Thinking Fast and Slow


On Facebook this morning, I ran across a recommendation by ZDoggMD (government name: Dr. Zubun Damania) — a book called “Thinking Fast and Slow” by From Daniel Kahneman. This piqued my interest for a couple of reasons. First, Kahneman, despite being a psychologist, won the Nobel Prize for Economics in 2002. Second, the book’s subject matter is Human Irrationality. In other words, why do we do stupid shit despite the fact that it’s bad for us?

Take, for example, drug abuse. It’s estimated that over a half-million people die every year from various forms of drug abuse. So, with overwhelming evidence saying that using is a bad thing (whether it’s tobacco, alcohol, or illicit drugs), why do people still choose to light up, drink up, or shoot up?

According to Kahneman (and other researchers involved in the project), it comes down to the way the brain is wired. How we perceive incoming data. We have inherent biases in our thinking that influence our memories of experiences.

He postulates that we have two systems of thinking going on. System 1 (the fast one) is pretty instinctual. It makes a decision at a subconscious level. But it works fast and cheap  — yet it’s pretty inaccurate. Example: You see a bowl of cherries with a cockroach sitting on top. You may instinctively feel intense revulsion. Your brain thinks, cockroach is bad, therefore, cherries are bad. From then on, you think cherries=bad.

System 2 (the slow one) happens at a conscious level. It’s methodical. Takes time. System 2 would sort through the information so you can see that cherries are still good even if you saw the cockroach on it. It considers that situation in a more logical, “scientific” way.

But System 2 takes time and it’s exhausting. It’s lazy. If it gives up too soon, System 1 takes over and you remain cemented in your belief that all cherries suck because… well… maybe your brain won’t even remember that cockroach after a while. You just remember knowing in your heart of hearts that cherries are gross. Period. Stuck in that belief because that’s just how it is. Harrumpf!

I’ve only started reading this intriguing book, but let me allow the New York Times to summarize what I’m trying to say:

“… the remembering self does not care about duration — how long a pleasant or unpleasant experience lasts. Rather, it retrospectively rates an experience by the peak level of pain or pleasure in the course of the experience, and by the way the experience ends.”

So… example… someone like me takes a Vicodin tablet. I’d taken Vicodin before and, while I enjoyed it, I never really loved it. It was a slow release, and even though the experience was pleasurable, it wasn’t really all that great. But I DO remember the day it hit me like a freight train! For various reasons, the drug gave me an intense high one day unlike any other — and the intensity of the experience shifted my bias. I wanted that to happen again and again and again. I pursued it into the ground despite all evidence that my life was spinning wildly out of control. I almost died trying to recreate that experience.

This is what Kahneman describes as the “Peak-End Rule” — not so much the duration of the experience, but the intensity by which it is felt — that drives my recollection and pursuit of repetition despite all logic to the contrary.

In truth, I have wondered about this theory for a long time. I’m pleased to see that a Nobel Prize-winning psychologist/economist has done the legwork for me. That perhaps it is not the length of time we do it, but the intensity of the experience that drives addiction. They don’t call it “chasing the dragon” for nothing. Always chasing that first high.

And perhaps that is why so many drug treatment plans fail — they cannot overcome that cognitive bias created by the peak of the drug experience. Going to classes all day, going to meetings, plodding along in our recovery — how can that possibly compare to the fireworks created by your drug of choice?

It can’t. That’s why healthcare workers recommend that treatment last so long even though insurance companies only want to pay for a couple of weeks or the traditional 28 days. 28 days isn’t nearly enough for System 2 to kick in. Not nearly enough. A dear friend of mine has been in treatment for almost a year now — and he does everything he’s supposed to do. He takes all the classes. He does all the work. He goes to meetings. He does every assignment he is given. Yet, while they have quieted, the urges are still there. If Kahneman’s theory of a mild experience for a long time versus an intense experience over a short time is true, the likelihood that my friend will relapse remains pretty high.

Which isn’t to say that the “System 2” cognitive version of Drug Rehab — the most common here in the United States — can’t or won’t work. It can and does for many people.  It may work for my friend. But perhaps we need to consider that if most of our patients are failing in this method of treatment, we need to reassess what we’re doing.

