in person, I have never personally seen someone use heroin, and I don’t know anyone actively using heroin at this time.

Even with a starting point of knowing nothing and no one, I have no doubt that 1) I could get heroin within 12 hours, and 2) I could get heroin faster than I could get someone treatment for heroin addiction.

Reach out a hand to help people with addictionWhile I appreciate the logic of people who think limiting supplies of heroin or other drugs will serve as a barrier, it’s laughable. (If they can’t get it, they won’t use it, right? No supply equals no demand, right? Usage data from Prohibition and the War on Drugs really supports that, doesn’t it?)

You know how you and I can get anything we want online? I even use Amazon.com to order my shampoo. Apply this logic: If I can order anything I want online, then that includes heroin. The supply will always be infinite.

This 2015 article from Forbes is cute and Hallmark-naive. Your teenaged son or daughter just might be ordering drugs online?

Your anyone – child, partner, parent, neighbor, boss, congressperson – can order drugs through the Internet.

So, let’s just put aside the irrelevant convo about limiting supply.

Now to my real subject:

WTF?! I have easier access to heroin than to treatment for heroin addiction?!

If someone came to me today and asked for help with heroin addiction, i.e. opioid use disorder, could I get them in to see a health care professional today for what the science says is effective treatment?

Absolutely not. In fact, it took me 3,000-words to explain to how to even begin to get treatment for addiction in my town.

With heroin use increasing, that any of us will be asked for help is moving from possible to probable.

Let’s say I wanted to extend a hand. I’ve got no more than 12 hours from last use before the person starts getting seriously ill from withdrawal.

See the medications listed by the U.S. Department of Health and Human Services to ease withdrawal from heroin and other opioids?

In my town, no health care professional at the ER, urgent care facility, or clinic staffed by primary care physicians can prescribe methadone or buprenorphine, the top evidence-based treatments for opioid use disorder. Even if I tried to take someone to a physician to lobby for clonidine?  I might get somewhere if I could convince the physician that, yes, addiction is a brain condition identifiable on the molecular level, and, no, this person doesn’t deserve the agonies of withdrawal for what society stubbornly persists in believing, in spite of what the science says, they’ve brought on themselves through bad choices.

(And why is naltrexone listed on that U.S. government page? It can precipitate acute and severe withdrawal symptoms and is only recommended after complete detox. Oh my, I hope the local doc is up-to-date on this!)

Even if the physician were professionally convinced that medication were needed, the facility might limit what can be prescribed to people diagnosed with substance use disorder. I’ve taken people to health care facilities in my town, have been told what’s evidence-based can’t be prescribed, and have, literally, been given a Band-Aid and turned out, professional heads shaking in disapproval over my person – and over me for “enabling” the person and keeping them from “hitting bottom.”

And now the 12 hours is up and the person who came to me for help with heroin addiction is beginning to ooze from every opening: sweat, mucus, vomit, diarrhea. The meds we might have gotten aren’t staying down…

And people in withdrawal from heroin, left unattended, can die.

What, my dear fellow citizen, would you do?

. . . . .

Try this experiment. At your next medical appointment, ask your health care professional a hypothetical question: “If I told you I were addicted to heroin and wanted help with it today, what would happen?” Listen for what the treatment would be and how quickly it would occur. In particular, listen to what would happen to your one precious body and mind in the 12-hour window before withdrawal kicks in. Become aware of how you feel and what you think about what you hear.

And then imagine how you would feel and what you would think about the answer if you were trying to get help for a loved one…

If you care to post your experiences in the comments, I would welcome hearing them.

DIY Addictions Recovery: Puzzle Out Your Own Case

I empathize with health care professionals who open the door and see me sitting there. I have alcoholism, one of the most puzzling and pernicious addictions to treat. And no consensus exists on what alcoholism or other addictions really are or how to treat them. Add the conundrums that addiction is often accompanied by mental illness, symptoms of trauma, physical illness, emotional and physical pain, and sleep disruption, well, that ranks it with the world’s impossible puzzles. If the smiling health care professional is inwardly groaning, I get it.

