What exactly is pleasure?  How does pleasure differ from happiness?  We know that pleasure can be physical (a hot bath, a good meal, a massage), emotional (connecting with friends, laughing, listening to music) or intellectual (reading, solving a puzzle, or debating ideas). While we might not be aware of all the pleasures we experience in our lives, we generally don’t have difficulty recognizing the absence of pleasure.  People suffering from depression or mourning a loss often complain about their inability to find pleasure in activities that once gave them pleasure. A good way to understand how they feel is to imagine losing your sense of taste so that all food was bland.

The concept of pleasure is intertwined with happiness but there is an important distinction between the two. Pleasure is, by its very nature, temporary whereas happiness better describes a state of being. Pleasure, unlike happiness, has a tipping point.  A pleasurable experience will become unpleasant if overindulged.  For example, if we stay in the hot bath too long, eat delicious food until we feel sick, get tickled till we can’t breathe or pursue a behavior at the expense of everything else in our lives, we will ultimately destroy the pleasure we were seeking. We may enjoy eating a fabulous piece of cake, but we will not enjoy eating the entire cake in one sitting. To put it bluntly, we have the power to take any pleasurable experience and make it anything but pleasant. I can’t think of anywhere that this observation applies more than to those who engage in addictive behaviors whether it is gambling, over-eating, alcohol or drugs.

In pursuing the definition of pleasure I came across something called the pleasure paradox. The label is a misnomer.  It should be called the happiness paradox.  The paradox is that the pursuit of happiness doesn’t lead to happiness.  Happiness is thought to be an unintended side-effect of an experience, engagement, or accomplishment. It can only be obtained indirectly.  And therein lies the paradox. The Declaration of Independence says we have a right to the pursuit of happiness but, if we believe the paradox, we must pursue something other than happiness in order to achieve happiness. Note, the Declaration doesn’t say we have the right to pursue pleasure. The paradox does not apply to pleasure; pleasure is sought directly.

The ancient Greeks were strong proponents of pleasure. They believed that one should devote themselves to finding pleasure and they proudly called it hedonism. The Roman emperors were unabashed hedonists. The Greek word ‘hedys’ means ‘sweet.’ It reminds me of how often I hear young people use the same word to describe something they like. “Sweet!” The Greeks also had a word for those who could not experience pleasure from normally pleasurable experiences; the word was ‘anhedonia.’  And that word is still used today by psychologists and physicians to describe persons who cannot find pleasure. It is, in fact, identified as one of the major symptoms of depression.

Does pleasure bring us happiness? No. A pleasurable experience, when received in a reasonable dose, will bring us, well, pleasure.  I may indulge myself in the pleasure of eating an ice cream cone but that will not place me in a state of happiness. Ask any dedicated smoker who finds pleasure in smoking a cigarette. He doesn’t find happiness in his cigarette; he finds pleasure.  And if you ask him if smoking makes him happy, he will likely say he wants to quit.  On the other hand, can we find happiness in the absence of pleasure?  I don’t believe we can.  I think we humans need a certain amount of pleasure in our lives.  But pleasure itself doesn’t bring us happiness any more than a sexual climax brings us love.

Often when discussing the subject of addiction, we accuse the addict of engaging in ‘pleasure seeking behaviors.’ Pleasure seeking behaviors are equated with any and all attempts to get high. While the addict will experience a temporary escape from withdrawal, they will not experience pleasure from their high.  Like the person who eats the entire cake, the pleasure is long gone.  Personally, I think addicts suffer from a complete absence of pleasure. I surmise that addicts progressively eliminate any and all pleasure in their lives. They become immune to physical and emotional comfort. They are cut off from engaging encounters.  Eventually they don’t read, go to movies, cook, listen to music, discuss ideas, follow world events or sports or politics. They don’t laugh or sing or dance or meditate. Their lives become void of art, poetry, science, adventure and ideas. They don’t have hobbies or take on projects. They cut themselves off from family and friends. Eventually there are no hot baths, warm beds, clean clothes, brushed teeth, combed hair or the slightest hint of comfort.

So here is my question; how important is pleasure in our lives?  How important is it in the lives of recovering addicts? I have, for a very long time, wondered about this. If a person has no pleasure, can they ever recover? Can anyone find a state of happiness without some pleasure in their life? How much pleasure do we need?   Can a person regain lost pleasures?  If so, how?

Many addicts go in and out of treatment programs over long periods of time. Relapse is a constant threat. We say that relapse is a part of recovery.  Is it? Or is that our way of justifying the revolving door in almost all recovery programs. Every relapse is a risk of death. Here is what I think. It is not enough to quit using a substance of choice.  It is not enough to do the 12 Steps. It is not enough to take medication to squelch the cravings. Offering more treatment is not a solution if treatment doesn’t alter the outcome. In no other field of medicine would insurance companies cover treatment that has such a dismal outcome.

Maybe pleasure is insignificant. Maybe pleasure has nothing to do with achieving a successful recovery. Perhaps pleasure, once lost, cannot be regained. But could we at least ask the question?  If I ran a treatment program, I would have art and writing classes, music, meditation and poetry.  And maybe it wouldn’t make a bit of difference. We offer all kinds of comfort to patients in other areas of healthcare so why don’t we offer comfort to addicts in treatment? Is it because we perceive them as guilty of ‘pleasure seeking behaviors?’ I have never heard anyone in the world of addiction treatment say ‘pleasure seeking behaviors’ in a positive light. Is it possible that deep down we believe they don’t deserve pleasure?   Here is an exercise: sit down and imagine yourself taking a perfect hot bath.  Think how good it feels to melt in the hot water. Smell your favorite soap. Envision your favorite towel, all warm and fuzzy. In your mind, select the music you will play as you relax in the tub. Now get up and go take a very cold shower.

The Pleasure Zone

We, who are coping with an addict in our midst, are told to take care of ourselves. It seems so counter-intuitive. Aren’t we supposed to be taking care of our addicted family member? But slowly, attending meeting after meeting, we become convinced of the wisdom in focusing on ourselves and not on our addicts.  We begin to embrace the idea of taking care of ourselves.  Pretty soon we find ourselves asking others “Are you taking care of yourself?” “What are you doing to take care of yourself?” Unfortunately the answers frequently offer limp and somewhat vague explanations. Maybe we throw out an activity we recently participated in or a trip we are planning. We say things like, “I’m feeling better,” which in no way answers the question but tends to divert the topic. We confess that since becoming parents we haven’t spent much time ‘taking care of ourselves.’ We also confess that we don’t really know what it means to take care of ourselves. So I’m going to hit this topic head on. What the hell are we talking about?

