Sunday, April 13, 2014

Some Thoughts About the Nature of Successful Addiction Recovery Programs






A successful program would not base effectiveness solely on sobriety, regardless of how ideal that state might be for the addict.

How many of us exist in the ideal state of our goals, dreams and hopes? Why do we insist on it for addicts? Individuation would necessarily dictate that there are people who are more seriously afflicted than others, and in innumerable individual combinations of ways. In that way it becomes essential to re-commit and re-assure those who have more difficulty with the intensity of their addiction, rather than assume weakness of will, intentional sabotage, or fear that failure of the power of intervention is at the basis of any presumed “failure”.

The ultimate test of the success of an addiction program is if it incorporates the understanding that individuation is a primary feature of the human brain and of human behavior. In that way the degree of intensity with which each individual is afflicted by the multi-faceted dis-ease of addiction would be the primary factor in the design of each person's "program" for recovery. Each program would stay, change and grow, evolve, in place regardless of frequency or duration of relapse.

The power of the addiction, the acceptance of the powerlessness over the addiction, is a primary facet of developing a recovery plan that reduces damage, improves quality of life, and informs the will to succeed in whatever way one measures success for each individual. Demanding ultimate sobriety and abandoning individuals to their own means outside the support structure of the program designed to help them manage the addiction because they have a darker and more insidious struggle against addiction is re-traumatizing at the least. This kind of abandonment might best be considered to be against the basic tenets of ethics for any helping professional engaged in the treatment of addiction.

Will-power may be an important ingredient in each person’s efforts to recover, but it too comes in individuated designs and expression. Combined with such a wide spectrum of individually experienced struggles with addiction, the role of Will and its so-called lack can only really account for one piece of the puzzle of why people succumb and relapse.

It is beyond judgmental, and in the end cruel and self-serving, to demand that Will be the primary attribute that determines a person’s success or failure when it is present in such a variety of degrees and presentations. Successful programs, then, would by necessity be required to re-examine and re-calibrate all of these forgone, generally counter-transference based, and all-too-common provider cultural attitudes about relapse and the role of Will in order to be determined to be successful.

Success would be less measured in terms of sobriety but by other means more fitting to the nature of what is possible according to each individual’s spectrum of abilities and strengths as opposed to what is preferable as determined by and for the provider.

Monday, December 16, 2013

Just In Time For the Holidays -- Some Thoughts About the Way Our Families Communicate






There's a short segment in the movie "Annie Hall" that I have used as an example in groups and have recommended in family meetings (I include the YouTube link to that clip at the end of this article). It's perfect for illustrating the cultural differences between what are called high context families and low context. It shows brilliantly and with great humor the kind of family differences that can emerge around the holiday dinner table.

In the clip we see Woody at Annie's family's Connecticut WASP Easter table. Quiet, no one overlaps in conversation, a lot of negative space, one conversation at a time... low context. Soon the screen divides and we are shown Woody's Brooklyn family around their table, much chatter, much conversational overlap and great ranges in dynamics of emotion and volume: high context, high emotional expression.

This range in family communication styles comes to the fore for many of us during the holidays. As families become more diverse in our society, the holiday table becomes more complicated to navigate. We all want to have closeness and love expressed during these, often rare, times of family togetherness, but often find it hard to accomplish. We go away disheartened and sometimes hurt, even when we had the best of intentions. There's a roller coaster ride aspect to the holiday table that makes it difficult for some people to feel comfortable.

I think there is a lot of bias toward low context problem solving in this culture when both are equally fraught with pitfalls and potential relationship dysfunction on a catastrophic level (as opposed to your every day "normal" dysfunction).

I prefer the high context scenario myself, and while that might be a bias, I think more damage is done when people withhold the intensity of feelings that they have and sanitize, silence or pervert them into indirect passive aggression.

Direct, passionate communication is scary stuff for many people from low context/passive aggressively based family systems. Just as many folks from more assertive/aggressive backgrounds and cultures can actually become a little unhinged in a group that is anchored in passive aggressive coping and problem solving strategies.

I believe there are studies that show that passive aggressive behavior is ultimately much more damaging and less likely to be adequately addressed and soothed than behavior on the aggressive end of the spectrum that is easily identified and named, harder to deny. People/families acclimated to it can often be enlisted to be much more readily committed to problem solving and admitting their feelings and shortfalls.

What is thought to be "Yelling" in passively instructed families/groups/systems can be quite mild on the spectrum/range. But avoidance of all conflict that elicits raised voices can be really destructive in the end. Perhaps it would be better to call acting out in passive aggressive ways a kind of yelling as well.