How to solve the puzzle of addiction?

Still, to quote Talk Talk, “It’s my life.” As a do-it-yourself addictions recovery practitioner, the first order of business for me is to get myself health care. What can I do to help health care professionals help me?

Let’s follow Stephen Covey’s advice: “Begin with the end in mind.”

What do I want to have happen as a result of consultations with health care professionals who might have help for me with addiction?

  1. Greater understanding of my unique story, i.e. my “case conceptualization.”
  2. More data a) to refine and deepen my understanding of my case and b) to provide increasingly comprehensive information during subsequent consultations with additional professionals.
  3. Treatment recommendations that might foster my stability. The more stable my inner system is and the more stable my living situation is, the more likely I am to progress rather than regress.

This post addresses #1 and #2 in the above list.

1) Case conceptualization

Case conceptualization is a counseling term for a description of what is thought to be going on with a person and why. It’s like a Wikipedia article on a person and his or her problems. What we do know about treating addiction is that it requires helping the whole person. But given the current limited state of knowledge of addiction, limited understanding of addictions treatment, and limited access to treatment, a person with addiction just has to try to puzzle out the “wholeness” for himself or herself.

If I envision my case as a jigsaw puzzle in a new box, I open the box and see a whole bunch of puzzle pieces. I take out a puzzle piece. If I recognize it, I can put it where it goes. If I don’t recognize it, what do I do?

As someone with addiction, I’m likely to have what Maia Szalavitz terms an “outlying temperament” which means that the volume on my inner state spikes or plummets very fast. (More about that in the last third of this post.) I tend to feel overwhelmed immediately when I don’t know what to do or don’t understand, either feeling highly anxious or deeply hopeless. Consciously looking at what’s going on with me is probably going to be distressing. I’ve got to engage my mind to help myself through these shifts in intensity.

If I don’t know where the puzzle piece fits, even what it represents, the piece goes back in the box, perhaps in a corner with other unknown pieces.

This piece and others I can’t identify are the ones with which I need help.

A professional has knowledge, training, expertise, experience and membership in expert networks that I do not. Using the jigsaw puzzle metaphor, a professional can look at a puzzle piece and identify it or, if the professional can’t, knows someone who can. Or the professional may rank the piece as more important or less important than I can. The professional may look in the box and be able to quickly identify pieces I haven’t gotten to. The point is that the professional can help me do what I cannot do for myself.

(The problem with DIY addictions recovery is that it’s actually impossible. I don’t know enough. And I don’t have enough credentials to access needed resources. I simply must work with others.)

While invaluable, a professional will have finite expertise and I will have finite time with that professional. In DIY addictions recovery, my priority during the appointment needs to be getting as many puzzle pieces identified as I can in the time we have. Then my job is to come home and start fitting them into the bigger picture.

2) Data

I need data for two reasons: a) to get more information with which to understand my own case, and b) to have updated information available for the next professional who might help me.

If I walk into an appointment wanting to a) tell my story or b) receive reassurance, I will misuse my time with this precious resource. It’s legitimate to want to be heard and to be comforted. These might well be byproducts of the appointment. But I need to get those needs met in other ways. This is a not-to-be-missed opportunity to have someone look at my box of puzzle pieces and see what they see.

To help the health professional help me, I need to provide as much data as possible – presented as concisely as possible due to short appointment times – to help the professional get up to speed on my case as quickly as possible.

If I can provide even a single one of these documents, ideally contained in a binder in this order, I offer invaluable help to someone who wants to help me:

  1. One-page list of current and past treatments, including current and past medications.
  2. Results of blood work.
  3. Timeline (for more on the timeline, scroll down to “Contribute to my loved one’s documentation” in this post.)
  4. Copies of previous medical records organized in reverse chronological order, i.e. most recent first, including hospitalizations, stays in treatment centers, reports from labs, scans and x-rays.
  5. My “case conceptualization,” i.e. my typed or handwritten narrative of what I think is up with me and why. (If writing is difficult for me, perhaps I can find someone to listen and type as I speak.)