What does it mean to take care of oneself?  Is washing my hair taking care of myself?  Is reading a mystery novel taking care of myself?  Maybe buying a new pair of shoes is taking care of myself. Somehow these activities don’t ring true.  I always wash my hair and I’m always reading a book.  Buying a new pair of shoes might be fun for some people but for me it is a chore.  Coping with addiction has not altered my day to day routine. I still go canoeing twice a year.  I still go to my workout.  I still travel and read books and knit sweaters. What it has altered is the level of pleasure I get from everything I do. Yes, everything.  Pleasure where are you?

And so, I’ve been thinking about pleasure and what it means. How important is pleasure in our lives? How is pleasure defined? According to Merriam-Webster pleasure can be a state of gratification, a source of delight or joy, even a frivolous amusement. We qualify pleasure with words like ‘sheer,’ ‘simple,’ and ‘great.’ We use it to describe both physical and emotional experiences and we retain our memories of pleasure. We can revisit a pleasure just by thinking about it in the same way we can revisit other experiences in our lives.  An absence of pleasure is a common complaint of persons in the early stages of recovery as well as in person who suffer from depression. I think a good analogy is losing one’s sense of taste. What happens when a person can no longer taste their food? Is pleasure essential to our well being?  I believe it is.

I’ve decided to explore some of my pleasure memories; maybe they can kick start my pleasure zone.  Because, let’s face it, that is what is missing. I can continue doing everything in my life but can I find joy? Can I get goosebumps?  Can I laugh until my side aches?  Can I delve into a book so deeply that I stay up all hours of the night reading it?  Can I dance with abandon? Can I completely relax so that I feel like I am floating on air? Can I do something that makes my heart pound and my breath gasp?  Can I close my eyes and feel warm and centered and content? Here are some physical pleasure memories I revisited.

I am in an old fashioned swimming pool, half asleep, drifting on a plastic float after a vigorous swim. This image stems from my childhood when I spent a good portion of my summers hanging out at my neighbor’s pool.  I was always welcomed there and treated with kindness; something that was often lacking at home. I recall the feeling of the sun slowly drying my skin. I experience a delicious shiver with light goose bumps on my forearms.  The warmth is intoxicating. My hands rest in the water.  If I float to the edge, I gently push off the side with my feet.  The motion of the water rocks me gently.  My eyes are sometimes half opened, or else blissfully closed.  I feel completely safe and content. Of course this floating didn’t take place until I was exhausted from jumping off the diving board, swimming under water, and playing Marco Polo. Perhaps that is why it was so utterly divine.

I have a memory of facing a friend, holding both her hands with both of my hands and twirling around in a circle. As we twirled, we would lean away from each other and throw our heads back, looking up at the sky.  Our loose cotton dresses would cling to our legs. Our feet were bare.  We would get completely dizzy and then fall on the grass in uncontrolled laughter. We’d try to stand up without success. We would look up into the trees and see the branches moving around in circles. We learned this pleasure from older kids. It made us feel giddy and high. Somehow we knew our parents would not approve. The sensation in our bellies similar to a roller coaster ride, the dizziness that made us unable to stand up and the knowledge that we were doing something we probably weren’t supposed to do was thrilling.

I once had a boyfriend who had a motorcycle. I loved the motorcycle far more than I loved him.  Despite all the warnings, the danger, the disapproval, I would fling myself on that motorcycle with complete abandon.  I remember the feeling of holding on to his waist and letting the air whip my hair in all directions.  Rather than feeling afraid, I felt exhilarated. My life was completely in his hands. There was a sensation of motion as I leaned left or right in sync with his body.  There was no conversation. I couldn’t see him or hear him.  Our communication was entirely between our two bodies.  It was such a physical pleasure that I think about it whenever I see a couple riding along on a motorcycle.

My husband and I took a vacation in the Czech Republic. It was a walking tour. Every day we walked 9 or 10 miles through the foothills and small towns. Naturally our feet would get hot and swollen.  Fortunately there were ice cold streams almost everywhere we went.  After hours or walking, we would sit by the stream and slip off our shoes and socks. We would slowly lower our feet into the water.  It was like an electric shock that was both painful and soothing. Our feet would literally go numb. The sensation was indescribable.  Whenever my feet are tired and hot, I long for the streams of the Czech Republic.

When I would work the night shift in the hospital, around 5 in the morning I would almost be sick with exhaustion.  It literally made me nauseous. The replacement team would arrive at 7:00 and the hustle and bustle of changing shifts would revive me. But on the way home, the exhaustion would return.  I would feel almost drugged. I would literally tear off my uniform and crawl into my bed.  In the moments before I slept, there was a physical pleasure that is hard to describe. The realization that I could now succumb to my exhaustion was exquisite.  I would actually fight sleep for a minute or two just to feel that feeling as I would surrender to my overwhelming need for sleep.

I have worked in the garden far too long. It’s hot and dry. My hair is matted from wearing a big hat.  My arms and neck are bathed with a mixture of dried sweat, sunscreen and dirt. My lips feel cracked. I have yet to clean up the mess I have made; garden tools and trimmings still need to be put away or tossed in bins. I look around and think about what I accomplished and what I didn’t. Every bone in my body aches. I remove my shoes and socks and carefully walk into the kitchen trying to avoid shaking off clumps of dirt in the house.  I open the refrigerator and get an ice cold drink (water, cola, tea, or beer) and tip toe back outside.  I plop down into a chair on the deck, put my feet up, open my drink and and take a big swig.  It is the best drink ever.  It quenches a thirst I have been ignoring for hours. Part of me wants to pour it over my head but I know I need every drop.  It is the reward for all my hard work. No drink is ever as satisfying or thirst quenching as the drink I have after hours of gardening.

So what do these physical memories have in common?  I let go. I succumb.  I’m on the brink of something: exhaustion, discomfort, thirst, defiance.  I allow myself to completely surrender.  I let go of all control.  There is no hesitation, no second guessing, no what ifs, no fear.  So, here is my pledge:  I’m going to quit thinking about caring for myself. I’m going to turn on the music and listen to a song, a song I love, one that I know every word.  I’m going to turn up the volume. I’m going to close my eyes and dance to that song.  I’m going to let my body sway and my feet move and pretend I am the performer. I’m going to twirl around with my arms extended until I feel dizzy. I’m going to run up and down the stairs until I am completely out of breath just to feel the pleasure of gasping for breath. I’m going to swim again, swim until I am exhausted and then ease myself into a jacuzzi and close my eyes. I’m going to watch a movie that makes me laugh really hard and maybe one that makes me cry really hard.  I’m not on a pleasure cruise, I’m on a pleasure hunt. It’s a start.

