A Bad Attitude About Gratitude
by Dana Bowman on November 24, 2015 in Living Sober My children and I are heading home after a long shopping trip at Walmart. This, in itself, should drive anyone to drink. But I cannot. I am an alcoholic in recovery and thus drinking is not a part of the plan for the rest of my evening. But today, the thought of dealing with cranky 6 and 7 year olds for another minute seems impossible. And since I can’t just leave them on the corner in front of Walmart, I decide to go for the lowest common denominator in child rearing and behavior management. “How’s about we stop and get dinner at McDonald’s, boys? Want some fries?” I think French fries can solve all of the world’s problems, even the challenges of sobriety. But then, I heard it. A small voice issued from the backseat: “What? No ice cream?” And what followed was not one of my best mothering moments. The lecture continued past two exits on the highway for a full 20 minutes and ended just as we pulled into our driveway. “So, in conclusion,” I said, through gritted teeth, “That is why we always need an ATTITUDE OF GRATITUDE. GOT IT?” Both boys had slumped so far down in their seats it’s a wonder they even knew we were home. They couldn’t see out the windows. Since the car had stopped moving, I am pretty sure they realized they could slink off with the great “Attitude of Gratitude” lecture firmly wedged in their brains for at least for the next five minutes or so. But, an attitude of gratitude is not learned through yelling. I know this because my boys were right back at discontentment with minutiae sooner than you can say, “Lecturing Never Works.” My children have a lot to teach me about gratitude, it seems. True, the McDonald’s incident was a great example of how NOT to be grateful. It’s always easy to spot a small child’s failings in this department because they usually don’t have the wherewithal to hide their selfishness. They’re built that way. But what really surprised me is that by observing my boys’ reluctance to channel their inner grateful guru, I too realized that I act the same way when it comes to being thankful. As I watched my boys slide out of their car seats and skulk up to the front door, all the while avoiding eye contact and praying that Mom would not start talking again, I kind of felt sorry for them. Gratitude under duress can feel a bit … lacking. I am working my recovery. And, it’s a lot of work. It’s a long journey, this road, and on it I need to carry as many tools for recoverywith me as I can. Gratitude is one of the toughest to wield because I have a natural inclination toward pessimism. My eyes see the glass not only as half empty, but sadly filled with some sort of wimpy non-alcoholic substance (like tea — I really hate tea). And so, the glass is doubly cursed. When my children are fussing with each other, I often force them to sit on the couch and hold hands. It’s kind of cute. Each child acts as though the other one has the plague. Then, if I am really feeling evil, I ask the boys to say out loud one merit about each other. They both look at me, their cruel oppressor, and sigh. They’ve played this game before, and they know there will be no movement from the couch until the kindnesses are uttered. Charlie manages to pair his words with so much slouching that his voice is strangled. “I like Henry because he plays Legos with me,” he whispers. I nod and decide to not push my luck by asking for some volume. Henry blurts, “Charlie’s trucks! He’s got ’em. He shares them. Sometimes. I guess. Well. Rome wasn’t built in a day. After this lukewarm attempt at goodwill, my boys then wander off, and all is well, for at least the next 30 minutes or so. But I realized, this is exactly how I deal with gratitude. I get surly. I slouch a lot and try to avoid eye contact with it. My sponsor asks me to write a gratitude list every morning, and every morning there is a lot of hemming and hawing. Too often, the list is then abandoned, forgotten under a pile of busyness. One afternoon, after a really interesting “text fight” with my husband about who is picking up the dry cleaning, I call my sponsor. I want to complain. My sponsor tells me, “Thank your Higher Power for the good in it, and the bad in it,” and I balk. Clearly, my sponsor is not understanding how marriage works, because I would so much rather whine a bit before thanking anyone for anything. I am reminded, gratitude under duress is a bit lacking. Or, it’s not. It’s a choice. Here’s the deal: gratitude is the power-lifter of recovery. Gratitude grabs hold of getting through another 24 hours without alcohol, and lifts it a bit. It graces all the other tools of recovery, some of which are quite tricky for me, and lightens their weight, so I can heft them more easily. I wonder at the physics of it, but not for very long. It’s one of those spiritual things that my Higher Power tells me not to mull over. “You think too much about too many things,” He says. “Go outside and play.” I do. One tool for recovery is my new dog, Hosmer. The Great and Mighty Hoz likes to go outside quite a lot. I would prefer not to. I am much more inclined to find a good soft chair and a book and stay there all day, but Hoz doesn’t read, and he does like to sniff at the wind and pee on trees. So, I take him on long walks. His tail sashays