It’s a lot, isn’t it?

The challenge with documenting one’s own case is that most people with addictions don’t feel very good and just aren’t up to the task. In addition, they may have cognitive limitations due to substance use, as well as due to the very impairments the illness of addiction itself makes to executive systems in the brain. Fitting puzzle pieces together can simply be impossible. Plus we have that outlying temperament that makes looking at each piece feel epic. We’re not wrong or bad for having challenges. We have a brain condition, a grave and serious illness. Of course we’re going to have challenges.

This is why if someone with addiction can find someone to help them document themselves, or serve as advocates as they navigate the system, it’s hugely helpful. Perhaps a trustworthy parent, partner, daughter or son, minister, friend, even neighbor could help! Recovering from addiction is hard enough. The barriers to treatment make it almost impossible. It is not weak to ask for or to accept help.

If you can’t do anything else, just keep receipts and printouts – of appointments, medications, any document related to your health care. You might feel better soon and can perhaps put them in reverse chronological order. Or someone might come along who can help you piece together your story.

Image: iStock

Last updated 10/01/16

. . . . .

A table of contents for the entire DIY Addictions Recovery series of posts is here.

New posts refer to subsequent posts and I’m doing my best to link them up in an understandable way. I update posts as I learn more.

This post is part of a series contained on this blog in the DIY Addictions Recovery category.

If you have suggestions or feedback, I welcome them. Feel free to contact me.

Disclosure and disclaimer: I am a counselor at a community services agency. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends. This content 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.

DIY Addictions Recovery: Health Care First

While faces get redder and voices get angrier as people debate what addiction is and what to do about it, the first order of business for do-it-yourselfers in addictions recovery is to take action on the evidence that addiction is a health condition and to arrange for health care for ourselves.

Addiction is a health problem - get health care

The health problem of addiction is often accompanied by mental illness, symptoms of trauma, physical illness, emotional and physical pain, and sleep disruption. Issues of temperament and personality may need assessment. Blood work needs to be done to test for the presence of function and dysfunction, to diagnose illnesses, and to assess suitability for medications. All of these factors need to be provided by, and considered and evaluated by, health care professionals. Ideally, these assessments would be coordinated by one specialist or a team of specialists but you will likely have to cobble together data for a comprehensive evaluation from multiple sources. From all the data, an individualized treatment plan can be devised.

So, the goals for getting medical care are to:

  1. get immediate care for immediate problems
  2. get assessed for medications to address addiction or co-occurring mental or physical conditions that exacerbate it
  3. begin to try to stabilize all conditions
  4. get referrals for more specialized care
  5. begin to create and collect data about your health conditions.

In my experience, people with addiction fall somewhere on a continuum of being in an emergency state, an urgent state, or in chronic distress.

Emergency State

If you’re in a state of emergency, call 911.

Urgent State

If you’re in an urgent state, still consider calling 911.

If you are in an urgent state and not calling 911, consider these options in priority order.

Consider the ER. Know that it is through the emergency room (E.R.) that many people with addiction make first contact with the local health care system. E.R.s help stabilize patients briefly, but are limited in the length of care they can provide, sometimes under 24 hours. Hospitals in my locale do not provide addiction treatment, medication-assisted treatment, or prescriptions for detox or pain medications.

Depending upon the system in which the E.R. operates,  referrals will be made to additional treatment through emergency evaluation services like these in our locale. Referrals from those services are to local treatment providers (here’s a list of our local treatment providers). Many referrals are for treatment at in-patient facilities, few of which have beds available immediately, most of which require health insurance or a needs-based assessment prior to admission. If you are considered a threat to yourself or others, a stay at a mental hospital will be required. An E.R. visit may result in a range of outcomes, including release into another’s care, time at a detox facility, or a stay at a mental hospital, possibly far from home.

If you’re released from an E.R. without a plan for immediate follow-up care, a return to use is probable.

