Canada Drug Rehab

Modern war and major disasters such as 9/11 and Hurricane Katrina have highlighted the horrendous effects of psychological trauma. Here are some rates of post-traumatic stress disorder (PTSD): 23 percent in regions in Israel that have been shelled, 40-70 percent in Gaza, 17 percent of US military personnel, 44 percent in high school seniors in Kosovo five years after hostilities ended, and 30 percent in New Orleans after the hurricane.

Many of these poor souls have turned to alcohol and other drugs to deal with the impact. New research is helping us develop new ways to treat these clients with co-occurring disorders.

The Impact of Trauma on the Brain

Trauma imprints itself in the brain’s memory system. Stress hormones that accompany the emotional intensity of trauma activate the amygdala, which in turn activates other subcortical structures in the limbic system, the primitive, ‘non-thinking’, part of the brain. In other words, emotion mediates how memories are consolidated. The precise mechanisms involved are still debated, but neuroscientist James McGaugh says everyone agrees that “Stronger emotional experiences make for stronger, more reliable memories” (2003, p. 327). Memories of a wartime fire-fight or a collapsed building may intrude repeatedly in a survivor’s daily life or lead to nightmares. Survivors appear to be sensitized that even a door slamming or an image on television can trigger the intense experience. As psychologist David Myers says, “It is as if they [the memories] were burned in” (2010, p. 342). Even months or years later, traumatic memories are so clear that victims recall the event with remarkable detail.

To understand the power of trauma on the memory, think back to 9/11. Chances are that you remember what you were doing on September 11, 2001. But do you remember what you were doing September 11, 1999? Myers reports a study in which victims of car accidents, rape, and other traumatic incidents were given either a placebo or propranolol, a drug that blunts memories. Three months later, half the placebo group and none of the propranolol group experienced stress disorder. “Weaker emotion means weaker memories” (Myers, 2010, p. 342).

Trauma and Drug Use

Statistically, there is an association between addiction and trauma, though much more work is needed to discover what the precise link is. Some say that those suffering from trauma are more vulnerable to addiction; the earlier the trauma, the stronger the association. This may be due to the impact of early trauma on the brain’s development. Others say that the addicted brain makes people more vulnerable to PTSD. Some suggest that traumatized people are more vulnerable to addiction because they want to medicate their condition. Still others say that those with trauma who are addicted to substances are not medicating their pain, but using substances as any addict does—to relieve boredom, despair, guilt, loneliness, and a lack of a sense of belonging. And so on.

Treatment

Traditionally, scientific treatment for trauma and addiction has relied on cognitive-behavioral therapy (CBT). Among the most the most famous for co-occurring additions and trauma is Lisa Najavits’ Seeking Safety (2002) program. But many are questioning whether CBT and traditional psychotherapy are enough. One of the more controversial figures advocating a new clinical approach is Bessel van der Kolk (2005). He has suggested that because trauma affects structures in the brain’s limbic system and inhibits key functioning in the ‘thinking’ brain, that body-oriented and self-regulation therapies may be more effective than traditional talk therapies alone.

Based on brain-imaging techniques that show traumatic memories appear to be mediated or moderated by the limbic system, some trauma experts are using techniques that integrate the mind and the body. James Gordon (2010), head of the college of mind-body medicine at Saybrook University, works with US soldiers and local residents in Gaza, Bosnia, Afghanistan, and elsewhere. Gordon’s mind-body approach focuses on client strengths, builds resiliency, and balances the sympathetic nervous system’s fight or flight response with the parasympathetic nervous system’s relaxation response. Initially, after creating a safe environment, he follows a three-step process: shake, breathe, and move to music. Strange as the idea may first appear, this body-work frees participants sufficiently to deal with the trauma. They often break down sobbing during this somatic process, able to talk about what happened to them. Othre clinicians use EMDR and OEI, various types of body-work, forms of psychodrama, and other cutting-edge techniques.

Today, little of this trauma work is applied in the addiction field. But there is great hope that as addictions clinicians become more familiar with trauma, that their traumatized clients will fare better.

References

Gordon, J. S. (2010, Jan 19). Trauma and transformation: Healing the wounds of war and other disasters. [Workshop]. College of Mind-Body Medicine, Saybrook University, San Franciso, CA.