back and forth and I find myself savoring the air as much as he does. I practice gratitude with each step. “Thank you for the breeze … thank you for the Hoz. Thank you for how his ears flutter when he walks. Thank you that he seems to be such a healthy little dog, as evidenced by the massive pile of poo he just left for me. Yes, thank you for that.” I bend over to pick up after my dog, the universal symbol of humility for canine owners around the world. “Thank you for exercise. And for this plastic bag.” Later that day, I am reading my Daily Reflections. I would rather watch Cesar Millan on Netflix and try and psychoanalyze my dog, but the book is another tool in my recovery. I grab it and focus on today’s entry. “Obviously, the dilemma of the wanderer from faith is that of profound confusion,” it reads. “He is the bewildered one.” I pause and try to meditate on the depth of these words, but my stomach growls. Now I am bewildered. There is half ton of Halloween candy in my laundry room, and all I want is a Kit Kat and a more solid faith. “Ok, I am grateful for my faith. I thank you for allowing me to be lousy at it. I thank you for daily rituals, for this book, and for the time to read it. Oh, and I really, really thank you for chocolate.” The rest of my day is full of deadlines and phone calls. My introversion asks me to bury myself in my work, my writing, and to avoid the phone at all costs. Its ring terrifies me, and when I hear it I tense up, like when Hoz hears the vacuum. I wish I could skitter off, my tail tucked between my legs, but one of my tools in recovery is to not isolate when anxious. I mutter the serenity prayer as I pick up the phone, and later I am grateful and a bit proud as I realize that I was an adult for all of 20 minutes. “Hey, look!” I tell my Higher Power, “I answered the phone! I am growing up! Thank you!” I never once wanted the phone to be a tool for my recovery, as I tend to treat it as if it is dipped in Ebola. But, I am grateful for its ring. I have friends. I have people in far away places that want me to come speak or write for them. This is a miracle. I remember to be thankful for the ring tone, which is set to some horrible electronic jive that sounds like a 1980s Casio synthesizer. It is so shrill, it simply cannot be ignored. I am also thankful for my 12-step meetings, where sometimes I get annoyed by that one guy Ron, who talks for 20 minutes and is really grumpy, or for Leah, whose opinions at times seem to come from another planet. I am thankful for these people, who remind me that the human race is not one to be controlled. I gave up any attempts at managing the universe back on my sobriety date, and I am grateful for the reminder. I am even grateful for when recovery goes really wrong, and all my tools can’t seem to help my horrible, terrible mood, and I feel like I might be turning into Ron. I am grateful even for the temper tantrum that I had while trying to cook dinner, because even with my yelling and my boys’ whining, I still managed to pull off the biggest feat known to mankind for that day: I didn’t drink over it. And I am grateful that on lousy days I get to just retreat to my bed, eat 50 fun size Kit Kats, and set the amazing “do-over” button for my life: my 6 a.m. wake-up call on my alarm clock. I had never actually been grateful for my alarm clock until I got sober. Some days are best ended with a, “Well, everyone sucks, but I didn’t drink today,” but this faithful little device reminds me: Take heart. Tomorrow is another day to mess up in a totally different, but maybe less colossal, way. Progress, not perfection! I am thankful for these tools and tricks of the recovery trade. Like the faded “Let go and let God” poster on the wall at my recovery group, they are a bit beat up and frayed about the edges, but they work. Nearly every tool is a mechanism that leads to thanksgiving. They help me to stop, and breathe, and listen for gratitude. After the McDonald’s lecture, I had two choices. I could simmer about my children and their stunning lack of humanity. Or I could forgive them (and myself) and move on. The first option had a lot more dramatic flair, so of course I leaned toward that one. However, I decided to opt for using another tool in recovery. I thought, “OK, I am having a tough time here, what can I do about it? How can I do the next right thing?” I am so thankful for the next right thing. It’s always right there, bright-eyed and raring to go. Most of the time, the next right thing involves eating more chocolate, and then I can double up by being grateful for that lovely confection. That evening, the next right thing was to go get a drink of water and sit with my feelings for a minute or two. I generally don’t like my feelings much, but I have learned even to be grateful for them. They don’t kill me. And, because of this realization, my children stayed alive that evening, too. When my family gathers this Thanksgiving for gluttony and football, I will look around the table and be grateful. My boys will probably be fussing about the food. There will be no French fries. And gravy, evidently, is so gross it engenders actual gagging from the youngest one. Charlie will whisper-shout that absolutely NO food should be touching, which is rather tough when all he picks to eat is some Jello and 50 olives. But