Saturday, December 19, 2009


It's a beautiful morning and it's good to be alive. I 've risen and made times for prayer and meditation. Sitting quietly listening for 'the wee small voice', giving the cares of the day to God, feeling the peace suffuse one's being, as the breath goes slowly calmly in and out and the thoughts return over and over again to God. Of course after a while the cat had the idea that the human sitting doing 'nothing' could well be utilized as a lap to lie on and with sufficient distracting purring and kneeding with claws out perhaps would chuck her chin.

Waiting for coffee I did the dishes that had gathered in the sink the last couple of days. As usual no government official arrived to give me a medal for the truly heroic. Throwing oneself on grenades, running into burning buildings, saving lives with intricate neurosurgery all begins with getting out of bed and making coffee and doing the dishes. This is where the Prime Minister should have his ministers handing out awards. Increasingly fewer Canadians are getting out of bed in the morning. The overwhelming task of facing the day and getting oneself presentable for going outside is too little appreciated.

With an aging population and expandable maternity clothes waists on jogging suits never used for anything but lounging attention should be given to those who get up and get out. That's the work that should be subsidized even before the 'so called' 'billable work' beginnings. I'm proud to say that despite it being Saturday I've already shaved. Somewhere the Hallelujah choir is singing in my mind.

That's the matter of perspective. H.A.L.T. is an acronym for Hungry, Angry, Lonely, Tired. It's a spot check for one's emotional state. It's critical in recovery. The drunk or druggie has literally broken their emotional discriminator. It's been co-opted by the drug of choice reducing the emotional landscape of the addict or alcoholic to "on" or "off". It's a binary code world that they emotionally live in. If they're "on", it means they have sufficient level of their drug of choice in their system to stop the 'craving'.

Drug addiction is not about getting 'high' for the addict or alcoholic. It's about avoiding pain. The "off" is an experience of negativity. That 'negative' experience is the early on set of craving. The length of time for craving to affect a person after the discontinuance of a drug of abuse is days, to weeks to months. Further 'trigger's' such as paraphernalia or the place where one used can cause a person to "jones", that is feel, the painful physiological need to use, almost like seeing a picture of a deceased friend can cause one to momentarily feel a tightness in the chest or a knot in the stomach.

While recovery is a process of healing physiologically it's like losing an lover. It pulls one back for at least a year. The addict though thinks that they're 'fine' in days, or weeks but the relapse rate due to cravings and 'craving equivalents' (negative feelings of ennui, boredom, anxiety, depression) is anywhere from 70 to 90% in the untreated. Even with the fullest best treatment strategies, relapse rates are not uncommonly 20 to 30% in the first year. Early AA ran a recovery rate of 75% and many treatment programs today can match that while the gold standard, Navy pilot program for alcoholism, ran an 80% success rate. The results for recovery on the first try are reduced significantly by the number of substances involved, by the presence or lack of support network (a non using, clean and sober environment of refuge such as the fellowship or 12 step programs or as commonly religious and spiritual communities), good health and work and meaningful relationships.

Because the 12 step programs are wholly voluntary and the tendency of the addict or alcoholic is to blame people even for their 'recovery' it's been a long standing policy to tell anyone 'belly aching' or not participating fully in recovery and claiming that their 'recurrent relapses' are the 'fault' of the therapy, that old timers said 'you'll get it when you reach your bottom'. The point was that a 'bottom' was whereeveer 'you had had enough misery' and wanted a 'way out" . "A Way Out", was one of the first names considered for the AA program. It never claimed to be the only way. However it did recognize that the alcoholic is primarily a 'critic' and negative. That's the "disease speaking". Those wanting instant gratification and a 'new drug' aren't too happy with the idea of 'patience' and serving others to distract yourself from focusing on your own 'misery'.

H.A.L.T. was the first aconym used to remind a person in recovery that their negative feelings weren't an indication that they needed a drug but rather that their emotions which had been numbed by constant Hiroshima like drug explosions in their pleasure centre was now coming back on line and asking for more than binary de-coding. Feeling 'off' doesn't need to mean "I need a fix". If one jumps to that conclusion then one misses the relearning and retraining of the link between emotions and mind and body. It's been severed by the addiction and now like a leg that's gone asleep it's waking up. So ask yourself if you're feeling poorly or negative, am I hungry, angry, lonely, or tired. So rather than take a drink, do a drug or act out an addiction, maybe have a snack, take a rest, call a friend or write down what it is that may be upsetting you.

It seems simple but it's a gargantuan learning task for a person in recovery. Those with process addictions for food, sex, gambling, shopping also learn to use H.A.L.T. as a first step to counteracting the craving or 'craving equivalents'. The big book of alcoholics anonymous personified alcohol as John Barleycorn and called him "cunning, baffling and powerful'. Addiction is very much this. Daily people in early recovery tell me with great pride that they don't have any 'craving' but they feel 'restless, irritable, or discontent". The so-called "R.I.D's" (restless, irritable and discontent) are 'craving". A drink or a fix are literally guaranteed to 'cure' those feelings. The trouble is that people want antidepressants or other medications or counseling or routine life to give them the 'buzz', or the 'high', or the 'fix'. The programs require honesty and the first step is the admission of addiction.