I wonder if that is why the controversial treatment of Ibogaine for opiate addiction has found a modicum of success as a ‘cure’ in other countries where it is legal — because it proffers an alternate psychoactive experience, one that shares a “Peak-End” in direct conflict with the original episode. Perhaps the two cancel each other out? I would be curious to find out more.

(I’m not in any way, shape, or form recommending Ibogaine, but I DO find that its results present us with new data that should be considered.)

At any rate, I think this book is a really intriguing read! Although I’ve just started reading it, I think this book is offering some real insight given our current drug crisis. Check it out! (It comes ZDoggMD recommended too!)

“Intelligence is not only the ability to reason; it is also the ability to find relevant material in memory and to deploy attention when needed.” —Thinking Fast and Slow, Daniel Kahneman.



Posted in + recovery, AA, addiction, education, loperamide, loperamide abuse, sobrietyland, therapy | Tagged , , , , , , , ,

Relapse: The Silent Killer

Let’s talk about the thing nobody in recovery wants to talk about.

Many things can be talked about freely “in the rooms” — i.e., in a 12-step meeting. You can talk about relationships. You can talk about a particular step. You can even discuss having gone to jail or rehab. But there is one topic above all others that scares the living crap out of a 12-step meeting.


There. I said it.


How much more dangerous it is when it remains unspoken.

It happens. It happens to the best of people. The most hardcore. The ones with 20 years of sobriety under their belts. Relapse. It’s the thing people in recovery fear the most out of any word in the English language. But it happens all the time.

A friend of mine recently re-entered rehab for what seems like the four billionth time. Everyone worries whether or not this time will stick — and they have a right to be concerned. Everyone — that is — except those who abandoned him after he relapsed. Even family members and friends fear relapse because the consequences are so dire. Every time an addict relapses, there’s the possibility (probablility?) that they could die this time. That all the bad things will happen all over again.

When I initially quit taking loperamide, withdrawals were so bad that one night I couldn’t take it anymore and took a few pills just so I could get a few hours of peace and rest. The next day, I attended a meeting and confessed what I’d done — I was EVISCERATED by the group for my relapse. My main mistake was, in explaining what had happened, saying “I know it’s a part of recovery” — to them, this was pure blasphemy, so I was told, in no uncertain terms, that was unacceptable.

Yet, I was not wrong. Relapse is an expected part of recovery. It doesn’t have to be, but it happens more often than any of us would prefer.


Source: JAMA, 284:1689-1695, 2000

Relapse in addiction recovery is no different than any other disease. (By the way, some people differentiate between a “slip” and a “relapse” but, to me, that’s just a matter of semantics. As I will be discussing it, they are the same thing.) Below is a chart that appeared in the Journal of the American Medical Association (reused by the National Institutes of Health) that compares relapse rates between drug addiction and other chronic illnesses such as Type I Diabetes, Hypertension, and Astham. Those illnesses require lifelong patient compliance, frequently with medication, and the breakdown of patient adherence to a treatment plan often causes a relapse of symptoms and repeated medical intervention.


Those who think Substance Abuse Disorder isn’t a disease need to consider this chart carefully.

Relapse is so terrifying because the consequences of it are so dire. As with any chronic disorder, it can quickly lead to hospitalization or death. The diabetic stops taking insulin, it doesn’t take long before glucose builds up and bad things happen. Untreated high blood pressure can lead to strokes and long-term irreversible damage. Untreated asthma can lead to hypoxia and death in minutes. Nobody wants this — but it can and does happen.

The important thing to remember is that relapse doesn’t have to be the end. It is a call to action. Renewed intervention in the disease process can lead to continued recovery with swift and decisive action.

But never give up. Never give up on the family member or friend who slips. And never give up on yourself. Recovery is an ongoing war; the loss of one battle doesn’t need to signal the end.



Posted in sobrietyland

Loperamide In the News… The Atlantic: Addicts Who Can’t Get Opioids Are Overdosing on a Diarrhea Drug

Loperamide is back in the news! This time it’s in The Atlantic, on Fox News, and in a few other locations. Apologies for not keeping up. School is sucking up all my free time (when I’m not sleeping, that is).