McGaugh, J. I. (2003). Memory and emotion: The making of lasting memories. New York, NY: Columbia University Press.

Myers, D. G.. (2010). Psychology. New York, NY: Worth Publishers.

Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York, NY: The Guilford Press.

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389-399.

By Geoff Thompson - MA, CCC
Program Director
Sunshine Coast Health Center

One of the beneficial things to do in recovery is occasionally to pause and reflect on how your life is going. Many in recovery are busy, doing this and that, and never take time to think about their progress, how far they have come from where they were.

With this in mind, this article will pause and reflect on the second anniversary that Sunshine Coast has been offering the online support program for its alumni. We’ve mentioned dozens of recovery topics from relapse prevention techniques to dealing with family members to discovering spirituality.

With more than 100 topics covered, what are the major themes that the online program has pursued? What are the most important, according to our alumni and research? Which topics seem to have the greatest impact?  

To be honest, we don’t know for sure. But pooling all the information, here are four. We’re not sure if these are the top four, but they’re close. 

We know that addicts suffer horribly because their do things in their lives that do not match what they truly value and what they truly believe. What has been controlling them is the substance. And we often find that those in early recovery are still being controlled by outside forces: family, financial crises, and so on. The secret to this dilemma is written on the AA chip: “To thine own self be true.”

Of course, being true to yourself doesn’t mean that you get to do anything that you feel like doing. You live in a world over which you have little control. This is our second topic: How do you take control of your life in a world that dictates everything from how fast you can drive your car to the fact that you will die. No matter how much you may want to play basketball in the NBA, if you’re 5’2” it’s not going to happen. That’s just the way the world is.

Our third topic reminds you that the key to happiness is to live a personally meaningful life. If you are living a personally meaningful life, then the byproduct will be that you are happy. You don’t even have to work at being happy; it just comes naturally.

The fourth topic is about suffering. Sadly, many people think that living the good life means not suffering. All those advertisements telling you that suffering is not necessary and can be avoided are wrong. If happiness depended on lack of suffering, then no one would be happy. Everybody suffers. So what’s the trick to dealing with suffering?

The fifth topic is on putting it all together.

Theme One—You are the author of your life

You are the author of your life. This is also backed up by research on recovery. In fact, it is likely the most important factor in your recovery, although in psychology we use terms such as “intrinsic motivation” or “internal locus of control.” Basically, being the author of your life means that it’s your job to figure out how to live your life.

You have one life to live, so how do you want to live it? That’s the bottom-line question that faces every human being. There will be no thunder-bolts coming down from the heavens to save you; you have to make choices.

You have lots of options. You can, for instance, become one of the crowd. There’s great benefit in this. You’ll be accepted, and you’ll have less conflict in life. But, of course, you likely won’t feel very good. In previous articles, we talked about the great psychologist, Rollo May, who said being one of the crowd was the single greatest reason why people suffered in the 20th century. People agreed to be part of the “herd” because they had such a desperate need to feel ‘part of’ that they were willing to give up what they valued and believed. Eugene O’Neill called them the “spiritual middle-class: how petty their dreams must have been.”

Similarly, you can live your life by avoiding things that make you uncomfortable. If you’re worried about being hurt by someone close to you, then you don’t have to get close to anyone. If you’re filled with worries about finances, you can choose to stay at your job even if you really don’t like it. If being around family makes you uncomfortable, you don’t have to deal with them.

Another option: You can choose to be a victim of life. ‘If only I hadn’t had such a lousy upbringing….’ Or ‘My family should stop treating me as a kid’. Or ‘It’s unfair that I got this disease….’

The choice is yours.

Theme Two: Ask Life what it demands of you

Viktor Frankl told us that unhappy people go about the universe demanding that others or things be a certain way. ‘My parents should be fully supportive of me in my recovery’. ‘My life would be so much better if my boss weren’t such a jerk’. ‘I’d fall in love if only I could meet a rich supermodel who would adore me’. ‘I’d be happy if only I had a million dollars’. And so on…

The problem with this approach is that people and things just do what they do, regardless of what you want. The only thing that gets accomplished by demanding things from life is that you get isolated and miserable. Studies of people with cancer, for instance, have shown that those who do not accept the reality of their illness will suffer more than those who do. As strange as this may seem to you, many people who have learned they are HIV+ have said that the diagnosis shocked them into realizing how precious life is.

