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.

The White Night Syndrome

Words matter.  Words not only have meaning but they can elicit emotion, mood,  memories, confidence or uncertainty.  Words can also cause confusion when there is a lack of agreement about what the word means or whether or not it conjures up a positive or a negative image in our minds.  I am taking issue with how the word enabling is used to describe behaviors of those of us who are the family and friends of persons suffering from addiction.  I have witnessed a lot of disagreement about what is and what is not ‘enabling,’ in part, because the verb to enable is, by definition, positive. If you look it up, you will find definitions like ‘to make possible or easy.’  Examples of enabling will go something like ‘his donation enabled the university to build a new athletic facility,’ or  ‘the scholarship enabled the student to complete her education.’  Synonyms for the word enable include empower, facilitate, invest, help, prepare, and make possible.  How can any of these synonyms be interpreted as a negative? And therein lies the problem.

People seem confused when they are told that enabling is undesirable. So while the rest of the world views enabling as a good thing, the world of addiction treatment views it as a bad thing.  When coping with addiction, loved ones are told that enabling means bailing someone out, denying them natural consequences, making excuses for them, covering up for the addict and sometimes even participating in illegal behaviors in order to shield the addict from legal consequences.  In other words, there is no mention of empowering or facilitating.

In my view,  the more precise description of what families do is engage in unsuccessful rescuing behaviors. The word rescue is defined as saving someone from danger or distress.  Examples of rescue include things like ‘the fireman rescued the child from a burning house.’  While rescuing is also seen as something positive, unlike enabling, it implies that something bad is about to happen and happen soon.  Rescuing, by its very nature, requires someone to be a victim of something ( a fire, a flood, an accident).  We ‘enablers’ tend to see the addict as a victim.  We often view them as helpless and we treat them as though they were helpless.  We sense a looming danger and respond with unnecessary urgency.  We are not thinking about causing something positive to happen; we are responding as though something really bad is going to happen.  And we are convinced that, barring our intervention,  it will happen sooner rather than later!  There is nothing wrong with rescuing someone from a burning house.  There is something wrong with rescuing someone when the house isn’t on fire.  And there is something wrong with rushing into the burning house when there is no one in the house to be rescued.  But that is what we do.  We try to rescue someone who does not wish to be rescued from a danger that only we see.   In fact, we spend a lot of time making up and playing out rescue scenarios in our heads. Our conversations are loaded with ‘what ifs.’  What if she doesn’t have insurance?  What if he doesn’t have a place to stay?  What if he gets mugged on his way to buy drugs?  Hey, maybe I should drive him to pick up his drugs so that he will at least be safe in that drug infested neighborhood!

So here is my question: why do we do it? What makes us anticipate every misstep and plot and plan how we will circumvent all undesirable or dangerous situations?   If we honestly assess our own history of rescuing behaviors, we might see a pattern that probably began long before our loved one started using drugs.  Rescuing has its own rewards.  Many professions attract people who are drawn to rescuing others (medicine, nursing, social work, fire fighting, etc.)   I have heard these professions referred to as “helping professions.”  Rescuing personalities can be found in relationships with an intimate partner, friends, colleagues, parents, children and siblings.  Psychologists label people who display rescuing behaviors in relationships as having the ‘white knight syndrome.’  Mary C Lamia’s published an article in Psychology Today called ‘ Rescuing yourself from your need to rescue others.’ I found it very enlightening.

Here are some key points that I believe apply to those of us who enable/rescue the addicts in our lives.  Lamia notes that people who rescue others generally have a consistent pattern in their rescue behavior.  They will go from one relationship to the next playing the hero to someone they perceive as needing to be rescued.  She says the repeated pattern on the part of the rescuer is an effort to repair a damaged sense of self that probably began in early childhood.  She points out that, with time, the rescuer becomes disappointed in and critical of the person they are attempting to rescue. The rescuer generally ends up feeling powerless.  Sound familiar?  I can certainly see that pattern in my own rescuing attempts.  Lamia doesn’t mention anger but, in my case, the critical me was definitely a version of the angry me.

If I look at my own family history, I wanted more than anything to be rescued from the suffering of my childhood.  But no one ever materialized to rescue me.  The damaging consequence to my sense of self was the agonizing fear that perhaps I didn’t deserve to be rescued.  Perhaps I didn’t matter.  For me, engaging in rescuing behaviors is about gaining control where I once had no control. It’s also about being in a unique position to try and orchestrate the outcome I longed for while growing up.  It’s about seeing myself as a heroine rather than an undeserving victim.