From The Atlantic:

“Until just a few years ago, the cardiac effects of loperamide were unknown even to most doctors—simply because people weren’t taking the drug in big enough doses until the opioid epidemic. And the trend is unlikely to go away soon. “We will see more cases because the more restrictions [there are] on opioids, the more doctors are afraid of trying to extend their prescriptions, the more people will seek different substances,” said Rasla.”

From Fox News:1491595210382

The article from Fox News is basically a retread of the one from The Atlantic. “The number of calls to poison centers regarding the ingestion of dangerous levels of the diarrhea treatment, known as loperamide, doubled between 2010 and 2015, the magazine reported.”

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The Pressure Cooker


Ah, the end of the semester has arrived. In less than a month, final exams will be over and this school year will be past. It’s hard to believe, but it’s true.

This past week, New York State became the first state in the nation to offer free tuition to 2-year and 4-year state colleges. Dubbed the “Excelsior” Scholarship, it is hoped that this effort will attract more students to New York for educational opportunities AND that some of those better-educated individuals will decide to stay and make New York their permanent address. It’s a brilliant idea.

I love it and hope it is massively successful. No one who is willing to work for a degree (and maintain a B average or higher) should have to be burdened with student loans for the rest of their natural lives just to be able to get a decent-paying job.

That said… hahaha… now that I’m enrolled in a private college for the fall, the change isn’t likely to help me much at all.

The pressure to succeed has built to its crescendo. Yes, for those whom much is given, much is expected, and this pressure from this expectation is showing. I think that is true of many college students, particularly about this time of the semester when things are winding down and approaching final exams. And for some who face certain additional life challenges, the pressure is compounded.

Free tuition doesn’t help much with pressure-related stress, that’s for sure.

And even with college costs, free tuition is only part of the equation. I’ve actually been pretty fortunate so far in that 99% of my education costs (including books) have been covered by various scholarships and grants.

Books — make no mistake about it — can be almost as costly as the tuition itself (at least at the community-college level). In medicine, book costs are outrageous. No shit. I mean it. Outrageous. I am taking associate’s level courses, and I can expect to pay $350-$400 per book for an average 3-credit class; sometimes a bit less, sometimes more. The Anatomy & Physiology class I’m taking now required a $400 book plus another $79 for the school-exclusive lab manual.

And buying used books isn’t an option like it used to be in the olden-molden days, since much of the classwork is heavily dependent on online quizzes and assignments, only available via an online key and password, usable by one person only, and exclusively accessible with the new edition of any book (new editions come out about once a semester). Hence, no cheap used books.

People don’t comprehend the actual costs of returning to college. Even if you get the free tuition, the book costs alone will kill you. And then there are all the other fees they don’t warn you about. The lab fees. The equipment fees. The testing fees. The this-and-that fees. Every time you turn around, the college has their hand out saying you owe them for this-or-that and — like any good loan shark — if you don’t pay up now, very bad shit will happen. You don’t graduate. You don’t pass. You don’t get an A.

I was recently accepted to a fancy foo-foo private college for the fall for Nursing. Included with my acceptance letter was a request for a $50 matriculation fee deposit and a notice that I was expected to attend a uniform fitting next week (no cost listed).

Okay, first of all, if $50 is the matriculation deposit, how much is the actual matriculation? Are they aware that I am poor? Are they aware that I am dependent on financial aid for this? So yeah, I’ll have to come up with the fifty bucks or risk losing my spot. As for the uniform fitting, all I can say is, they can fit me, but I can’t pay for it until all the financial aid stuff is arranged.

And so it begins.

Some people say that when you’re young, going to college is easier. And to a certain extent, they’re right. There is a reason that MOST people attend college when they’re kids straight out of high school. Most will have the advantage of parental support (both financial and otherwise), many will have few responsibilities, means of housing and transport, most don’t work or have familial responsibilities yet, and many are young and foolish and have yet to learn to appreciate the sweet, sweet glory of 8 hours of sleep each night. In other words, they adapt well because don’t know any better.

But as a returning student, an adult with many years of experience doing various things under her belt, this shit is hard. Way hard. Maintaining a job and going to school? Oh my God, so hard. I can tell you that I know now — better than at any other time in my life — what I’m capable of and what I’m not. I happily push the envelope, but I recognize my limits (not that I always abide by them).