The Fates

Modern day humans spend a lot of time searching for answers to the universal questions: Why does life happen the way it happens?  And Why do we behave the way we behave?  We examine our past, revisit the way our parents raised us, explore our culture, and focus on critical events that we believe impact us individually and communally. More recently, we have added our genetic makeup to our quest to understand ourselves.  We believe that every experience, good or bad, makes a permanent imprint on our lives. Whether we feel victimized or blessed, we generally can’t resist asking ourselves the nagging question ‘why?’   Why did this happen to me?  Why do I feel the way I feel?  Why did I escape injuries when others did not?  Entire fields of study are devoted to answering these questions: social studies, psychiatry, psychology, genetics, etc. And, if we are honest, we are mostly seeking answers to questions that concern the negative things in our lives.  Most people don’t seek therapy to discover why they are so lucky. We also bank on the idea that if we can understand why, we can somehow fix it or perhaps simply cope with it better.

I believe the ‘why’ questions have always been asked; it is the answers that have differed dramatically throughout history.  I remember a history teacher who pointed out that during the middle ages a person accused of witchcraft would be hauled away.  Today, the person who accuses someone of witchcraft would be hauled away. It’s all about context.  Prior to psychoanalysis, the majority of explanations were based on religion. We’ve all heard the phrase ‘lot in life;’ casting a lot basically means choosing someone at random (the old short stick solution).  But in the bible, the person chosen by lot was thought to reflect the will of God.  Interpretation of events (or addressing the ‘why’ question) bounced between divine grace and the wrath of God. You were either blessed or cursed. The bible tells the story of the sailors casting lots to ‘choose’ who was responsible for bringing the wrath of God upon their ship (Jonah 1:7).  In this sense, your lot was your fate and God, not you, determined your fate. The unlucky sailor who got the short stick was likely thrown overboard.

The ancient Greeks had a very different approach to the ‘why’ questions. They believed that three goddesses determined a man’s fate.  They were in fact called The Fates.  Klotho spun the thread of a man’s life. Lakhesis measured the thread to determined the length and destiny of that life, and Atropos determined how a man would die when the proper time came.   A man’s fate was assigned by ‘eternal laws;’ laws of the universe that were thought to be immutable (never changing).  The first law was the Law of Mentalism which states there exists a single universal consciousness that is plainly revealed.  The second law was the Law of Correspondence; that there is harmony, agreement and correspondence between the physical, mental and spiritual realms in the world. The third law was the Law of Vibration which states that everything moves, everything vibrates, only the frequencies vary; your thoughts and emotions are merely vibrations.

While The Fates did not directly interfere with a man’s life, they also did not allow other gods to interfere with or obstruct a man’s fate.  Even so, fate was somewhat pliable.  It was believed that a man could alter his own fate through choices he made; the old adage that you cannot necessarily control what happens but you can control how you respond to what happens (a very modern idea). Therefore, The Fates determined consequences for a man’s actions or responses. Interestingly, The Fates were portrayed as ugly old women who were stern and unforgiving but always faithful to the eternal laws.  My guess is that The Fates were more often credited with bad luck than they were credited with good luck and thus were created in the image of a mean old aunt who was out to get you.

Because we believe that the answers to our questions lie in the modern day explanations of environment, experiences, and genetics, we devote serious time and energy attempting to understand ourselves. We often draw explanations that involve our families, our negative and positive experiences, our trauma, our parents trauma (epigenetics). We think in terms of fair versus unfair.  We are prone to delve into the ‘what if….’ fantasies that are so alluring.  What if I had been given more opportunities?  What if my parents had not gotten divorced?  What if I had married someone else?  What if my mother had been more affectionate?  What if I had been a better parent?

Unlike persons who believe their fate is predetermined by three unattractive goddesses and unlike persons who believe that their fate represents messages from God, modern day ‘answers’  can send us to a place of blame, guilt, self pity, regret, and even self-loathing. We can allow our thoughts to wallow in ‘what if’ and ‘why me’ and ‘should’ and ‘should not,’ etc. It’s a heavy load to bear. But probably the most destructive feature of our modern day ‘answers’ is that it can prevent us from embracing acceptance. So maybe the ancient Greeks understood something that we don’t.  If a person believes his or her life’s course is predetermined, s/he can more easily accept what happens or doesn’t happen. And if s/he believe that his or her life is but a small vibration in tune with the harmony of life, s/he might be less inclined to judge his life in terms of what s/he did or did not do or get or experience.  S/he would be less responsible for the lives around them because they would recognize that their parents and children and neighbors also had lives that were essentially predetermined. They might focus more on how they respond to events than how they caused events. They might embrace self-acceptance and acceptance of others. They might even view themselves as a tiny vibration in the physical, mental and spiritual realms of the world. They might even believe in The Fates.

Finding my happy place

Today I stopped by and picked up some plants for my garden.  It is early July and a couple of the flower pots on my deck need a lift.  As I wondered through the garden center, a woman asked me a question about one of the plants.  We shared a few comments.  On the way out to my car, she was right behind me and as she passed with her cart of flowers, she said, “Now, I get to go to my happy place.”  I smiled. Yes, that is exactly how I feel when I purchase plants or garden supplies.  I’m about to go to my happy place.  Despite the fact that it is brutally hot and my lower back is bothering me and I have more garden projects than I can possibly complete before the end of the summer, I seek it out with great anticipation and enthusiasm.  I put on my raggedy clothes and an old floppy hat and slip on shoes that are falling apart.  I drag out all my tools; you never know what you will need, and I usually get filthy dirty and wet (sometimes the hose has a mind of its own).

I have often thought that I could never be a fisherman. Standing in one place hour after hour and casting over and over would drive me bonkers.  The fishermen generally seek out cold and drizzling weather because that is when the fish are biting.  I hate cold and drizzling weather. They start really early in the morning or late in the evening. They are often alone and they like it that way. Many are of an age where I’m certain they suffer the usual aches and pains of arthritis; pains that intensify in the cold damp weather, standing in waders in ice cold water. But the point is, it doesn’t matter to them; they are in their happy place.

So it has dawned on me  that our happy place isn’t about being physically comfortable. It isn’t about doing something that is easy or convenient.  It isn’t passive either; we are not in our happy place watching TV. It isn’t something we do for a living; it’s not our job. We don’t get paid to do it. It’s not a part of our resume unless it is mentioned in that space for hobbies or interests and we decide to list it. My husband is in his happy place when he is cooking.  He spends time thinking about the meal he wants to prepare, reading recipes, planning what he will need, going to the market, chopping and dicing and seasoning the ingredients.  He makes a considerable mess. Often he is trying something new, an experiment in flavors one might say.  I have no doubt he is in his happy place.  He gets excited just thinking about what he is going to make and he works hard.