Bill W. said that a key to recovery was to “Live life on life’s terms.” Frankl’s version of this was “Ask life what it demands of you.” This is the opposite of demanding that others or things be a certain way.

Here’s just one small example:Many clients at Sunshine Coast tell us they have problems making decisions because they don’t want to lose out. “I’ll have a couple of lovers around; that way, if one dumps me, I have a backup.” “I don’t know what to do because I’m afraid of making a bad choice.” People who operate like this have not yet figured out reality. It’s simply part of the rules of life that whatever choice you make, you will lose out. If you choose one lover over another, you lose one. If you choose school over work, you lose the paycheque. If you work on Saturdays, you may miss your son’s soccer game. This is reality.

(BTW, not making a choice is a choice. When you don’t take control and choose, reality eventually steps in and makes the choice for you.)

Theme Three: Happiness means living a personally meaningful life

This is, of course, Viktor Frankl’s theory of human happiness. As we mentioned last month, psychology is torn between whether the key is to live a hedonistic life (do what makes you feel good) or to live a meaningful life. At Sunshine Coast, we go with Frankl.

We often ask questions to Sunshine Coast clients to help them begin the process of figuring out what is meaningful to them. Why would you bother going through the irritation of cleaning up? What is it about your life that you are willing to fight for it? What makes you want to get up in the morning with energy and passion? Of course, most clients struggle with these questions, but they are fundamental to recovery.

As we’ve mentioned many times to our clients, happiness is what recovery is really about — which means that living a meaningful life is what recovery is all about. So many people run into trouble because they believe that the goal of recovery is abstinence or going to three AA meetings each week or eating right, and so on. These goals hardly equal living a meaningful life. You have to keep your eye on what makes you feel fulfilled, contented, alive. The big picture in your life. 

Theme Four: The problem of suffering

Suffering is one of those things that people have been trying to make sense of for millennia, and we’ve touched on this idea in several online programs. At Sunshine Coast, we help clients find ways to eliminate unnecessary suffering due to their addictions, but we also try to help them make sense of their suffering in a new way.

Shifting how you look at suffering is important for recovery. Modern research is showing that your life will improve if you can find meaning in suffering. It is through suffering that people often transform and discover how to live a fulfilling and vital life. In fact, it is usually because of suffering that we change how we live.

The first part of transforming suffering is to accept it. One of those truisms in life is that sh*t happens. Remember that old saying (about 2100 years old, actually): It’s not about what happens to you, it’s about how you deal with it. For the rest of your life, there will be lots of things happening to you that are not so pleasant or unexpected and really irritating. You may be hurt by a lover, find yourself in a ridiculous lawsuit because of a disgruntled person, be the victim of a scam, break your leg while skiing, find that someone has broken a promise to you, realize that someone lied to you, and on and on.

The second part of transforming suffering is to rise above it. Psychologist Paul Wong who developed the therapy model we use at Sunshine Coast, and who is suffering from cancer, told us last summer: “I’m thankful that I’ve suffered so much in my life.” Suffering had taught him to stick to his values regardless of outside pressure. It taught him how beautiful life could be. It taught him that he could be a role model for others who suffered but who did not know how to handle suffering. And so on. Paul has not avoided suffering—he’s risen above it.

Theme Five—Living the good life

Here’s just one of all the fellows who went through Sunshine Coast: After his fourth time hitting bottom, Harry (not his real name) decided that he had to do something with his life. In his first time at Sunshine Coast (third treatment center), Harry, a senior citizen whose wife passed away recently, was in rough physical shape. He learned how not to live his life. After treatment, he went to AA but found it boring and had no feeling that he really belonged there. He lived along and didn’t have much contact with his kids. The only real contact was with his alcoholic neighbor. Six months later, he relapsed.

When he came back to Sunshine Coast for his second time, he figured out that he needed a reason not to quit drinking. So he put together an impressive plan for how to live a full life, in spite of his physical ailments, age, and loss of his wife. We hear from Harry every once in a while—he now has a couple of years of sobriety and tells us that he is doing well.