Some people, of course, are simply not equipped to engage in a dynamic passionate manner, and so will not, should not... and often find ways to manage the high emotional states that everyone has in other ways.

It is not so important to attempt to conform yourself or your family to a particular style that appears from the outside to be more "perfect" than your own. The primary strength for each of us, and each of our families, lies in our individuation. In that way, identification of what works about how you and your family function along the spectrum from high to low context can be as instructive and revealing as any plan to change the inherent structure of how your family communicates... especially if the plan is based on one person's judgment and not on some consensus. The holidays are rarely a time to engage in consensus building over anything but who gets the turkey leg or who can have the last of the pumpkin pie... and even that can be fraught with peril!

http://www.youtube.com/watch?v=z8TSvMx2wPI.

Saturday, November 16, 2013

WHAT I LEARNED ABOUT HOARDING DISORDER THIS WEEK:




I learned that people with a hoarding disorder often do not, cannot, see the same things in their homes as someone who is visiting them. Their brains distort how the mess in their homes is perceived. If you show them a picture of the inside of their homes, they often do not recognize it as theirs, but if you take them to visit another hoarders home they are appalled.  Hoarding, as we are finding with many other brain disorders, is an integrated dysfunction: it is genetic, brain-based, and nurture based at the same time. In a culture of acquisition like this one, it can become very common and is reinforced.

Hoarders’ brains make it difficult to impossible for them to evaluate comparative worth of one thing from another.  A theme in treatment for hoarders is to try to teach them to make “quick and imperfect” decisions.

Hoarding is not OCD, although it is related. OCD is ego-dystonic, which means it brings no pleasure. Hoarding is ego-syntonic, in that it does bring pleasure. Hoarders have difficulty with jobs and with relationships for some of these related reasons: they are often unable to act as if a relationship (with friends, significant others, children) is more or less valuable than things. They are unable to recognize how their behavior devalues relationships or makes relationships equal to things. They have difficulty with prioritizing decision-making and the idea of perfectionism is a theme in how they approach day-to-day decisions. Hoarders and their hoarding very often come to the attention of authorities through Child Protective Services.

Hoarders often believe that their immense stash is valuable beyond measure and, even if they die suddenly, leaving family in charge of the clean up, they will be forever lauded because of the value of what they have left behind. The truth is that the cost of cleaning up after a hoarder has died costs families between 30,000 and 50,000 dollars.

Confrontation doesn’t work as an approach, mostly due to the manner in which the brain accommodates or produces the need to collect and store things and the inability to measure worth and discard what is unworthy. Neither does purging or forced clean up directed by a concerned friend or family, although there is often a need to do just that. Forced clean ups and purges often reinforce the need to collect and increase the frequency and amount of collection.

Hoarding at various levels occurs in up to 1 out of every twenty to one out of every fifty individuals and is more prevalent in men than in women.

Approaches, Ideas and Guidelines:

·      Cut off all paper flow
·      Steady throwing away daily
·      Throw away pieces if you can’t throw away entire objects
·      Foul the trash (to avoid retrieving)
·      Involve Family Members
·      Seek assistance to help develop guidelines for keeping vs tossing

Themes for Hoarding Behavior Change :

·      Do you want to build a legacy of trash?
·      Everything goes to the dumpster eventually
·      Build relationships with people… not things
·      Things are here to serve us, not the other way around
·      “How does this item add to my life?”


-- taken in part from  “Identifying and treating Hoarding Behaviors”
Laura M. Lokers LCSW
University of Michigan Dept. of Psychiatry

Suggested Reading: ”Stuff” R. Frost and G. Steketee. (good for both clinicians and as self help)

Sunday, March 24, 2013

Facing the Facebook Scenario






Recently someone I haven’t seen in almost forty years requested that I “friend” him. We were quite close as teenagers, especially in our last year of school, then I lost track of him. He stayed in my hometown. I went to college and grew my hair. I lost track of many people in the five or six years after high school, and, to tell you the truth, Facebook has been a boon for me in terms of reconnecting with folks I haven’t seen in decades. Friends and lovers and then the friends of friends of friends of lovers from all over the world busy on their computers finding out what happened. What happened to you? Where have you been? What are you doing now? What do you think?

Decades.