I have a healthy respect for sleep deprivation. I know the value of a buck, and I know first hand how important it is to keep the lights on. I know what it takes to study for an exam and pass. I also know when I can’t. When it’s too much. I can skate by, but I know the consequences that entails.

Moreover, I am at an age where I am prescient enough to see the low dark clouds of trouble on the horizon. And know what that means.

For instance, I know that this fall, should attending the foo-foo private nursing college come to pass as planned, I will be in over my head. No question about it.

It’s all about support though. Getting myself prepared for the onslaught. Will my life be set up well enough by then that I can survive it?

Let me just say — I don’t worry because school is hard. (Shit, I know that.) And I’m not worried because I’m not smart enough. (I know I am.) I’m worried because of the pressure of everything else. All those loose ends are the problem. They can do me in.

My depression has returned full-blast now. I suddenly started to cry uncontrollably on the way to class the other day and had to take a few moments to collect myself before I walked through the door. It almost blew into a full-on panic attack. That’s a very bad sign. I know it because I’ve seen it happen before. It just comes out of the blue like a rogue wave on the ocean — and like that tsunami, it is a sign of seismic activity deep under the surface. A low rumbling of real danger.

Compound that with the pressure of work, an end-of-semester project that I cannot complete, final exams in two difficult subjects, a total lack of transportation and support, unresponsiveness from my doctor regarding my depression, my best friend is in jail, no time, maintaining my sobriety, and no money at all to correct any of it — I know I’m in trouble. Any one of those things on their own would be difficult, but, yes, this is as overwhelming as it appears.

(Does anyone ever hear me, I wonder, when I ask for help?)

I see it happening, yet I can’t stop it. It’s as if I’m tied to the railroad tracks watching the train approach from a distance while Snidely Whiplash twists his mustache and cackles in cruel delight. Only for me, Dudley Do-Right isn’t coming. I’m lying on the train tracks wondering whether or not you feel your organs crush under the train’s wheels or do you black out before that kills you?

For many people in college, this kind of scenario can happen. MIT recently asked for feedback on college burnout and received several really interesting replies particularly from their overachieving A-students. One remark sums up my sentiments exactly: “Nothing ever feels like enough. I feel like I’m in the most amazing place in the world with the most amazing people in the world but all I can think about are shortcomings.” Yep. Most of the time, I feel like a disappointment, so success isn’t always felt nor enjoyed as it should be.

I was offered an invitation-only opportunity for a summer class that any med/nursing student would kill get in on, but I’ll probably have to turn it down. Why? Because I can’t get there. I don’t have a working car right now, and that’s not likely to change in the next three weeks. So, I can’t go, not because I’m not smart enough. Not because I won’t put forth the time and effort. Not because I’m unwilling to make the sacrifices necessary to do it. But because of something as simple as not being able to get there. It’s killing me that I won’t be able to go.

In an AMA article titled, “Students Under Pressure”, almost half of students questioned claimed to have sought help for mental health related issues (namely, anxiety and depression) during the course of their school year. 30% seriously thought of suicide. So it isn’t like this situation is new.

You could certainly argue that much of the pressure is caused by personal expectations, and that’s certainly true of me. Students under pressure want to find an escape valve. For some, that’s exercise. They run, punch, lift weights, or kick their way to mental health. For others, they just need to take some time off. Hell, I could just take a year off and wait, trying to get my life together before going back. And many young people could use that option.

But for me, what would that really achieve? And wouldn’t I be sacrificing the momentum built from all I’ve been able to do so far? Not to mention my age. Dudes, I don’t want to be retirement age when I graduate. The time is now.

The most important thing, all experts agree, is to maintain a healthy lifestyle that is supportive of the pressures of school and home. That’s difficult in the real world. You have to have a tremendous amount of support and love from the people around you to make that work. Being proactive about health concerns helps too. Staying on top of homework assignments (not procrastinating) is another assist. Eating well. Drinking enough water. Stuff like that.