As family members of a person suffering from addiction, we learn that we need to take care of ourselves.  We are not really clear about the concept because most of us have spent our lives focused on taking care of someone else. We tend not to raise our hands and ask, “What the heck does that mean?”  We are polite and timid; afraid to admit that we have never thought of taking care of ourselves. Are we talking about personal hygiene? No.  Are we talking about going our for dinner and a movie?  Maybe. Are we talking about going on a vacation? Possibly.  But I really think we are talking about finding our happy place.  When I am in the garden, I think of nothing else.  I work hard.  I can’t wait to get started and I always linger when I should be finishing up.  I don’t think about how I look or what I say because I don’t say anything.  I am, for the most part, alone. I don’t listen to music or talk radio. I share my happy place with my friends who have also found their happy place in the garden.  We discuss plans, plant sales, tips and problems.  We discuss roses and pests and soil amendments. We take garden tours through each other’s yards.  “I’m going to divide these iris at the end of the summer.  Do you want some?” I imagine fishermen do the same.

Our happy place takes us somewhere; somewhere away from our problems, our bills, our errands, our family.  We are not doing it to gain recognition.  We won’t get a certificate or a degree.  And somehow we know we are there when we are there.  Here are my telltale signs:  I get excited when I go to a garden center or when I see a beautiful garden. In the grocery line my eyes seek out the Home and Garden or Sunset magazine covers, not the People or US magazine covers. When I go on walks I observe and critique the landscapes and gardens I see along the way.  I get ideas. While sometimes I receive compliments on my garden, I know I would garden even if no one else ever saw my yard.

It doesn’t mean that I am never happy doing anything else.  I can enjoy lying on the couch and watching a good movie or going out for a nice dinner.  But those things don’t sustain me. They don’t give me purpose or inner satisfaction.  For me, taking care of myself means spending time in my happy place.  It is not an escape nor is it a means of avoidance.  It is a place where I spend time with myself. I experience a type of limbo where I am not identified as a mother, a nurse, a wife, a daughter, a sibling. Nor am I a gardener or a landscaper; I am simply gardening. I observe and touch and feed and water. I listen to the sounds of the birds, the squirrels, distant voices of neighbors and sometimes machinery. And when I leave that happy place and return to all else that is my life, I am refreshed.  I have taken care of myself.

What do We Mean When We Say Treatment?

Every summer my church offers a lecture series. Until this year, I had never offered to be a speaker.  Then came the endless headlines about the opioid epidemic and I realized it was a timely subject and I could share some of what I have learned. So I volunteered to give a talk on addiction. That was back in March.  Summer seemed a long way aways so I immediately put it on the back burner.  Time went by and every once in a while I would tell myself I needed to start thinking about my talk.  When I finally had to get serious, I felt a bit overwhelmed.  I knew I needed to narrow my focus.  I found myself vacillating from one topic to the next.  Should I talk about the biology, the legal consequences, the drugs themselves, the different types of treatment, etc.?  There seemed no end.  I wandered around in circles.  Finally I sat down and thought about what it is that interests me most when I think about addiction.  Two things came to mind. The first is the broad and somewhat blurry definition of treatment itself and the general absence of studies that consistently measure outcomes.  And the second topic that interests me is how addicts are treated when they are in treatment or in need of treatment or in recovery. Today I’m going to about the first topic.

Several years ago I read the Pulitzer Prize winning book, The Emperor of All Maladies, by the oncologist Siddhartha Mukherjee.  It was a book about the history of cancer and cancer treatment.  As I read it, I realized that all the cancer patients I had taken care of in the 1970s and 80s were receiving care based on what was known or theorized at the time. Makes sense. But the truth is, that what was ‘known’ was mostly wrong. There was no knowledge of the influence of genetics or immunology, or anything else that we now know relates to cancer. Lesson; just because a ‘treatment’ is established or consistently used, it doesn’t mean that it is valid or useful. We can be consistently and persistently wrong and we often are.  Remember that there was a time when  cocaine was used to treat morphine addiction and morphine was used to treat alcoholism.   Wrong, wrong and wrong again.

Unfortunately, care providers get attached to the treatments they know and often insist that these treatments work despite empirical data indicating otherwise. Professional care providers can actually ostracize anyone who dares to bring up an alternative or contradicting theory regarding the cause or the cure of a disease. We want to believe in the treatments we offer and we don’t appreciate outsiders telling us that our current treatment is useless or, even worse, actually harmful. Change is not only painstaking but it can be met with serious resistance and even hostility.

In my talk, I began, as I often do, by looking at the history of drug abuse and was surprised at what I found. Alcoholism was first identified as a disease in the 1700s.  Yes!  Dr. Benjamin Rush, a physician and one of our founding fathers, wrote that chronic drunkenness was a disease that should be treated by physicians. I’m certain he would have felt the same about drug addiction. The questions is, how would a physician have treated alcoholism or drug addiction at that time?  It is surprising to learn about some of the insights they had back then; insights that we assume are very modern.  In 1750 Native American Tribes created Sobriety Circles (take that AA).  In 1891, the Keeley League announced, “The law must recognize a leading fact: medical not penal treatment reforms the drunkard.”

It’s also interesting to note the conflicting behaviors and attitudes of society towards the use of addictive substances and towards persons who become addicted.  A network of asylums and sober homes were established to ‘treat’ people with addiction but at the same time, drug companies were selling and boldly advertising morphine laced potions to middle and upper middle class women for whatever might ail them. At the turn of the century, the American Medical Association approved heroin for general use rather than morphine because morphine was addictive.  It’s really quite amazing.  Many people entered sanatoriums for whatever addictions they were suffering and generally received alternative addicting substances such as cocaine to relieve them of their withdrawal symptoms.  When the hypodermic needle was introduced it was touted as a way to avoid addiction because it was thought that injected morphine would not be addictive. Who knows where that idea came from.

So what have I learned?  First and foremost that a lot of unproven ideas have led to inappropriate and sometimes harmful treatment. If you are in the field of healthcare, as I am, you know that treatment is classified in a variety of ways.

Symptomatic treatment is a treatment or therapy that targets the symptoms of a disease but not the cause of the disease. A symptomatic treatment could be something like a medication that you take for nausea.  It helps the nausea to subside but the cause of the nausea is not addressed by the medication. Causal treatment targets the cause of the disease. For example, if the cause of congestive heart failure (CHF) was a leaky heart valve, then surgery to replace the valve would target the cause of the CHF. Of course it is essential to know what the cause is and that can be tricky.  And even if you do know the cause, it doesn’t mean that a treatment exists that will actually address the cause.  Then there is palliative treatment that focuses on relief of pain and discomfort without addressing the disease itself.

I could go on but I think this will suffice. Because what I want to ask is what kind of treatment is addiction treatment?  Are drugs that help with cravings considered symptomatic treatment or palliative treatment? If we wanted to treat their discomfort, we might consider giving them a maintenance dose of their drug. Are we attempting to discover a causal treatment? In the came of addiction, a causal treatment would likely focus on prevention; finding out who is at risk and helping them avoid experimenting with drugs or alcohol. I think many people associate treatment with a cure. Families get their loved ones into treatment because they want them to be cured.  They want them to be discharged from their Rehab program free of addiction.  They fantasize that they will all return to ‘normal.’ But, of course, that isn’t what happens.