we will survive all of this. I am grateful for my little boys. They run me through endless drills of gratitude training every day. They are a part of my recovery, too. And the relationship I have with my boys now is a gift. That’s how gratitude works. We learn the tools, we lean into them, even the hard ones, and then we find ourselves so grateful for them that we find ourselves swimming in good feelings. Perhaps even joy. The work becomes the blessing. At the Thanksgiving table, my family will hold hands and pray, and each family member will say what they are most thankful for this year. Last year, Henry said, without hesitation: “Kitties!” but Charlie squirmed. He hates having to “do gratitude” on request. But he did finally whisper, “Football. And kitties.” And I smiled at him, acknowledging that gratitude, when pressed, can be tough. But it doesn’t mean we will ever give up asking for it. Gratitude doesn’t always come easily, but I will still practice it, every day. I will sit with it, hold hands with it, make my lists about it, and grumble, but then continue on. And, as I looked around the table and smiled at my family, I said, “I’m still here.” And it was enough. And I am forever grateful. Looking back over an incredible and exciting journey that encompasses over 35 years of working with adolescents and young adults I am always amazed at the power of nature. From being a camp counselor to a primary care substance abuse counselor in the wilderness I have seen nature be a calming and transforming source in people’s lives. Having grown up camping and exploring the great outdoors, I know the profound effect nature has had on me, so it is no surprise that I would find myself still working as a therapeutic wilderness guide at the age of 50. I began my career as a guide some 150+ expeditions ago with the words of a mentor saying “You can be the worst therapist in the world and be a great Wilderness Therapist.” And while his words were spoken in jest, some of the best therapists I have ever met were wilderness therapist, I must agree there is something remarkable to the healing power of nature. So why nature? There seems to be many misconceptions about wilderness therapy and how effective it is. Certainly in the early days of wilderness therapy the “boot-camp”, “scared-straight” style of wilderness therapy proved to be less than effective. However, as with all therapy, wilderness has evolved. We have learned that we do not need to establish superficial, abrasive, non-logical boundaries. Nature has a very “natural” system of rewards and consequences. In the words of Stephen Foster nature is “the most exacting teacher of all”. There are so many lessons I have learned through nature and the reasons I believe it is the most powerful therapeutic tool we have available to us today that I could not possibly include them all in one post. So I have decided to do a series of post on Why Wilderness. This is the first: Needs Vs Wants First, there is the lesson of needs vs wants. Many of our adolescents and young adults have a very distorted view of what “the world owes them” and what they need to do to get it. Dan Millman defines happiness as the ability to put needs over wants. When you are backpacking the back country and having to carry everything you need to survive an extended expedition in the pack on your back, you learn very quickly to decide what is important and needed versus what is just a luxury. It is then that a book can become a luxury not to mention an ipod. When you learn that you can live off of rice, then that special meal you want becomes so much more precious. When you learn that a cold bath in the river is all you need, then a hot shower is a blessing. When you are sleeping four deep in a tent with someone snoring in your ear, then a roof over your head and a private room becomes almost miraculous. There is no entitlement in nature. Have you ever seen a tree go I am an Oak so I am more important and deserve this. Or a bear say I am more important than the raven? Nature works in harmony with itself each part working as it should. The lesson of needs vs wants is quickly taught through nature. Once we have learned what is a “need” and what is a “want” then we can become truly grateful for all the “wants” that we do have. Gratitude is the beginning of the journey toward love of oneself and others and that is where the healing begins. Larry has spent most of his life as a counselor, coach, and mentor to adolescents and young adults. He is a master level wilderness guide, North Carolina Certified Substance Abuse Counselor and a Virginia Drug and Alcohol Counselor. Larry also helps facilitate rites of passage ceremonies and believes in the power of nature to heal. Larry has seen how substance abuse affects the entire family dynamics and knows that in order to achieve long term sobriety the family must heal as a unit. As owner of Buck Run Recovery Solutions and a Certified ARISE Interventionist and Continuing Care provider, he is committed to helping those hurting to find the help they need. Why I Am Open About My Addiction RecoveryI remember when I was deep in the thrones of my addictions (alcohol, drugs, and an eating disorder). I was living in the darkness. I felt alone and isolated. I didn't think anyone knew or could understand how I was feeling.