The one thing I can tell you for sure is, going back to school as an adult isn’t easy. In fact, the bigger your dream, the harder it’s going to be. Wanna return to be a plumber? Okay. Wanna return to be a doctor? Good luck (HA!) The bigger the dream, the bigger the laugh from God.

It seems one has to survive the hard parts to make the good parts possible. So I press on.

Good luck.

“Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty… I have never in my life envied a human being who led an easy life. I have envied a great many people who led difficult lives and led them well.” — Theodore Roosevelt

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Truth or Consequences


One of the hardest things to deal with in recovery is watching someone you love relapse. Even harder is when that relapse leads to something worse.

In 12-step programs, you will often hear the following: “We are people in the grip of a continuing and progressive illness whose ends are always the same: jails, institutions, and death.”

Jails. Institutions. Death. Basically, if you use, these are your three most common outcomes. Me? I got lucky. The only institution I was in was the hospital as a medical patient, then released on my own to deal with things in outpatient. I was never in rehab; I was never in a mental institution. I was never jailed. And — okay, technically, I died — but I didn’t stay dead. And that, ladies and germs, is a VERRRRRRY rare thing indeed. That’s why I’m an anomaly; I shouldn’t be here.

But for most people in the grips of an addiction — whether heroin or vicodin or loperamide — that is not the case. They end up dead. Or they go to jail. Or they find themselves involuntarily institutionalized. And that isn’t even accounting for those whose habits lead to them becoming brain damaged or physically disabled.

Bottom line here is, nothing good is the outcome of the addiction. Oh sure, it’s fun for a while, but that fun turns into not-fun very quickly. And not-fun becomes worse and worse until one of the above three things happens.

And all along the way, there are lies. Lies you tell other people. Lies you tell yourself. Lies that the drug/alcohol tells you. Each lie forms a new thread in a web of falsehood that becomes the life you lead. You lie to a loved one. You cheat on someone you care about. You invent a pseudo-truth, like a dirty accountant keeping two sets of books, in order to maintain the outward appearance of honesty.

For a while, you’re lucky. You beat the odds. It’s a self-reinforcing process. You get away with it all long enough, and you become bolder. You do more. You try more. You lie more. You stay lucky. Maybe there are a few errors. Some cracks in your armor begin to form. You slip up and screw up, but swear you’ll be fine.

But the one universal truth about luck is that eventually it runs out.

That happened to a very dear friend of mine (let’s call him Bob) nine days ago. I knew about Bob’s relapse, and like many, I tried my best to help. I wanted to keep him safe. To help. To be that understanding soft place to fall. He began to rely on me for help. He would call me, and I would get up in the middle of the night to pick him up when he was intoxicated and in a bad part of town. (I did that a lot.) I sometimes walked him home. He would get in trouble, and I would come running to rescue him. It happened over and over again. And each time, I hoped it would be the last. I tried everything in my power to keep him safe and none of it worked. Of course, you could certainly argue that perhaps things would have been worse if I hadn’t been there at all. But I fear that everything I did — or tried to do — merely delayed the inevitable. Luckily, he didn’t die.

Last Friday, Bob was arrested. Allegedly, Bob had been drinking and using drugs and got caught by the cops with aforementioned remaining drugs in his pocket. It was in the wee mornings after a night when I had to work, so I wasn’t there for him (and frankly, I was tired and wanted to sleep anyway). He texted me “Hey” at 5:15am Friday morning, but I was sleeping and didn’t respond. I happened to wake up at 5:45, saw his message, and responded. I didn’t hear anything after that.

I had no idea what happened, but with Bob, sometimes he’d go home and pass out, sleeping for hours before ever responding. So I didn’t worry about it at first. Bob’s nightly “partying” on his days off had become so frequent that I had become accustomed to not worrying. He would sometimes become irritated with me if I challenged him. It wasn’t always like that, but it had become much more that way in recent months.

After a day of not hearing from him, I presumed Bob had run out of minutes on his phone. Recently, he had told me that in an effort to save money, he might let his phone lapse for a week or two before recharging the minutes. So again, I tried not to worry, but I’ll be honest with you — I was becoming increasingly anxious.

After three days, Bob’s brothers contacted me asking if I’d heard from him. I laughingly reassured them that he probably let his minutes lapse and would get new ones once he was paid on Friday. But inside, that excuse was beginning to falter. This was strange even for him.