Rescuing differs from enabling in one other important sense; it is dramatic.  If nothing else, my childhood was dramatic.  There is usually little that is dramatic in enabling; people don’t rush to witness an enabling event but they will come out in hoards for a rescue event.   Families attending support groups perk up when someone begins to tell a dramatic story of their latest family saga.  And rather than focus on how we intend to take care of ourselves, the group dynamic can quickly disintegrate into an interrogation of the person telling the story along with a plethora of unsolicited advice.

So the next time I am in a support group and someone starts talking about what their spouse or teenager did last weekend, I will try to focus on the person telling the story rather than the story.  I will hold back on questions related to the story; I don’t need to feed into the drama.  If I ask a question, I will ask a question about the story teller such as: “what are you doing to take care of yourself?” I will try to be aware of my own response to the story.  Do I find myself kind of drawn to the drama?  Is my mind racing with all kinds of ‘helpful’ suggestions?  Am I looking for my white horse?  Because if I am, I guarantee that I am not enabling recovery.

What Prayer Cannot Do

In family meetings I hear many people talk about praying and they don’t hesitate to say what it is they are praying for; they want their loved one to get sober or stay sober or simply to stay alive so there is a chance they will get sober in the future. And this made me think about prayer and what it means to us. Why do we pray and are our prayers ever answered? I recently came across the following words of Abraham Joshua Heschel, highly respected American rabbi and theologian born in Poland in the early 1900s.

Prayer invites God,                                                                                           to be present in our spirits                                                                           and in our lives.

Prayer cannot                                                                                              bring water to parched land                                                                       nor mend a broken bridge,                                                                          nor rebuild a ruined city,

but prayer can                                                                                            water an arid soul,                                                                                      mend a broken heart,                                                                                   and rebuild a weakened will.

Abraham Heschel’s poem provides an interesting perspective on prayer.  He says that prayer isn’t to make external things happen such as mending broken bridges or, perhaps, curing our children of their addiction.  He says prayer is about inviting what is holy into our lives. That is altogether different than asking God to make something happen. Instead, he views prayer is an invitation to God to enter our inner self. He implies that prayer offers sustenance for our wounded souls. Mahatma Gandhi said that prayer is not asking; he said it is a longing of the soul.

So what does my soul long for?  I believe that it longs for connection. I long to love and be loved, to feel deeply, and to respond fully. I long to experience awe and wonder, to soak up the intellectual, emotional and sensory pleasures the world offers.  I long to feel centered and grounded, and to experience an inner peace that allows me freedom from the weight of trying to control, manipulate and force outcomes. Prayer, according to Heschel, is about the spiritual world, not the concrete world. Not everyone may agree. But in the future, my prayers  will ask for patience, understanding, wisdom and acceptance.  I will ask for courage and perspective.  I will not pray that my son will stop using or stay sober or finally see the light. I will not pray that he will do what I want him to do or not do what I don’t want him to do.  Instead I will sit still and focus on what connects me to the world.  I will not ask for happiness because I cannot define the word; and, even if I could, would I be asking for my own happiness or my son’s happiness?  This doesn’t mean that I cannot mend a broken bridge; it does mean I cannot mend it through prayer.

And if I say a prayer for you, I shall ask the same; that you find water to quench your arid soul.  I will not ask that you change or that I change or that the world changes. ‘God, give me the serenity to accept the things I cannot change…….’

Fear of Death

There is death and then there is fear of death.   In my mind, these are two very different things.  Death itself is final while fear of death is never ending.  In death, we must, by definition, continue to live without the person we have lost. But fear of death prevents us from living; instead we become paralyzed by our fears. Death, once confirmed, does not provide us with the illusion that we can undo it. But fear of death hoodwinks us into thinking we can intervene; we can manipulate the future and outsmart death.  Nothing could be further from the truth.  While we cannot undo death, we do have an opportunity to break the fear of death cycle.

Having worked in a pediatric intensive care unit, I am no stranger to the death of children.  I think we can all agree that the death of a child is, by far, a parent’s greatest fear. We can hardly speak of it without trembling.  I have handed dead infants to mothers to hold for the very last time.  I have watched grown men collapse while sobbing.  I have gently placed dead children’s bodies in the cold drawer in the morgue. I have thought about what these parents will face when they go home; the child’s room, the toys, the photographs and the memories.  I know that their homes will be deadly silent and that no amount of comforting arms will actually be comforting.  I recognize that many will end up divorced, especially if the death is related to an accident. But I also know, with time, they will come to terms with their loss. So you might find it odd when I tell you that death is not always as devastating as fear of death. Let me explain.