My identity was my addictions. I had no idea who I was. This mentality and mindset was my reality up until a little over three years ago. I remember when I went to rehab, I thought I needed to stay for two weeks and break the cycle. I was wrong. Those two weeks turned into a few months and while I was down there, that innate light and spark within began to come to the surface. I was and continue to be a lucky one because the disease of addiction ultimately wants me dead. I know many individuals who are active in their addictions. According to theSubstance Abuse and Mental Health Services Administration (SAMHSA), 23.5 million Americans are addicted to alcohol and drugs. That's approximately one in every 10 Americans over the age of 12. The harsh reality is that only 11 percent of those with an addiction receive treatment. Addiction takes the lives of far too many individuals. Every day I hear another story about an overdose death, suicide, or drunk driving accident. There is still such a stigma tied to the word addiction. It is looked at as a form of weakness, or poor self-control. That is so far from the truth. So I choose to be honest and open about my recovery. I do not keep it anonymous. Here are 5 reasons why: 1. Reduces shame. I lived with shame and guilt running the show for years. I stuffed down every emotion I was feeling and got myself involved in dangerous and embarrassing situations. This cycle continued and fueled my addictions. By outing my addictions, I am able to give them less power and tap into the person I was truly put here to be. 2. It helps others. I never thought that my story would inspire others. I never thought people would want to listen to what I have to say. When I opened up about my addictions, a new connection with others began. A sense of vulnerability I never felt before. I have thousands of people part of my SPARKITE community and by being honest and open about my struggles, I watch as it helps and heals others. 3. Let go of baggage. Carrying baggage is detrimental. I did it for years. When I got sober, I cleaned up my side of the street. By letting go of this baggage, I am able to focus on the here and now. And with this mindset, I can focus on helping, servicing, and inspiring others. That is part of my purpose for being here and the more I block that off, the more self-involved and destructive I am with myself. 4. No more secrets. Secrets have an ability to give some this illusion of control and a small high. There is a power play involved with secrets. I experienced this first hand. I hid my addictions and destructive behaviors from most people. At the time I thought it was normal. I didn't realize a life without secrets was an option. So when I let go of my addictions, I couldn't hide anymore. And with this, I don't carry that shame, regret, or disappointment in myself. I can show up and take ownership over my life now. 5. Authentic relationships with others. Relationships can be tricky. This is true for anyone. In the past it was never about fully being there for another person. It was always about what could I get from that person to fill the void I felt within. I needed that validation and since I wasn't getting it from within, I turned to everything outside of myself. Ultimately, that didn't work. I can now have authentic and intimate relationships with others. This means addressing my needs and desires and instead of holding onto anger and resentment, speaking my truth. It benefits all involved. Who Is Most Likely to Overdose on a Painkiller?