So Wednesday, I became concerned enough to Google-fu Bob’s name. Immediately, his arrest record popped up. My blood ran cold. Denial — the first and favorite of all reactions — popped up. No. It can’t be. Yet there it was in virtual black and white.

Bob’s luck ran out.

The web of lies and deceit that he had laid finally failed him. The casual, nonchalance now replaced with sobering agitation.

Bob wore an orange prison jumpsuit. His face fatigued and a 7-day growth of beard framed his jaw and neck. He couldn’t sit still, every inch of his body jittered and trembled. His speech solemn and almost monotone. He pled not guilty to what he’d done; I knew the truth. Bob’s family was gone and had now written him off as persona non grata. No one was visiting him. No one bailed him out. Once the web of lies collapsed, so did all of his support. No one was there for him. Except me.

It broke my heart.

As helpless as I feel, I was actually always helpless. That’s one of the toughest things to deal with when you have a loved one with an addiction. I was told time and time again that trying to help an addict — if they do not want help, that is — is impossible. It isn’t until they accept that they have a problem and are willing to accept help that you can offer any usable guidance or assistance of any kind.

About a year ago, I had a dream about Bob. I was in heaven (or rather a heaven of sorts) and there were these guiding spirits who were showing me around. They told me I wasn’t dead, just visiting. They had some things to show me. We walked down this bricked streetscape, and as we looked in the windows, I could see certain things — honestly, I don’t remember much of it. But at one point, they showed me Bob. As I watched him, they said, “You will go on to do many great things in your life. But Bob? Bob, you cannot help. You can’t stop what’s going to happen.”

In my dream I started to cry. “I have to try,” I said.

“You can try, but you will fail.” they replied.

“But I have to try,” I cried, “I can’t leave him in hell by himself.”

The guiding spirits showed me what was coming for Bob. Perhaps not literal, but interpretive. I saw him act foolishly, goofing around, only to fall in the path of an oncoming truck. I saw him in the hospital with his legs being reattached and the doctors commenting how miraculous his recovery was. I saw him go back to his habits of drinking and using, and finally saw him at a bar ten years down the line looking old and haggard beyond his years, a ghost of his former self.

I woke up crying. I knew it was a fail-certain venture, but from that day on, I worked at keeping Bob safe. I offered assistance. I even offered on many, many occasions, to help him get help and treatment. I would say, “When you’re ready, all you have to do is ask and I can get a whole team of people assembled to get you better and keep you safe.” He would laugh and assure me he had this thing. He didn’t need help.

And on the rare occasions when all the powers of my persusasion would get him to see and admit in his heart of hearts that perhaps he wasn’t so in-control of this thing — and this happened at least three times since his relapse — when I had him in the palm of my hand, ready to unleash all I had ready and waiting to help him, the minute he was out of my sight, something would always happen, and he’d back out.

My influence lasted only as long as I was there. And I couldn’t be there 24/7.

Now Bob is in jail and — as illogical as it seems — I blame myself. I know I shouldn’t. I know it isn’t really my fault. I feel responsible on every count. What if I’d done this? What if I’d done that? Did I try hard enough? What if I had answered his text at 5am? What if I could have been there? Maybe I could have stopped this thing.

Even Bob said it wasn’t my fault at all — that it was inevitable that everything would catch up to him — and that this was on him, not me.

I walked inside hell to seek and find him. I grabbed his arm, clung tight, and tried to drag him out. But he just wouldn’t go.

Whose fault is that? The person trying to help for not trying hard enough, or the addict subbornly refusing to change?

Now, as Bob prepares to leave prison (“Jail”) and enter state-ordered rehab (“Institutions”), I wonder if this will be enough. The “new” Bob certainly seems a lot more self-aware than before. But will it last? Or will the next step inevitably be the final one (“death”)?

Caring about someone with the disease of addiction is heartbreaking. It’s frightening. It’s a crazy, mixed-up bag of emotional upheaval and worry.