It's accepting that quite frankly, "I broke my brain…..I trashed my central processing unit….my main computer is fried by misuse". Step two of the 12 step program quite simply says, "you're insane". Insaniety is self destruction and addiction is the enthrallment with death. It's playing with death and focusing on the 'pleasure' a sex addict gets from strangulation and masturbation, the high of self inflicted 'near death' experiences. It's the alcoholic or addict who uses till they 'pass out' or 'get legless' or are 'incapacitated' so don't know with any certainty if they will 'survive'. They throw their fate to the wind and retreating to the great maternal 'teat' of the universe ask to suck and be rescued from themselves. Addiction is 'slow suicide'. It's impairment. And because of the denial and the addicted experience the realization that the 'addiction' which 'feels good' is the culprit in the negatives of one's life (the country and western song quality of losing jobs, ideals, dreams, relationships) is this 'first love" (idolatry – addiction is a religion and the object of worship is the addiction or idol).

In recovery we simply don't 'trust' ourselves and our first thoughts. We recognize that our 'best thinking' got us to this place of addiction. We become humble and 'teachable' and don't tell those who have kicked their addictions or know the disease of addiction that we're 'terminally unique', that might 'work' with others but 'wouldn't work' with me. It's a disease. There are 'evidence based' treatments for addiction. If you take them. The corner stone of therapy is to get 'out of oneself'. Isolation or participating with 'slippery persons, places or things" is the precursor of relapse.

Up to a year after marijuania or benzodiazpepine abuse people will commonly complain of sleep disturbance and disturbed mood. Almost everyone has trouble with sleep disturbance for months after stopping drugs or alcohol. Mood swings are the norm in the first year or two of recovery. Most people in early addiction if they see a general psychiatrist without specialized training in addiction will immediately diagnose them as "Bipolar II". This is lesser variant of the mood swings of manic depression, where the mania is described as 'irritability' and the depression has a 'self pitying' quality. Go figure.

The process of recovery is no different from the physiotherapy that a person whose been in an accident and has to have physiotherapy to relearn the ability to walk.

I work with brain injury and addiction. I have seen hundreds of 'mechanical' brain injuries and 'thousands' of people recovering from addiction and frankly its empirically overwhelmingly obvious that addiction is a form of 'chemical' brain injury. That's what the functional MRI's and PET scan research is showing. The emotions of an addict have to be 'retrained'. The emotional centre of the amygdale is impaired. The executive functioning of the area of human judgement and planning in the forebrain is literally mis firing for three months after stopping addictions. The brain of the addict has been coopted by the addiction. It's like a parasite or virus that takes a person hostage and uses them as host to get their needs met, more of whatever it is that the addiction is.

The good news is recovery works. For those accepting and following the treatment of recovery, attending groups, doing the Steps, getting outside help, seeing doctors, staying away from 'slippery person's places and things', getting a new spiritual focus in life, having a really healthy respect if not downright fear of the previous source of addiction, and recognizing that the process of recovery is not days or weeks but years. At 5 years people are out of the woods. After that for most people in recovery less than 50 % will relapse and those that do are least likely to return to their previous levels of difficulty. After 5 years of abstinence the 'harm reduction' and 'controlled' approaches show some success for a distinct minority suggesting that the disease is like other diseases, like cancer, which is said to be 'cured' after 5 years recovery. In these cases the 'risk' remains high but maintaining a high degree of awareness can counteract the potential damage. Commonly because of denial people delay getting help for addiction and other diseases too but once they've had treatment successfully they can be aware of the recurrence and risk.

In AA they say the 'door swings both ways' and many people who relapse return to recovery in days or weeks realizing that the downhill spiral has begun and accepting readily that this is the addiction and not some projection onto the outside world that is the hallmark of the negativity of untreated addiction. The same occurs with recurrence of cancer. People who've had breast or skin cancer see the lump and get help immediately and have a high success for cure despite this being a 'recurrence'. The same occurs with addiction. The 'trick' is to get back into recovery as quickly as possible.

"H.A.LT." (hungry, angry, lonely, tired) Returning to the addiction will cure the "R.I.D's" (restless, irritable and discontent) but books like AA's "Living Sober" give a whole slew of non chemical means to address this condition of human existence. Seligman's site "Authentic Happiness" is a major psychological resource. Maslow's studies on "hierarchy of needs' helps one understand what it really takes to 'feel good'. Montaigne and Cicero , the great philosophers, along with many others discussed "happiness". The major religions have as their principle area of interest "overcoming fear" and "finding joy". The Bible is about first a nations search for enlightment and then individuals search for the source of power. Addictions are a dead end or at best a detour. Life is where the answers lie, good living.

Mental Health is the abilility to love work and play. Addiction is a lousy lover, a dead end and ultimately horrible job and eventually there is simply no play in Addiction. Hang out with people who don't have addictions or at least those who have balance and moderation in their life and you're learn what it really is to 'love' and what the joy and prayer of 'work' are and for sure play again as an adult. Laughter is the hall mark of recovery.

Psychiatrists have long known that humor, ascetiscism and altruism are hallmarks of maturity and wisdom. The Bible teaches 'prayer and fasting'. The beauty of addiction is that recovery is 'fasting' and yet for a 'sacrifice' to be really effective it supposedly must be something really 'desired'. The blind man who loses his sight develops amazing hearing and feelings of touch. Similiarly the addict who foregoes the addiction has the world as an "oyster". Everything else can be experienced even more fully.

As one friend said, if "you're going 180 miles another in the wrong direction, all God has to do is turn you around and you're going 180 miles an hour' in the right direction. That's probably while Jung laughed saying alcoholics were great spiritual seekers but like C.S. Lewis later said they looked for the architect in the wall. They were great seekers but sought the wrong thing or went in the wrong direction.

Recovery is an up elevator that gets faster every minutes, first as you 'retrace' your steps finding your way out of the dark passage detour and then you get on the 'happy road of destiny' taking the mainstream path of recovery. It's truly exciting. It's a whole new adventure. Being "rocketed into the 4th dimension'.!!!

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