In our modern world, I have seen families desperately clinging to life, insisting on every intervention known to medicine in order to keep their child alive.  It doesn’t matter that their child is brain dead or will spend the rest of his life attached to a respirator.  And no one can tell them what’s ahead at the moment they make the decision to do everything known to man to save their child. They can’t see their future, but I can.  I know what happens to families with children who require care 24 hours a day, 7 days a week.  Often the child ends up in a nursing home until they die of one complication or another.  The guilt settles in and families are virtually torn apart.  So here is a question; are we obsessed with saving our children at all costs or are we really obsessed with saving ourselves from loss?

When I attend my parent meetings, I am acutely aware of this fear of death undercurrent in all conversations.  Parents say things like, what if I refuse to provide him with shelter and he freezes to death?  What if I don’t give her a ride to her meetings and she relapses and overdoses and dies?  What if I don’t give him money and he returns to dealing drugs because he can’t get any other kind of work and then he is shot by a ruthless drug dealer who, unlike my child, is a real drug dealer?  The ‘what ifs’ are never ending and I can’t help but admit that they do speak to creative, although morbid, imaginations.  Trying to anticipate every life scenario and projecting every conceivable negative outcome is not only futile but exhausting.  Behind these neurotic mental gymnastics lies an important question.  Is the primary concern that the child continues to be alive or is the primary concern to ascertain that the parent in no way contributed to the death of the child or or is the primary concern that the parent doesn’t suffer the loss of their child?  Is this whole self-defeating circle of irrational thinking really about saving our children or is it about saving ourselves?  Ask yourself this: if you could be guaranteed that your child would live to be 100 years old, would you be OK if they chose to live out their lives as an addict, on the streets, dealing drugs?

Here is a scenario.  Your husband is about to leave for work and you run after him to remind him to pick up something at the grocery store before he returns home.  You chat a bit about what’s for dinner. He leaves and is killed in a horrible car accident 3 blocks from your house.  Do you believe that if only you had not run after him and had that brief conversation, he would have missed being involved in the accident? Are you somehow at fault?  Let’s look at it another way.  What if you had the brief conversation and he had missed the horrible accident?  How much time can anyone spend scrutinizing the moments of their day as to whether or not those moments were the direct cause of actual outcomes?

Death is inevitable. We all die.  Some of us have short lives and some of us have very long lives.  Some of us can anticipate the end because we are ill or quite old but for others, death is unexpected.  Sometimes people cause other people to die and sometimes people save others from dying.  Those who are left behind will suffer; there is no way around that.  Losing a child is thought to be one of the hardest losses because we see our children as an extension of ourselves.  I understand this, but to spend our lives in constant turmoil about the threat of a  premature death is neither healthy nor productive. To spend our time attempting to manipulate and orchestrate their lives in order to avoid the possibility of death is insane.

Sit down and think about death.  How many people in the history of mankind have lost one or more children?  Millions. Fearing death will no more eliminate its possibility than fearing a tornado will alter its path.  If I guaranteed you that your child would die tomorrow, would you want to curl up in a ball and cry uncontrollably or would you want to hold your child and tell him you love him and you’ll miss him and you are so glad that he has been a part of your life? How will you mourn her death, honor her life, and cope with your sadness?   Go to the place you dread and sit there. Instead of thinking about all the ways you can intervene to assure they don’t die, think about how you will face their death. Go into detail.  Plan their funeral.  Write their obituary. Be there, sit there.

Now let it go.  Know that you will survive whatever happens.  Stay in the present. Take a deep breath. Be grateful for this day and this moment. Acknowledge that you have no magical powers. Nothing you do will be the cause of your child’s death in the same way that nothing you do is the cause of your child’s addiction and nothing you do will be the cause of his or her recovery. Whatever happens will happen. I have friends who have lost children.  One lost her two children to separate accidents 6 months apart.  One lost her only baby to H Flu Meningitis.  One lost her son to suicide. One lost her child to drowning. None of us are immune to this possibility.  It is the risk we take when we have children. It is the risk we take when we love. We are vulnerable, yes, but not responsible. Life is responsible.  This is life. We have no more control than all the parents who lost their children to pertussis or influenza or cholera or accidents or murder.

Courage is not the same as fearless.  Courage is about conquering our fears, stepping into our authority and facing them head on. We must not allow our fear of death to paralyze our ability to live life.  Nor can we allow our fear of death to paralyze the freedom of others to live their lives.  We are not the gatekeeper of death; we are the traveler in life.