Interestingly, worry by loved ones seems to be something a lot of addicts can’t wrap their intoxicated brains around. Other people’s worry seems like an annoyance more than a help. I know that’s how it was for me, too. “What are you worrying about me for?” I’d cry in a tirade, “Worry about yourself,” never acknowledging their worry as a sign of affection.

Bob asked me just a couple of weeks ago why I worried about him so much. I replied, “Because I care about you, stupid! I worry when I see you suffer. I want you to be happy. And worrying is what caring people do!” He looked at his feet bashfully and contemplated the meaning of caring. Bob explained that he associated caring with how, for instance, he is happy for me when I do well at school or get an A on a test. He seemed genuinely surprised at how happy he could be for me, and contemplated why, despite the fact that it has nothing to do with him, that such things would matter.

“That’s it, Bob,” I said, adding, “When you care about someone, you worry when things go badly for them, and you’re happy when things go well for them. And yeah, that’s the mystery — even though it doesn’t effect you directly, you still feel it. That’s empathy. That’s love,” adding with a laugh, “okay, well, sorta.” He laughed too.

For me, it’s scary that Bob is going into rehab. On the one hand, I’m thrilled that he now has the opportunity to get clean and sober — and maybe get happy too. I hope against hope that the web of lies that’s come crashing down doesn’t get rebuilt. I want those visions of him old and haggard are replaced with him happy and healthy.  On the other hand, I worry for myself that Bob’s recovery will mean my dismissal.

And many people who are friends or loved ones of addicts find themselves in the same predicament. “What role do I play if I’m no longer the rescuer?” There is a definite and real co-dependence that develops between the sober person and the addict. This dance is chaotic, but well-rehearsed. So what happens when the dance is over?

Of course, the easy answer to this is, start worrying about your own life and just be a friend. And yes, that’s the ultimate goal. But getting there is an uneasy minefield of emotion.

But I am willing to walk away if it means Bob can get better and stay better. And if he can, maybe those visions will never come true. In that case, everybody wins. Well, except me of course. But his family gets better. His relationship with his brothers gets better. All the people in his life who are important to him win by getting Bob back in their lives.

Trading me for a life well-lived might have to be good enough.

“Remember that sometimes not getting what you want is a wonderful stroke of luck.” ― Dalai Lama XIV

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What to do when a relative or friend is a recovering addict

nobel.jpgI’ve been clean for a long, long time now. My DOC (drug of choice), Vicodin, is a distant memory now, but I will admit there are days when my resolve weakens.

My mind drifts and I fantasize about how good it felt, only to shake my head back out of the fog of remembrance and back to reality. The reality is, going back to that lifestyle is not an option for me. It is incompatible with my goals and the things I can do with my life now.

The challenge is in remembering this fact even in the worst of times. I was an addict and part of me always will be.

Does a prior addiction history mean that I should be sentenced to a life where I am not allowed to be gainfully employed or obtain educational opportunities? Should I be denied college entrance because I abused painkillers? Should someone not hire me because of something I did ten years ago? At some point is it okay to be great again?

There are people out there who believe this is exactly what should happen. For these people, no penance is or ever will be enough.

I don’t understand this unforgiving mindset. I have often said that if I were to receive the Nobel Prize for Medicine, a certain person in my life would be sitting on the sidelines commenting that the Nobel Prize committee must have lowered their standards by giving the award to someone with an addiction history.

Addiction is defined by the NIDA as a disease. Part of the addictive disease process is a maladaptive learning history. For instance, at some point, I learned that taking an opiate was an efficient means of feeling better. Whatever it was I was feeling bad about — or even that which made me feel great — it was made better by introducing an opiate high. Yet, for many, many people, this addictive process never happens. Other things make them happy. Family. Friends. A sunny sky. A good cup of coffee. A great TV show. Sports. Something fills that need — and yet, often in addiction, the most direct route to feeling “better” is discovered to be a drug or a bottle of booze. Frequent, habitual use of this substance/s leads to altered brain function.

And just like a person with diabetes needs to be on medication, the addict needs to obtain treatment too — often involving abstinence from the addictive substance. But often, the only real successful treatment deals with the core issues and the maladaptive process. The brain needs to relearn how to deal with the world in a more socially acceptable (and far less harmful way). And like someone with diabetes, treatment requires daily maintenance.