by Arthur Robinson Williams, MD, MBE on August 31, 2015 in Drug Addiction Expert Blogs 2Unintentional overdose deaths in the U.S. have been skyrocketing in the past decade, largely due to the widespread increase in long-term use of opioid pain pills like OxyContin, Vicodin, Percocet and others used to treat chronic pain. More recently, there has also been an upswing in heroin-related overdose deaths as people move from expensive pharmaceuticals to cheaper heroin. Because heroin is traded in the black market, its potency is unknown and it’s often contaminated with adulterants. People who progress to using heroin are also more likely to start injecting drugs, which carries additional risks such as disease transmission (hepatitis C, HIV), skin infections and abscesses, and, again, overdose. An overdose from opiates (which includes narcotic painkillers and heroin) is when someone stops breathing and loses oxygen to the brain, potentially causing death. Who is most likely to die from an overdose specifically related to pain pills? There are a few indicators that are now known to portend bad outcomes, namely:
Aside from the total dose (number of milligrams) taken over the course of each day, the duration of action can also increase risk for overdose. Namely, extended release (“XR”), controlled release (“CR”) and long-acting (“LA”) formulations tend to be associated disproportionately with overdoses. In general, some longer-acting medications can build up to dangerous levels in the body if taken too closely together. Sometimes the pain relief from a pill wears off before blood levels actually decrease. Patients in desperation for more relief may keep taking pills (such as methadone pills) to maintain the analgesic effect without realizing that their blood levels are climbing to dangerous levels. In other words, sometimes the subjective effect that you feel from a medication doesn’t fully represent the circulating blood levels of that medication. What Dramatically Raises OD RiskThe riskiest behavior involves combining opioid pain pills with benzodiazepines such as Xanax, Klonopin, Ativan and others, and/or with alcohol. All three of these classes of substances suppress the body’s ability to keep breathing. When taken in combination they have synergistic effects that exponentially increase the risk of fatal overdose. Even individuals with a high tolerance to opioids remain at heightened risk of overdose when taking even small amounts of benzodiazepines or alcohol. Finally, all of the above risk factors are multiplied among people with a pre-existing health problem such as lung disease (COPD), heart disease (congestive heart failure, aortic insufficiency) or a neurologic condition like dementia, a prior stroke or any brain injury. Opioid painkillers certainly have important roles to play in clinical and surgical medicine, but at high doses and in combination with other medications they warrant close scrutiny to prevent a life-threatening overdose. Part of the physician’s responsibility, both clinically and legally, is to assess their patients for the risks and benefits of every treatment the doctor prescribes. If you feel your physician is not adequately addressing your questions, consider getting a second opinion. Just as a second opinion can be helpful in making a diagnosis or determining a treatment plan, it’s worth considering getting input from another doctor if you have concerns about your pain regimen and ways to reduce your risk of overdose. Arthur Robinson Williams, MD, MBE Arthur Robinson Williams, MD, MBE, graduated from the Woodrow Wilson School at Princeton University and the Perelman School of Medicine at the University of Pennsylvania where he also earned a Master in Bioethics from the Center for Bioethics. He completed his residency at NYU-Bellevue and is a board-certified psychiatrist. He currently works in a clinical and research position at Columbia University in the Division of Substance Abuse, Department of Psychiatry. His research addressing addiction and mental illness, policy and the law has been published widely. Dr. Williams also maintains a limited private practice in New York City and can be reached at [email protected]. Read more from this expert's blog: A Sober Look at the Science of Addiction and Mental Illness As I listen to the news over the last few weeks I think I am more confused than ever. We hear labels like Islamic, Muslim, terrorist, Christian, atheist, liberal, conservative, homeless. I hear arguments for allowing refugees into our country and arguments that they should not be allowed. Frankly, I find merit in both arguments. I wonder however if we were to look at the pictures of the devastation coming out of Syria and the people without homes or food, and we did not have the backstory with which to create labels what would we do? The reality is I am afraid of allowing terrorist into our borders, I am afraid of another 9/11, I am afraid of a Paris, I am afraid of a Mali. But if I live in fear then the terrorist have won because that is what they want is for us to live in fear of them. I believe in a great God who is not surprised by world events. That same God’s son, said to allow the children to come to him, there was no stipulation of white kids, or American only. He even went so far as to say that it would be better for a millstone be hung around your neck and you thrown into the sea than for you to offend one of these children. I realize that this is actually a metaphor for evangelizing the children but what better way to show the love of God than to open your home to the needy, be they a homeless vet or a Syrian refugee. In the rooms of AA and NA we hear the term “The next right thing” a lot. When you are living your