Consider urgent care. I have taken several people with health insurance coverage with illnesses or injuries that have resulted from addiction – not for addiction itself – to Velocity Care urgent care centers and have been impressed with how quickly the person is seen and how much attention each person is given by the care provider. Velocity Care also makes it routine to provide a printout of services provided for record-keeping. If you’re in state of  of physical or mental emergency, however, they will refer you to the E.R. and the visit will waste precious time. However, E.R. wait times are long and an urgent care center might be worth a try if you’re stable enough for it.

Consider walk-in “after hours” care. If you’re in an urgent state during your clinic’s walk-in hours, try to get in there. The clinic will know your case, have access to your records, and may be able to offer more individualized care than an urgent care facility or emergency room.

Consider seeing if a primary care physician (PCP) or nurse practitioner (NP) has an opening today. This is probably the least likely way to get care because most PCPs and NPs are booked solid, but sometimes you can find an opening due to a cancellation.

Chronic Distress

While I appreciate learning that most people “age-out” of addiction, I didn’t get a chance to because I had late onset at age 50, and the people I know with addiction didn’t, so most of us are in an acute state of addiction from having it long-term and/or having it under-treated or maltreated. We’re either actively using, practicing some kind of harm reduction by using less often or using less harmful substances or, like I am, miserably holding on to abstinence.

And hardly a one of us was told to go to a doctor.

It’s not too late.

While we don’t exactly know what directly cures addiction – although buprenorphine for opioid use disorder can seem pretty darn close – conditions that often co-occur with addiction, i.e. mental illness, chronic pain, and sleep disorders, can be directly addressed medically.

Lessening the suffering caused by other conditions can potentially reduce the intensity with which addiction is experienced. Return to use or increased use is correlated with increased stress. Getting treatment for untreated medical conditions can reduce stress.

If you’re semi-stable, you can use the list above for accessing medical care in reverse order. Start with your PCP to begin the laborious process of being set up for appointments with specialists – start first with making an appointment to see a psychiatrist because that can require a lengthy wait – and then continue to see specialists for other problems.

[Personal anecdote: It took me 3 years of pouring over the literature to find this 2009 report citing two studies, one from 1992 and one from 2000, about medication for alcoholism. It states, “[P]atients who achieve abstinence may benefit from taking naltrexone at times when they are at higher risk of relapse, such as on vacations, on holidays, or during a personal tragedy.” I was able to muscle through the 6-month wait time to see a psychiatrist, ran this report by her, and have an arrangement with her that if another of the intermittent bouts of abject longing to return to drinking occurs for me, she’ll prescribe me 3 months of naltrexone. This is a radical approach: less than 9% of people with alcoholism receive medications to treat it.]

If addictions medicine practices, or psychiatrists or psychologists who specialize in addictions are available via self-pay, I would avail myself of them. Clients pay directly for services and the provider does not bill insurance. This is simply too grave of a condition with too dire of consequences for penny-pinching. In my locale, TASL offers direct payment for addictions medicine care. Payment in person by cash is required to make the first appointment and cash or credit cards are accepted after that. TASL explains its services clearly and specifically via phone recording. Select option 3 for new patient information, 540-443-0114.

If you don’t have money and you don’t have health insurance, then you’re going to have to work the system and get some. Scroll down  in this post to section 3 entitled “Make appointments” for my explanation on how to do that.

Ignore Naysayers

The evidence is in that the earth is round, although it was believed for a long time to be flat.

The evidence is in that addiction is a health problem although it’s been believed to be a personal, behavioral, and moral problem for a long time.

Addiction is a treatable, chronic disease that can be managed successfully. Research shows that combining behavioral therapy with medications, where available, is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric, and social problems.
National Institute on Drug Abuse, NIDA

Some of the most resolve-strengthening advice I’ve ever been given as a person in recovery was given to me by another person in recovery and I’ll share it with you:

Trudge, baby, trudge.

However you can – run if you can, trudge if you have to – get yourself to a doctor.

. . . . .

Last updated 9/16/16

This post is part of a series contained on this blog in the DIY Addictions Recovery category.

A table of contents for the DIY Addictions Recovery series of posts is here.

Disclosure and disclaimer: I am a counselor at a community services agency. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends. This content 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.