the three pieces of effective recovery from addiction
A Balanced TriangleThink of the basic geometry and physics of a piece of furniture that is sturdy and can support weight – it has to have at least three legs. When one is missing or is of insufficient length, it cannot support its occupant. The three areas of life that must be addressed in an effective recovery approach are: Physiological, Psychological, and Social. Or if you prefer, Body, Mind and Relationships. In this model, the three are separate functions, but also overlap and must work together, like the legs of a stool.
PhysiologicalThe physiological elements of recovery include the initial and prolonged experience of withdrawal, and knowing how to prepare for and handle this safely. The body and brain have become dependent on the presence of the external substance to function normally. The removal of this substance will often be uncomfortable, and sometimes a dangerous shock to the system. Alcohol and benzodiazepines may require a medical detox, and it is always recommended that medical advice on this step be followed, as withdrawal can be fatal. Opiates and other substances, though very uncomfortable, are not life threatening, and can benefit from the assistance of medications. Suboxone (for opiates) Naltrexone and its long-lasting injection form, Vivitrol (alcohol and opiates) and Zyban or buproprion (for nicotine) have been on the market for years, and providers can easily be found through an online search. These prescription medications are known to lessen the experience of physical cravings and can be very helpful in the early phase of recovery. The body will take time to heal and rebalance, and patience and knowledge of what to expect are necessary. Rest, nutrition, and physical movement are also keys to balance, as substances can overwhelm and deplete the adrenal and nervous system, as well as drain the body of necessary nutrients.
PsychologicalOften, making the decision to stop using a substance or a process addiction, will challenge our belief systems about self, identity and ability to cope with life. The exploration of beliefs is a necessary part of the process in that, if not acknowledged, one may not be able to address the problem or become open to change. There may be parts of the mind that are not willing to accept the addiction, and so deny its impact, generally steering us back into use. There may be parts of us that have learned that the substance or process is the only way to feel joy or freedom, or even believe that to change is a betrayal of past decisions that informed our identity. All of these beliefs have sources of experience that can be worked with and supported or updated.
Personal value systems may need to be re-examined and updated. On a deep level, we know what is truly important to us, and the addiction has more often than not created a great imbalance of our priorities. The experience of living from what really matters to us, living for what we love and value, is a source of authentic joy that no addiction can compete with in the long term.
Understanding of the rewiring of our physical reward system can help us understand why we have used or made the choices in the ways we have. Knowledge of this neurological reality can take the shame and the “cunning and baffling” elements out of the equation. Treatment providers and programs inform us of the nature of the changes that have taken place in our operating systems. We learn how our decisions have been based on the brain’s desire to acquire and maintain a level of dopamine that it has become accustomed to over the course of use, and now seeks that level and makes choices without the input of the pre-frontal cortex (the executive decision-making part of the brain that puts things into perspective for us). When we understand how and why this happens, we can learn to work with that process, and plan our actions accordingly, rather than repeat the same patterns or shame ourselves for faulty character.
Of course, learning to deal with emotions is the real work and reward of recovery. It is what enables us to be present in our world and fully live the 10,000 joys and the 10,000 sorrows of the human experience. We have often undergone a shrinking of the “window of tolerance”; the amount of feeling, stress, or discomfort our systems are able to handle without resorting to a shutting down or an escape hatch. Addiction has taught the mind that it does not have to tolerate something perceived as unpleasant when there is another option available, and so many challenges and growth opportunities are avoided, resulting in a far less fulfilling life. Expanding that window tolerance through DBT (https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy ), Mindfulness practice, ACT (https://positivepsychology.com/act-acceptance-and-commitment-therapy/ ) or exposure and support returns to us the chance to thrive in our own lives.
SocialPart of the trap of addiction is its isolating nature. We are a species that is naturally wired for connection, and as substances or process addictions cause us to further retreat, the less available the real source of happiness and security becomes. This Ted Talk provides an excellent description of this phenomenon: https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong?language=enWhat we need are positive relationships that provide attunement, understanding vs. shame, and a sense of being truly valued. Connection and sharing with other people is in itself a form of emotional regulation (via the neurological mirroring process we require to recognize, normalize and stabilize emotional systems). We are also tribal creatures, and need to have an identity that serves a tribe. For some, recovery may mean shifting our sense of identity from one tribe to another. For others, taking on a new role in our tribe that fits our current needs is healing and empowering. Historically, this shift has been more challenging to make, but our current social design offers so many options to explore.
Recovery is Possible, Even ProbableAll effective approaches to addiction recovery cover all of these necessary basics. High quality treatment centers abound. Peer-recovery programs have flourished. Trauma-informed care has become a normalized part of treatment. New research continues to assist the removal of the stickier roadblocks to effective recovery. And best of all, addiction has lost the majority of the stigma that has kept it thriving in the shadows. But we can’t take shortcuts. The most effective path to true recovery involves both therapy and peer support. If you think you might need a detox service, seek one that includes both detox and treatment. Then, look for a therapist trained and experienced in addiction, to either substances, process addictions, or both. And if you are open to peer support, the options are many! There is of course the original standard of Alcoholics Anonymous and/or Narcotics Anonymous, which operates a spiritual 12-step program (which actually hits on most of the neurological requirements of adaptive re-wiring of the brain and reward system, as it turns out), the more Mindfulness based approach, known as Recovery Dharma, which has evolved to blend Buddhism and meditation with a structured step process. And for the more secular-minded, there is Rational Recovery and SMART Recovery…. All of which are also currently available online in this pandemic era as Zoom meetings. So it seems, after all, we don’t have to do this blindly or alone.And perhaps we don’t have to be afraid of our minds anymore. Meghan Scully, LCSW, CADC, ext. 338