What had happened? I would suggest that Harry finally realized that if he wanted any sort of life, he’d have to make it happen for himself. He had to fight for his life, which meant that he had to believe that he was worth fighting for. He used his creative intelligence to figure out how he could live in a way that made him feel satisfied, and he put all the pieces together. He returned to AA, but this time found a home group where he felt he fit in. He started to volunteer at a place that he felt he could contribute his talents. He made a schedule to meet with his kids. 

Not that everything was easy or worked out for Harry. When he screwed up, he learned from it. He fought through the cravings, knowing that he was quite capable of this. He didn’t say ‘F-it’ and give up when he was having a bad day. He didn’t blame others or his health or for his misery. He had a mission to live a better life.

By Geoff Thompson, MA CCC
Program Director
Sunshine Coast Health Center

We are relational beings, which means that we were born to live with others. The evidence for this seems overwhelming. Some psychologists believe that we are ‘hardwired’ for relationships. Our brains are designed to be with other people. A famous psychologist, Roy Baumeister, argues that the reason human children take so long to become independent—compared with any other animal—is that they have to learn how to live with others.

As you know, one of the worst dynamics of addiction is that it isolates the user. Loneliness is a feeling that all addicts have. This isn’t just the feeling of boredom because you have no one to go out with on a Friday night; it is a deep and intrusive feeling that you are separated from the rest of the world. As one client put it, “I used to go out on the street and see people smiling and wonder how they could be happy.” Of course, using drugs usually gets rid of the feeling, at least temporarily.

So, one of the keys to recovery is to feel connected with others. This is a human thing, a natural yearning of individuals. It’s a big part of what gives us meaning in life, what makes us happy.

The old Greek philosopher, Aristotle, said that without friends no one would choose to live, even if he had money and health and fame. We know that one of the worst punishments for people is to deprive them of the community of others (ostracism). Being ostracized is considered the worst punishment. In China, for instance, someone who goes against the prescribed behaviors is often ostracized. Posters with the person’s face and name tell people in the community not to talk to the person. In some religions, being excommunicated is a grave punishment. And a few centuries ago, being banished from the land was considered a fate worse than death.

Being shunned by others or excluded from a group increases activity in the part of your brain called the anterior cingulate cortex. This is the part of your brain that is also stimulated when you feel physical pain. So some psychologists have argued that when you feel shunned, you feel the same “emotional unpleasantness” that you endure when you are in physical pain.

And psychologists have discovered—to their great surprise—that many computer users feel ostracized when they are ignored in chat rooms. The name they’ve given this is “cyber-ostracism.”

Psychologist Bruce Alexander observed that addicts need to hang out together. Because they have distanced their clean and sober family and friends, they find a sense of belonging with other users—not an ideal situation but better than nothing.

An interesting fact is that we know from research that when we feel loved and supported, our self-esteem rises. On the other hand, if we don’t feel support of others, then our self-esteem is low. This is useful knowledge for counselors because if someone tells us that he has low self-esteem, he is also telling us that he does not feel connected with others. He’s missing an essential part of what he needs for recovery.

Part One: Group Therapy at Sunshine Coast

If you are an alumni of Sunshine Coast, you know that we use a lot of group therapy. There is a reason for this. Addicts tend to be lonely, feeling as if they don’t belong. And this, of course, means they have low self-esteem. The idea of using group, rather than relying exclusively on individual therapy is, in part, to help clients in early recovery regain a sense of belonging, to realize that there is nothing wrong with them, that they are not different. And a nice by-product of this is that the client’s self-esteem improves.  

As well as connecting with others, group therapy is also a good way to get to know yourself. It is one of those peculiar things about humans that they gain most of their self awareness not from figuring out things for themselves but by getting feedback from others. Some of you may have learned about the Johari Window. According to this psychology model, we are blind to some parts of ourselves; others, however, are not. They see things that we don’t know about ourselves, and group therapy provides the opportunity for us to learn about this blind side.

But group therapy is more important than simply learning about our blind side. Irvin Yalom, the guru of group therapy, says that you can know yourself only by getting input from other people. Who you think you are as a person is based in great part on how others treat you. (By the way, that’s one of the main reasons why those who feel loved have good self-esteem.)