So my question is, what do we mean when we, the families, healthcare providers, law enforcement, the media, the justice system call for more treatment?  There is a bit of hysteria right now with claims that only 10% of people with substance abuse issues will ever receive treatment.  Large sums of money are going to be flung at the states to address the opioid crisis but no where does it say how that money should be spent.  It is a set up for fraud, abuse and disappointment especially since there is little oversight for addiction treatment facilities. Add to that a frightening shortage of licensed and credentialed persons trained to provide treatment; a dearth of scientific studies to validate what does and doesn’t work; powerful drug companies chomping at the bit to capture the market for drugs that reduce cravings, sober living homes happy to bill insurance companies for services not provided and a legal system eager to court-order people into treatment.

My take?  The first thing we need to do is step back and take a deep breath. And then we need to sit down and quietly ask the question, what is treatment?

What We Say, Says it All

I’m at a parent support group. We begin our meeting by going around the room and ‘checking in.’  Check-in can be a brief update or it can include introducing ourselves and our history to any guests or new members joining the group.  It generally goes something like this, “I’m Nancy, the mother of a heroin addict. My daughter is 24 years old, living on the streets and I haven’t heard from her in over a year.  She began using around age 14.  We sent her to numerous treatment programs and at one point she stayed sober for 13 months….”  The next person does essentially the same thing.  Over time we all know each other’s stories and even the name, age, drug of choice, history of use and relapse of every adult child. I notice that each participant frames their introduction around the addict in their life.

What strikes me is this: when a parent doesn’t say enough about his or her addicted child, the group doesn’t hesitate to jump in. Someone asks “Is Sam still in jail?” Someone else chimes in, “When is his next court date?” The entire group is focused on the addict even though this is supposed to be a parent support group. What we do say about ourselves tends to be on the vague side and far less than what we say about our addict; “I’m doing OK. I’m trying to take care of myself. I’m feeling better,” etc.  A common question we ask when we greet one another is, “How is <name of addict>  doing?”  rather than “How are you doing?” I hate to say this, but sometimes it seems like these inquiries are really about satisfying a morbid curiosity especially if the last inquiry brought up something dramatic (e.g. an overdose or an arrest). I’ve asked these same questions too.

As we go around the room, I drift off to contemplate conversations between parents of adult children who are not addicts.  Many conversations between parents of grown children focus on the grown child and not on the lives of the two people having the conversation. The majority of these conversations begin with the ‘listener’ making an inquiry such as ‘How is your daughter doing?’ The listener nods his or her head, asks appropriate questions and interjects things like, isn’t that wonderful. Most of what is said is positive and brings a bit of a puffed chest to the parent or grandparent who is responding to the inquiry. “Charlie just finished graduate school. Susan was promoted in her job. Andrea is expecting a baby this summer.” I’ve never heard someone say something like “Timothy is a couch potato who has put on 30 extra pounds and is still out of work.” As soon as one party finishes describing the feats or accomplishments of his or her offspring, the listening party will be ready to do the same. Its a bit of a dance.

How are these interactions similar or dissimilar? In both cases the conversation often begins with an inquiry about a third party; the adult children.  The information shared tends to focus on facts: Tommy graduated from medical school; James got arrested; Karen overdosed last Friday. The listening party doesn’t actually know the adult child or only knows them from a distance (e.g. I met your son once while he was in rehab with my daughter or I remember your granddaughter because she went to high school with my granddaughter). The inquiries serve an underlying purpose; In the case of parents discussing the accomplishments of their adult children, there is a sense of pride and taking some indirect credit for the accomplishments or their offspring. In the case of the parents discussing the woes of their addicted children, there is a subtle competition to attract the most sympathy; a bit like being Queen for a Day, an old TV program where people actually competed by telling their terrible predicament and the audience deciding which contestant had the most compelling story based on an applause meter. The person whose story invoked the most sympathy was rewarded with assistance and prizes.  Hey, it was a really popular show in the 50s!

The person making the inquiry may also have an unwitting agenda. Asking someone about their grown children can be an invitation to be asked about your own grown children. On the other hand, it can also be a kindness that allows someone an opportunity to gloat a bit; especially true when you inquire about grandchildren.  If I were asked to paraphrase the message, I might say ‘listen to how well my offspring are doing and what does that say about me!”  A few years ago I took my 86 year old mother to Jackson Wyoming for a 4 day weekend.  We had a fabulous time.  My sister informed me that one of the best things about our trip was the ‘telling’ after it was over!  My mother shared every detail with her bridge partners; message: “I have a wonderful daughter who cares about me and takes me to fabulous places like Jackson, Wyoming!”

Asking someone about the status of their addicted child can also have a hidden agenda. It can be an effort to simply catch up; e.g. “the last I heard your son was in jail, is he still there?”  But in all honesty, it can also be a means of satisfying an itching curiosity; better known as gossip. Example, one week a mother reported that she hadn’t heard from her newly recovered daughter in 4 days;  the support group is dying to know if the daughter relapsed. Sometimes a parent reveals something about their addict such as “my son was arrested last night.” Instead of asking the mother how she is doing,  the group besieges her with questions asking for more and more detail; e,g, “what are the charges, is it a felony, are you going to bail him out, have you gotten a lawyer?” Whew!

So here is what I think. When we talk about others, we reveal a lot about ourselves. Perhaps a better way of saying this is ‘everything we say, reflects on us far more than it reflects on the topic of conversation especially when that topic is someone else.’  When a father tells you his son has been accepted to an elite university, he is telling you that he values that acceptance; he puts a lot of weight on where someone goes to school; and he takes some credit for his son’s acceptance to that school. The listener can assume that the father/son relationship has been greatly influenced by this value. The listener has gained insight into the father, not the son.

When the parent of an adult child focuses his or her conversation on the adult child’s addiction or behavior or troubles, it tells the listener that the parent continues to take responsibility for what is going on in their adult child’s life. It tells the listener that the parent is controlled by fear and devotes considerable time anticipating pitfalls. It says that the parent has not separated his or her self from their grown child. It also tells the listener that the parent is reluctant to confront their own personal issues, to look inward rather than outward. Again, the listener gains a lot of insight into the parent, not the addicted adult child.

In both scenarios the focus can divert the participants from making a meaningful connection. One of the things that addicts often confront is their need for drama in their lives.  So I’m beginning to wonder if the family members are not vulnerable to the same need. Chasing the scoop diverts us from ourselves and allows us to sidestep the real reason we are here, to work on ourselves.

Oh, it’s my turn to introduce myself. I say my name, that I am a mother of an addict, that I write a blog about addiction and that I am feeling pretty good today. Within two seconds, someone in the group asks, “What about your son?” Someone else asks “Is he still in jail?” and another person asks “How is he doing?”

I rest my case.