Can the diabetic relapse? Yes. Can the addict relapse? Yes.

So why is it the diabetic is treated with more respect than the addict?

I realize this is far from a perfect analogy, but I do wish families and friends would think before speaking to their addict friend or family member. Cruelty helps no one.

I have been clean for years. Yet, because I “came out” last year to my friends and family as an addict, I have had to deal with prejudicial statements and attitudes from a couple of people that attempt to pigeonhole me as hopeless. I suppose it would surprise no one that this judgmental attitude about addiction is precisely why I never “came out” before. Fortunately for me, most of my friends were amazingly understanding and being privy to this long-held secret only deepened our friendship.

However, the narrow-minded negative reaction is exactly what my pessimistic mind had expected and is very disappointed in.

I can say that my prior addiction history hasn’t been much of a hindrance in any way (except in my own mind). Schools have so far had no problem with it, and my current employer (who does extensive background checks and expensive hair drug testing) found it suitable to employ me. And I’m great at both.

This doesn’t mean that I won’t run into prejudicial people going forward, but so far, my merits and hard work have outweighed my past indiscretions. I just don’t understand the negativity. I really don’t.

But it’s not uncommon. I’ve talked to many people in recovery (and some who are still actively using) and this lack of understanding and forgiveness, particularly among family members, is pervasive. The addicts become demoralized in this atmosphere. How do you ever win? It does NO good for anyone.

So, a little advice to loved ones of addicts:

Don’t feel it necessary to bring up their addiction history all the time. If they’ve moved forward and are doing good things, let the past be in the past. Don’t be THAT GUY who wants to badger them about it constantly — or tell them that whatever good thing isn’t deserved because they were a scumbag alcoholic/drug addict. In other words, don’t be an asshole. And if your problem is that you’re still sore about the whole thing… then…

Forgive. Whatever screwed up thing they did to you, look at the person and realize that who they were as an addict is not an accurate representation of who they are now. That doesn’t mean they suddenly turned into a saint, but who is?  Life is all about second chances — wouldn’t YOU want one if it was you?

Understand. Not every day is going to be peaches and cream. Lots of days suck. Be understanding about it and, if you can, help them get through it. Be encouraging. Get that person out of their head and back to reality. Offer to go for a walk or to a movie or something — but be helpful, not hurtful.

Be honest. If you are angry, say so. If you are tired, say so. Don’t be afraid that anything you do will set off the addict. And secrets (particularly addiction) thrives in silence — the more you lie, the more they lie, and the more IT lies. If an addict is in recovery, they need to learn to handle your emotions as well as their own in an atmosphere of honesty. Engender and encourage that.

Take care of yourself. Don’t wrap yourself up in everything the addict is doing or saying or thinking. Don’t make saving them your mission — it isn’t — but being a non-asshole friend or family member IS your job. Get your own hobbies and go out and do things for yourself. De-stress when you need to. Addicts in early recovery are like colicky, screaming newborns. Take time out as necessary.

Let go and let God. They teach this phrase in recovery, and it’s as true for the addict as it is for their loved ones. You can’t control the addict — and yes, let’s be honest. Despite all efforts, they MAY relapse. That is NOT your fault, nor is it a personal weakness on their part. This disease is an ongoing battle — and make no mistake about it — it’s DEADLY. The only thing you can do is be a force of goodwill in their world, and by doing so, you can help lessen that chance of relapse. Leave the rest up to God/the Universe/Nature/Higher Power. That’s not your job.

Ultimately, if you love this person, you need to be a friend. Don’t tie this person down to the things they did “in the before times”. And frankly, it reflects more on you (and poorly, I might add) if you hang around this person for the simple pleasure of torturing them, making them pay for their past perceived mistakes every day, than if you were to forgive them and help them be that better person you know is just waiting to flourish.

If they truly are your friend — or your sister, brother, mother, father — and if you love them, they are worth it. If they aren’t important to you, and you find you can’t forgive and move on, then just go and leave them be. It helps no one for you to keep torturing each other.

As I said before, would you want any less for yourself if it were you?

“No man can put a chain about the ankle of his fellow man without at last finding the other end fastened about his own neck. ” — Frederick Douglass

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