Part Two: Sense of belonging

The internet has become part of our natural need to feel related to others. Those entering college report that they spend from one to five or more hours each week on social networking sites, such as Facebook. If you understand the importance of relationships to human beings, then it’s really no surprise why these sites are so popular, not to mention text messaging.

Eugene O’Neill, the great addict-writer, said that the reason he got loaded was because he never felt a sense of belonging in the world. He never felt part of… until he got drunk. His solution was to find a sense of belonging, to feel part of something, but without the need for the booze. Although he knew nothing of AA or addiction treatment, he figured out one of the key dynamics of recovery—it’s important to feel a sense of belonging.

If you were a client at Sunshine Coast, you remember we talked constantly about getting a support group. Many people in early recovery don’t pay as much attention to a support group as they should. But if you realize that this is a natural human thing that is necessary for happiness, it might help you understand just how powerful being supported is—and why it’s worth the effort to find a group of people. Those who have support networks have people who can listen to them and treat them as important people. The sense of being listened to is important for everyone but particularly for those who are in pain.

Part Three: Feeling connected with others

At Sunshine Coast, we define addiction with the great psychiatrist, Viktor Frankl, who said that addiction was a response to living a live that was not particularly comfortable, which seemed to have no direction, in which you felt you did not really fit in. Frankl called this living a life that had no personal meaning.

One of the important things to recognize from Frankl is that addiction is serving a specific purpose for the addict. It allows him to exist in a world in which he feels he does not belong. In other words, addiction is a substitute for living a meaningful life.

The solution to addiction was, for Frankl, to live a life that feels personally meaningful. If you live this life, then the addiction serves no purpose. And this is one of the things we’ve been discovering about recovery. Those who are living lives where they feel are worthwhile, where they have good self-esteem, have little interest in getting loaded—the drugs no long serve a purpose.

If we had to pick one reason why alumni of Sunshine Coast slipped or relapsed after treatment, it would be hard to find a better one than difficulty in relationships. The alumni who have had slips often call us up. Inevitably, what triggered the relapse was a situation in which they no longer felt comfortable in a relationship (or they were still feeling isolated and alone).

Part Four: The good and the bad of relationships

In this article we’ve been talking this month about relationships and their importance for living the good life. And when you are living a good life, one where you feel a sense of belonging, then drugs lose their power.

But not all relationships are necessarily healthy ones.

We have a natural need to find a sense of belonging. Studies of the modern ‘gangs’ have shown that they are appealing only for those who are lost or who don’t feel they fit in with regular society. Around the world, terrorists find a ready supply of disciples in third-world ghettos and among the displaced. So, we can find a sense of belonging in family and community or we can find a sense of belonging with gangs or fanatical movements.

One of the sad things about gangs is they demand that the members follow a code or set of rules of behavior. Many gang members have to go against their values or beliefs in order to be part of the group. We’ve talked before on the online program about people who give up who they are—what they value and believe—in order to fit in with a group.  This is a recipe for suffering. Of course, it tells us how important it is to find a sense of belonging. But it’s one of those sad things about people that we can be so desperate that we are willing to give up our identity to belong. 

Another example of this is abusive relationships. When the fear of being alone is greater than the fear of abuse, many people stay in abusive relationships. We’ve seen over the years that many clients stay in relationships that are not healthy. They seem afraid of standing up and saying, ‘This isn’t working out’. And we’ve seen over the years that some clients have many relationships on the go at the same time. Their thinking seems to be, ‘If this one doesn’t work out, I always have another one ready to step in’. What this tells us is just how great the fear of being alone really is.

By Geoff Thompson - MA, CCC
Program Director
Sunshine Coast Health Center

Addicts do not like surprises. That’s why they are, what we affectionately call, control freaks. It’s important for recovery to overcome this desire to control, which means learning to live comfortably in the grey areas of life. The grey areas are those times when there are no immediate solutions to problems, no immediate answers to questions, no understanding of how things will work out in the future…no control.

The AA Big Book makes a big deal about the addict’s desire to control:

“Each person is like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in his own way. If his arrangements would only stay put, if only people would do as he wished, the show would be great. Everybody, including himself, would be pleased.”

Psychologists, too, have noticed that addicts are obsessed with trying to manipulate others and events. Why? If people do what the addict wants, and life happens as the addict wants, then the addict feels better. Those who relapse inevitably tell us that people or things didn’t work out as they wanted or expected; they got stressed out and relapsed.