Goals vs. Wants

You may wonder why I have chosen this topic for my blog.  As I have said previously, my brother is an accomplished cognitive behavioral psychologist (CBP) who shares his observations and thoughts with me. Because so much about recovery relates to change and one’s ability to set realistic and positive goals, I have chosen to discuss this topic.  I think as you read this, you will begin to see the connection.  How a person perceives and sets a goal has a major influence on how he or she will achieve or not achieve that goal. It really is quite fascinating.  Here goes.

What are goals?  What does it mean to have a goal?  Where do you begin? I think of a goal as some kind of desired outcome and it generally is something I want to accomplish (e.g’.complete a degree or run a marathon) or have (e.g. a better job or a better attitude).  Obstacles are the things that stand in my way to obtaining my goal and could be anything from money to time.  How I respond to my goal-related obstacles is called ‘coping’ and it can be highly effective or not.  Here are a few other concepts that will contribute to my success: well-being or how I like myself and the life I am leading; mindset or problem-solving mindset is how I experience my goal related obstacles; motivation is the energy or lack of energy I display in my problem-solving efforts; action plans are the actual steps I intend to take towards achieving my goal.  It’s essential that an action plan is both realistic and healthy and that I am capable of modifying it as needed.  I will need to monitor my program and have a plan to overcome the inevitable challenges I will likely face as I try to achieve my goal. I will definitely need to develop some strategies to assist me on my venture.

First of all, I need to set a goal that is both healthy and realistic.  I am not going to be an opera star any time soon.  The truth is that an unrealistic goal can never be a healthy goal; by nature it is an exercise in defeat.  But what else defines a healthy goal?  A healthy goal is connected to well-being so the first question I need to ask is how will my goal effect my feelings about myself, my feelings about my life and my mood? I can ask this question in reverse.  How will NOT achieving my goal effect these same measures?  Who will determine if my goal is achieved?  This is called the locus of control (LOC).  Will I decide I have reached my goal or will someone else decide I have reached my goal?  If I have a goal to be chosen as a starter on my soccer team then the coach gets to decide if I have reached my goal. The idea is to identify a goal where I have the LOC, a goal that I determine such as mastering specific soccer skills that will improve my game. This is not to say that I won’t face outcomes that are determined by others, e.g. getting accepted to a graduate program. But if my goals focus on my own behavior (complete assignments, keep a GPA needed for graduate school, set up a schedule to study for a pre-graduate exam, etc.) then I am able to set the stage for future opportunities such as getting into the graduate program of my choice.

I need to think about any and all likely obstacles I will face. Some will be external while others will be internal.  Are the obstacles mainly within me or are they mostly within the goal? In some cases they are mostly in the goal: I want to win a Nobel Peace Prize.  Not many people have accomplished that goal.  I want to fly a hot air balloon around the world. Ditto.  If few people can accomplish the goal then most of the obstacles are within the goal itself.  But if many people can accomplish the goal (lose 20 pounds., quit smoking, run a marathon) then most of the obstacles are internal. Identifying the internal obstacles is a key to  success. I not only need to identify them, I need to correctly interpret them and that involves my mindset.  Do I see a goal as unfair?  If yes, then I am verging on seeing it as insurmountable which can lead me to “here’s why it won’t work.”  If I see an obstacle as challenging but fair it will lead me to thoughts of “I’m not afraid of pursuing a meaningful goal even if it is difficult.”  The first mindset is a Can’t Do Mindset and the latter is a Can Do Mindset. I have often given advice to people in the Can’t Do Mindset where they tell me their troubles and I make suggestions and they tell me why none of those suggestions will work. To sum it up, how I identify my obstacles, how I view them and describe them will be extremely important in how I address them.

Obviously I need to avoid a Can’t Do Mindset. However, pursuing goals invites uncertainty; there is no guarantee that I will succeed.  Taking a deep breath and keeping the faith might be in order. Here are four things I need to consider.  The first is Mastery, my ability to handle any goal-related obstacle. The second is Resilience, my tolerance for discomfort.  The third is Initiation, my ability to get off the couch and get started.  The fourth is Persistence, my commitment to keep at it.

Before I get started, maybe I need to spend a bit of time thinking about my past pattern of coping or my coping style. Actually two types of coping have been identified in the literature: Approach Coping and Avoidant Coping. They are pretty self-explanatory.  The first is to confront problems head on and the second is to sidestep problems.  I’ve probably been engaged in both types depending on what is involved. A sizable subset of the Avoidant Coping is centered around activities that make us feel better in the moment (drug/alcohol intake, binge eating, shopping, computer games, Netflix marathon or anything that keeps us in continual distraction). It’s not that these activities don’t work, they do make us feel better but only in the moment. Unfortunately that they don’t address the underlying problem. Makes sense.

Mixed up in all of this is understanding the difference between goals and wants.  Goals typically require significant effort up front and are likely to be achieved later rather than sooner. Wants are the opposite.  Wants generally offer immediate comfort and require little effort.  A goal would be to lose weight, a want would be to eat a second helping of mashed potatoes.  Wants follow the pleasure principle: feel good, avoid pain.  It runs on autopilot and is hard wired into our brains. Wants have a lot of clout at the decision-making table and can cause goals to self-destruct before our very eyes. Here is how my brother explains it:

So, how is it that our wants triumph over our goals so readily?  Well, wants have several major advantages over goals: 1) they are immediately rewarding (my goal is to be drug free, but getting high would feel great right now); 2) they do not involve getting out of our comfort zone (my goal is to overcome my social anxiety, but talking to people makes me nervous); 3) they require minimal effort (watching Netflix is a lot easier than hitting the gym); and 4) because wants fit our mood in the moment, they are almost guaranteed to satisfy (I wanted some comfort food and I am thoroughly enjoying my quart of Häagen-Dazs).

He also points out that Wants pretty much offer certainty of an outcome: taking this drug will alleviate a drug craving.  Yes it will. Wants fit our mood and that is why they are so satisfying.  Goals, on the other hand offer no such certainties. Going to the gym doesn’t guarantee that you will meet your fitness goals, studying hard does not guarantee that you will pass the test, etc. Often the behaviors we need to reach our goals are anything but comfortable and they are not rewarding in the moment.

This has been a brief overview but I think it is important to understand what is involved when any person attempts to change behavior, whether it is ourselves as parents of addicts or the addict who is trying to stay sober.  We live in a world that does little to support our efforts towards achieving goals and everything to satisfy our immediate wants. We almost never need to step out of our comfort zone in our day to day lives. Satisfying wants doesn’t address the underlying problem and the underlying problem isn’t going away, instead it is growing.  In my next blog I am going to talk about action plans and Cognitive-Behavioral Therapy.  It is often recommended for addicts.  When you read it, you will see why!

It is Dearness Only……….