life one day at a time, sometimes “the next right thing” is all that you can see in front of you. I think it is time to get back to basics, stop living in fear, and just do the next right thing. Chris Christie isn't the doctor in the GOP race for president, but suddenly he sure sounds like it. Take, for example, the New Jersey governor's impassioned speech on drug addiction that has gone viral with more than 8 million views. Yes, you read that right. A speech about drug addicts has captured the nation's attention. Speaking of his late mother's smoking habit, Christie told a town hall meeting in New Hampshire: "No one came to me and said, 'Hey, your mother was dumb. She started smoking when she was 16, and after we told her it was bad for her, she kept doing it, so we're not going to give her chemotherapy, we're not going to give her radiation, or any of that stuff. You know why? Because she's getting what she deserves.' No one said that. No one said that about someone who had cancer. Yet somehow, if it's heroin or cocaine or alcohol, we say, 'Well, they decided. They're getting what they deserve.'" For those of us who treat addicts, Christie was preaching to the choir. Call it a voice from the heavens. But his voice is getting the attention that ours haven't. And the fact that a candidate for the presidency might reinvigorate a slumping campaign by throwing addicts a lifeline, by not chipping away but rather taking a jackhammer to the old-fashioned idea that addicts are to be shamed and blamed and locked up, gives me great hope that we are on the verge of a paradigm shift in the treatment of this disease. Glass Houses In a recent appearance on CNN, Christie was asked how he would respond to people who say addicts deserve what they get. "This can happen to anyone, regardless of your education level, regardless of your socioeconomic status. What we have to do is say, yes, it was a bad choice to use drugs ... but haven't all of us made bad choices in our lives? We're just fortunate it didn't involve an addiction to drugs or alcohol. It's a disease and we need to treat it." Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse, takes it a step further. She calls addiction "a disease of free will." You see, Volkow's family, too, was touched by addiction. Her alcoholic grandfather killed himself in his despair at not being able to resist his strong urges to drink. "Addiction is not just 'a disease of the brain,'" Volkow says, "but one in which the circuits that enable us to exert free will no longer function as they should. Drugs disrupt these circuits. Addicted people in my laboratory often say it's not even pleasurable," but that they just can't control it. Volkow's view is shared, in one way or another, throughout most of the addiction treatment community. But it is rare for the discussion to come from the political stage, and particularly from the right side of the aisle. While the rhetoric from Democrats has generally been more treatment-friendly, though like-minded policy has not always followed, the GOP has typically favored punishment over rehab. And Christie isn't the only GOP candidate who gets it. Jeb Bush recently told The Huffington Post that his daughter, Noelle, who struggled with drugs, "went through hell." Bush has said he would focus on recovery rather than incarceration if he's elected. Ted Cruz is also jumping on the bandwagon, calling addiction a "horrible disease." He lost his half-sister to drug and alcohol abuse. Carly Fiorina, who lost a stepdaughter to addiction, wants more money spent on addiction treatment and says, "drug addiction shouldn't be criminalized." Yes, it appears actually caring about addicts, helping them, treating them as human beings who have made bad choices and gotten caught, is the bandwagon issue of 2015. Talk about a double-take. New Face of Opioid Addiction Christie has hit hard the "addiction can happen to anyone" refrain. We can see that just by looking at the families of these candidates. What are the odds that so many of them would be personally touched by addiction? In a word, good. Forty-four people in the United States die every day from overdosing on prescription drugs -- let alone illicit ones -- according to the U.S. Centers for Disease Control and Prevention. Recent research finds that nearly 90 percent of the people who used heroin for the first time in the last decade were white. In addition, the greatest increases have occurred in people with private insurance and higher incomes. With the exception of Ben Carson, the makeup of the field of GOP candidates for the White House lines up squarely within those demographics. Yes, addiction can happen to anyone -- your neighbor, your mechanic, your accountant, even your grandmother. The governor has brought a voice to this debate that speaks to conservatives and liberals alike, a voice that may finally have addiction understood as a disease, not a moral failing. What drug abusers deserve is the same thing smokers deserve. Help. A chance to live another day, whether the healing comes as the result of having a lung removed or treatment in rehab. Every life is indeed precious. Bravo, governor. Jason Powers, M.D., is the chief medical officer at Promises Austin drug rehabilitation program and The Right Step network of substance abuse treatment centers in Texas. He is the pioneer of Positive Recovery, an approach to addiction treatment that helps people discover meaning and purpose in their lives. Mindfulness-Based Relapse Prevention Holds Promise For Treating Addiction The treatment protocol targets the very roots of addictive behavior. Carolyn GregoireSenior Health & Science Writer, The Huffington Post
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