Wow. The fact that I’m old enough to think in terms of multiple groupings of ten-year spans is a little overwhelming. There’s a great gift in this, right? Suddenly this episodic life full of moves and different groupings of friends has found a place, even if it’s “virtual”, that gifts me with the presence of representatives of every one of those episodes.  People from my college years are writing short blurbs and blats to people who are inseparable from my identity as an artist. How does this happen? Mostly they get along. Mostly. But back to the scenario:

It starts out okay. We greet each other enthusiastically. We reminisce. He is a terrible speller, but then, so am I at times when I don’t check and recheck (and even then, I miss embarrassing words. Its and It’s anyone? sheesh!). Then comes the bomb. 

Now, I have Facebook friends who have views that are diametrically opposed to mine.  I am not the kind of guy who automatically de-friends or blocks someone who finds their way on to my friends list and is, say, vehemently anti-abortion. My mother had an illegal abortion in the years before she married my father. She told me this story tearfully. One of the only times I ever saw her cry. How could I be anything BUT pro-choice? Then there are those whose Christian ejaculations on Facebook are rather frequent. I am a committed and radical agnostic. But, especially recently, I have made a commitment to keep as wide a range of Facebook friends as possible. I can scroll past anything that is not to my liking. Easy. Or I can engage in a little debate if I wish. Debate can be good for my own thinking, and for my writing. Why not? If we can start and end respectfully, don’t call names or let the sarcasm get too completely out of hand, we can go on and find areas, even surprisingly, where we agree and can celebrate that agreement.

That’s not to say I haven’t blocked or de-friended. When I first started on Facebook I was almost immediately appalled at what people posted and what they would say to one another. I quickly, out of the excitement for the new medium, gathered a bunch of people to my list, friends of friends and acquaintances that I didn’t know well. But I had different expectations. I offended many of them by speaking my mind. I had this idea that people there would automatically agree with my passions and my politics. Boy was I surprised!

This has been a recurring theme in my life. I remember attending my first poetry workshop. I was a callow twenty year old writing my first poems and presenting them for the first time to people in a rather large group of academics (my first creative writing teacher encouraged me to come) mixed with Sylvia Plath wanna-bes and post beatnik beatniks. I was appalled then too. There were, alas, a fare share of assholes. Can I use that word? But I had expected a great loving gathering of writers interested in inner and outer peace. Instead we were to quibble about rhyme and the use of repetition, with passive-aggressive snubs being the most commonly employed tool for conflict resolution. Like I said, I had unrealistic expectations. Which begs the question: who was really the asshole? Still, I went, again and again. Which brings me back to my first try at Facebook: within a month or two I decided to de-friend and block almost everyone who had been drawn magnetically, magically, to my friend list and started, quite slowly, all over again. I think I got the hang of it after that.

I have, however, encouraged people to de-friend me. I remember one situation in which a person sought me out for “friending”. We had been childhood classmates, never what I would call friends. We graduated from the same school. Our initial greetings on Facebook were enthusiastic. After a few weeks she posted a plea under a rather mainstream news article I had posted to “PLEASE STOP PUTTING POLITICS ON MY (her) PAGE!!!!!!”  I was nonplussed. I had to do little about this incident however. My son and his wife leapt upon her overly capitalized post with all the vehemence and snarling of mama bears (I wasn’t aware of how closely my bodyguards travel to me) and all I had to do was politely encourage her to de-friend me if she wanted no news of the world aside from saccharine pictures of soon-to-be extinct animals in completely anthropomorphized photographs. She did. De-friend me. I am sure we are both happier for it.

That being said the other reasons I have blocked, temporarily or permanently, members of my disparate and global little circle of friends, have been the following: 1) Constant name calling in political discussions 2.) Overly enthusiastic and numerous political campaign stances for any side. 3) Obvious and constant unchecked insanity. Other than that I am willing to be entertained by almost anything anyone wants to post. It’s better than TV, which I haven’t watched in decades. It’s a relatively free world. Mindfully speaking. I like knowing where other people stand on it. And on Facebook, as in the world, everyone has a different idea about what is meaningful enough to talk about, to represent and to be passionate enough to share.

But back to my old friend, and our original scenario: I could not continue to argue with him. His spelling and rationale and rants were so close to those of the people I work with in my work as a psychiatric social worker I could only wonder what happened to him. What went wrong? How did you end up where you are from where you started? You were bright and laughed often and valued friendship and connection regardless of, or perhaps because of, differences. I could not block. I just wanted to know what happened.

So I asked. What happened to you?

He hasn’t answered yet. Maybe I’ve been blocked.


This article originally appeared in the spring 2013 issue of "The Compass, A Mental Health Magazine"