My husband and I were gone for ten days, traveling back east to visit old friends and family, to attend a conference in honor of a colleague, to see a 4 month old great nephew for the first time and so on.  When we got home, there were many things we needed to get done.  The mail was piled high, there were loads of laundry and unread emails to beat the band.  But unfortunately, we were coming down with the flu.  Yes, we got our flu shots but we got the flu anyway.   Instead  of doing all the things we needed to do, we went to bed with fevers and coughs and an overwhelming fatigue.  Personally, I always find it hard to return from a trip and get everything back in order; the flu really added to my miseries.  But that is life; things don’t always go as planned. Lying in bed allowed me to reflect on our trip.  Between bouts of uncontrolled coughing, I thought about our many encounters with old friends and distant family members who are not in contact with our daily lives. I thought about the inevitable question that confronted us, “How is your son?”

We are never quite sure how to respond.  Those asking haven’t seen our son in many years, perhaps when he was a teenager or even a child.  In general, they don’t know him, they only know of him. It is natural to ask.  I do it all the time. Sometimes they don’t know about his history of addiction or they have some vague notion that he struggled through his adolescence. On our trip there were some people who asked about him and others who didn’t ask.  I do not interpret this as indifference but, rather, I see it as sensitivity. It seems some people noticed that we hadn’t brought him up and they sensed that it might be best not to ask.  I was honest with one distant but long time friend who is currently taking care of her elderly frail husband.  She was helping me take our luggage up to her guest room. We were alone.  She looked into my eyes and asked me how our son was doing.  I said, “he’s in jail.”  She nodded and said. “I won’t ask any more,”  and she didn’t. I appreciated her quick and firm response. I know it’s hard not to ask for details.

In general when people ask someone about their grown children, they are asking what do they do for a living, where do they work, are they married, where do they live, do they have children. Often times the respondent throws in other tidbits such as “my daughter just ran a marathon or my son was recently promoted or they bought their first home.”  And usually you can’t help but notice their faces beaming a bit as they reveal their pride in the achievements of their offspring.  I get it. I would do the same. We ask, not because we are really that interested in the grown children of our friends, but we ask because we want to provide our friends an opportunity to enjoy telling us, to puff up a bit and to relish the accomplishments of their children. It’s almost a courtesy as much as an inquiry.

I am not ashamed to talk about my son but I know how uncomfortable it can make people when I tell them the truth. He has a drug problem.  He struggles. He is in a recovery program or he has relapsed. He is looking for work or just lost his job.  He is on probation.  He is in jail. No, he isn’t married.  No, he doesn’t have children. When he is not in jail,  he is living at home. At times I have to say we haven’t heard from him in awhile. Here is what I want to say. My son is an addict. He is currently in jail. Don’t feel sorry for him and don’t feel sorry for us.  He  is reading and loving all of Sir Conan Doyle’s Sherlock Holmes stories. He has grown a big beard because the razors that are provided are so awful that it was, as far as he was concerned, his only option.  He is studying geography because he feels it is a good goal to learn all the countries and major world landmarks and oceans and rivers and capitals and why not?  He doesn’t have much else to do right now.  I would mention that he is the current ping-pong champion at the Oxbow jail. I would reveal that I love his phone calls because we talk about Sir Conan Doyle or politics or the latest findings related to treatment of addiction. I might say that he has lost weight because the food is so bad and that he tells me not to worry because he actually needed to drop a few pounds anyway.  I would let them know that he still makes me laugh and writes me letters filled with love and gratitude. I could mention that he feels discouraged and lonely at times. I would not tell them that he has cried in the shower so no one would see him crying or that at times he feels lonely and discouraged.  I would tell them that he is still kind and funny and loves animals. I would tell them that we miss him every day.

And if they were to ask me if I could have things be different than they are, they might be surprised by my answer.  They would probably expect me to say that I wished he were not in jail, were not an addict, and would never relapse again.  But they would be wrong.  If I could change one thing and only one thing it would be this: my son would like himself, truly like himself, in fact, love himself.  He would like himself as much as other people like him.  And because he liked himself, he would be less likely to be filled with shame and self-doubt; less likely to tear himself down and be filled with despair; less likely to engage in self destructive behavior; more likely to have healthy relationships; less likely to have panic attacks that are almost unbearable. And it wouldn’t matter what kind of job he has or car he drives or cell phone. It wouldn’t matter where he lives or how buff he is or how pretty a girlfriend he has.  None of those things would matter because they only matter when you don’t like yourself.  It wouldn’t matter if he got married or didn’t, owned a house or didn’t, lived in Salt Lake City or New York or rural Nevada.  It wouldn’t matter if he was a Republican or a Democrat or an Independent or didn’t give a hoot for politics. It wouldn’t matter if he had dogs or cats or no pets at all.  Because what matters, what has always mattered in the past and will matter in the future, is how we engage with everything around us, how we embrace life and respond to life. What matters is our relationship with life itself.  Is our glass half empty or is it half full?  Can we bite into a fresh peach and feel that it can’t get much better?  Can we laugh till we almost pee?  Can we spontaneously stop our car and jump out to look at a full moon?  Can we cry?  Can we be moved? Can we be human?

My son told me that when he gets out he is going to go up into the mountains. He is going to hike and sleep outside in a sleeping bag. He is going to bring something delicious to eat and a good book.  He is anticipating the smell of the air, being absolutely alone, and looking at a star filled sky.  He is going to listen to the sounds of nature. He has never been a camping or hiking kind of guy but sitting in jail for several months has changed him. That is now what he longs for.

In his pamphlet, Common Sense, Thomas Paine wrote, “What we obtain too cheap, we esteem too lightly, It is dearness only that gives everything its value…”  He was, of course,  talking about our country’s fight for freedom during the Revolutionary War. I believe that my son is finding value where he never found it before.  And so am I.

The Consequence Model

The phrase ‘negative consequences’ is abundant whenever and wherever addiction is discussed and yet the relationship between consequences and behavior is not clear. There is an assumption that negative consequences change behavior, an assumption that pretty much goes unchallenged. In one sense, the assumption suits society’s narrative of how things should be. It seems only rational that a negative consequence will steer a person away from an unwanted behavior.  This conviction influences our rules of conduct as well as our disciplinary framework.  It begins early in life; if you don’t share your toys, your visiting playmate will be sent home. If you are late for soccer practice, you will not be able to play in the next game. If you don’t turn your assignment in on time, your grade will be dropped.  There are endless examples of consequences set up to alter behavior.  We say things like ‘that will teach him a lesson,’ or ‘she will learn from her mistakes.’   So it makes sense that we are bewildered when negative consequences do not alter behavior. Instead of questioning the assumption, we dig in our heels. If the consequences don’t work, then what the person needs is more consequences.

Maia Szalavitz, former heroin addict, author of “Unbroken Brain,” and leading journalist covering addiction, said the following: “…….I came to find out that addiction is basically defined as compulsive behavior despite negative consequences. And the irony here is that we use punishment, which is just another word for negative consequences, to try to stop addiction. And if that actually worked, addiction wouldn’t exist.”  I have to agree.  The person receiving a fifth DUI did not alter his or her behavior despite the consequences which include losing one’s driver’s license, heavy fines, possibly law suits and serious jail time.  When an addict refuses to change his or her behavior, we turn to a simple explanation which is ‘the consequences were not bad enough,’ or they have yet to hit ‘rock bottom.’  For whatever reason, we seem incapable of considering the possibility that negative consequences do not work.

You may get the impression that I am personally against consequences, that I never think that punishment is appropriate or perhaps you think I have a chip on my shoulder. Not true. I simply cannot help observing that punishment or negative consequences do not seem to counter addictive behavior!  I am not saying that addicts do not recover.  Many do.  I just don’t think it was punishment that enabled them to get sober and stay sober.  It was something though. Something clicked, some light went on, some something that made them able and ready to recover.  And whatever it was, it is out there ready to be tapped. But identifying it requires us to look at a problem from a new perspective.  It requires us to think differently, to explore other options and engage in research. But unless we can let go of the punishment model, we will not solve this problem. In fact, it will only get worse.

A Tiny Light

I woke up today feeling unsettled.  Sensing a weight on my chest, I rested my hand on my throat as though it would somehow protect me, although I wasn’t sure from what.  I went to workout and got on the elliptical with the intention of dragging myself through my usual 50 minute cardio workout. I plugged in my earphones, selected my iTunes and chose only songs that were melancholy and had a good dose of saxophone. The music  reflects my mood.  I went faster and longer than I have ever gone before and I felt like I could keep on going. Sweat dripped off my forehead and my hair was wet and messy.  I drank my 24 ounces of water and refilled the bottle. I gulped down another 24. If not for the perspiration, I felt like a machine.

Lately I can’t write or, rather, I should say that I can’t post what I write. My thoughts seem to wander in all directions.  When I read what I’ve written, it makes no sense. I have blogs that I have written and read and re-written and re-read so many times that I am dizzy.  They sit in my non-posted folder. What is the matter with me?  I read something I have written and can’t even figure out what the point was when I started.  I’ve edited myself into a hole.  Sometimes I turn away from my computer and clean out a closet. I feel totally disgusted with myself. This has been going on for weeks but today I reacted. Something happened this weekend. Something hit me.  I liken it to discovering a bruise on your arm, a bruise that you have no idea how it got there.  You can’t remember bumping it or falling or doing anything to cause the bruise and yet there it is big as life. Here is what I know.

My son lives in a sober house in the south of the valley.  He has told me about his house manager (I’ll call him Jim); someone he likes and admires.  This guy is smart and funny and manages the house very well. One day my son said, “You’ll never guess what Jim’s last name is?”  I agreed, I would never guess. Then he said it’s your maiden name.  I was so surprised because I have an unusual maiden name. I can pretty much assume that others with my name are related to me even if it is a distant connection.  Anyway, I said I wanted to meet him and felt kind of excited.  I mean, what are the chances, right? Maybe I could even go to one of those websites they are always advertising on TV and Jim and I could delve into a little family history.

On Saturday my son came over to visit and help me in the yard.  He said that he was anxious because Jim had gone to visit his mother in Southern Utah but hadn’t been in touch with the house in 3 days.  That wasn’t like him.  My son had texted him but got no reply.  Then he said, “I’m worried he has relapsed.” I held back my immediate thought, “Now you know how we feel when we don’t hear from you.”  I could see that my son was genuinely worried.  I offered some possible explanations.  My son nodded but I knew he was thinking the worst. He was doing exactly what all the parents in my family treatment group do; thinking the worst.  It’s our specialty.  I asked him if he had noticed anything different about Jim before he left for Southern Utah.  He said no.

The next day my son called me to tell me that Jim had relapsed. He would not be returning to the house.  Now the house would need a new manager.  A person from the organization that runs the sober living homes called on my son to ask him if he would step into the position.  I know why they asked him; he has the right personality and skills but, in my opinion, he hasn’t been in the sober housing that long.  He needed Jim to be there, not to be Jim.  Jim made the house run smoothly, kept people accountable, was kind but firm.  My son looked up to him. My son confided in me that he had a full panic attack over the weekend.  I’m not surprised.  Getting a position because someone else has relapsed, can’t feel good. Trying to fill someone else’s shoes conjures up feelings of self-doubt and anxiety. Worrying about someone you care about can make you feel helpless. And, recognizing that relapse can also be in your own future, can lead to a feeling of hopelessness.


I’ve never met Jim and, yet, I cannot stop thinking about him.  I wanted to meet him.  I wanted to tell him how much my son likes him.  I wanted to see if we had a family connection. After a long pause, my son said, “The thing is, with heroin there is such a risk of dying.”  I nodded but said nothing. And then it hit me, parents are not the only ones who suffer loss and the fear of loss.  Addicts face loss and fear of loss every day.  Addicts make friends with other addicts.  Addicts go through treatment with other addicts; they know each other’s stories.  Addicts have history with those they have used with and those they have been in treatment with. Addicts have bared their souls in front of their peers and shared their fears, their hopelessness and their shame.  Whatever else can be said about addicts, they do have a community and, whether using or in recovery, that community is tight.

I tried to think of other groups of young adults who worry about their friends dying or who have experienced such a level of intimacy with their peers?  The only group I could think of that comes close is soldiers experiencing combat.   We don’t apply post traumatic stress disorder to addicts but maybe we should.  As a young adult, I didn’t live in fear of losing my friends.

I cannot bail my son out of the dark place he goes where fear and doubt, anxiety and loss gather.  I can listen, share a funny story, touch him gently, and offer him a  cup of lemon tea.  I cannot reassure him or convince him that he is OK or that things will be OK.  I cannot offer suggestions or solutions.  I don’t have any.  I can be a witness to his pain and suffering.  And so it dawns on me, I am like the hospice nurse.  I cannot spare him life’s inevitable pain but I can bring comfort.  I can offer my presence, my caring, my love.

When I am in my dark place (and I have been in a dark place lately), I cannot expect anyone else to bail me out either.  I must search for the light. When I cannot make sense of anything, I must go back to what did make sense and begin again.  When fear or anxiety grab me by the throat, I must breathe deeply and find my courage. No one else can do it for me.  They can be present. They can make me laugh. They can fix me a cup of tea.  They can sit with me in silence but they cannot step into the light for me.

Here is what I am going to do. I’m going to begin by posting this imperfect blog.  I’ll read it once or twice for spelling or grammatical errors.  I will not read it 20 times.  I will not continue to edit it until my eyes are crossed.  I will not save it in my non-posted blog folder.

Wait! I think I see a light, a tiny light.  Can you see it? I hope so.