And that’s a BIG problem: People and things don’t operate according to the addict’s wishes. As the Big Books says, “What usually happens? The show doesn’t come off very well.” And then the addict gets irritated and tries to be even more controlling.

Giving up this desire to control is one of the keys to recovery. But it’s tough. If the addict doesn’t control people, places, and things, then he might get surprised. Those curveballs in life upset him. He might have to exist in a world where there are no immediate answers. He might have to deal with all those unexpected things in life.

And the unexpected can be complicated. Say an alumnus was hurt deeply because his partner cheated on him. They split up, but he would like another relationship. If he gives up his desire to control, then he has to take the risk that he might get hurt again. Or say an alumnus worries about talking in public. He can either try to keep control by never speaking in public, or he can take a risk and give it a shot. But who knows what will happen? Perhaps the audience will laugh at him. Or say an alumnus only likes his job because of the paycheque. He could go back to the job because it’s good money, or he could face all the uncertainties of finding new work.

The idea of giving up the need to control is frightening for most in early recovery. It demands that they learn to live in a world they have little power over. Of course, they never really had control, but the thought of voluntarily giving it up is what stresses them.

In this article we’ll look at why those in early recovery are so desperate to control the world they live in, and then we’ll provide a few techniques that you, as a person in recovery, can use to learn to live comfortably—when you don’t have answers, when you can’t see how things will work out, when you accept that you have no control over life.

Part One: Why Addicts Want Control

It is true that all people need to feel in charge of their lives. Happy people have figured out how to do this. Unhappy people haven’t. The best tactic that unhappy people can think of is to control others and, as the Big Book says, “the lighting, the scenery, etc.”

Addicts have all sorts of tactics to take control. Here are some examples from Sunshine Coast clients: Guilt a family member into doing something: “You’ve never cared about me and what I need.” Blackmail: “If you don’t do what I want you to do, I’ll relapse.” Directive: “You have to learn to quit nagging me, so you should go to Al-Anon or a therapist.”

These tactics show up all the time in Sunshine Coast groups. “You [counsellor] are causing me to get angry.” “I lost 10 days of treatment because you [staff] didn’t do your job.” “If I don’t get to the EI office in one hour, then I’ll have a really bad day.” And so on. Of course, in group, this is fantastic stuff to work with, helping clients understand that they [not staff] determine how they feel.

And others had better change quickly. Few things seem to drive recovering addicts crazy more than not having a problem fixed instantly.

It’s pretty obvious that life does not operate according to what the addict wants. So why does he keep trying to control it? The answer is simple: Fear. What would happen if he did not control others and things? The outcome, life, would be unpredictable. He might get surprised. He may be hurt by what happens. How will he deal with hurt and stress without retreating to the bottle or the drug?

He might even have to accept that he is the author of his life. Yeow! And if he is in charge of his life, then there is no one to blame. No easy way out. If there is no one to blame, then he has to change if he wants a better life. He has to give up all the excuses.

And that’s scary.

Part Two: Step Back and Reflect

One of the best techniques to learn how to live in the grey area of life is to step back and have a look at a situation that is not meeting your expectations. Whenever you find yourself frustrated, take a moment and reflect. How important is it, really? If you don’t get something done immediately, will this have an impact on you five years from now? What is so important about this particular situation that it MUST be resolved immediately?

A typical example with Sunshine Coast clients is when they have an unpleasant phone call with a family member. They or the family member hangs up abruptly. The client often becomes almost panicky—a desperation—he has to resolve the problem. We’ve seen clients phone back half a dozen times trying to settle the issue. And clients often tell us that an unresolved issue “ruined my whole day.”

But when we talk with the client about the situation, we usually discover that there is no panic. There is no need for the problem to be fixed immediately. The client may want the issue resolved but there is no need for some immediate solution (having something settled is why, by the way, we often hear clients say: “I don’t care which way it goes; I just want it settled.”)

One of the reasons that this technique of stepping back and reflecting works is because you get some distance from the situation. If you can reflect on it, then you won’t act in some knee-jerk manner, reacting out of habit. Anyone who constantly blames others for his suffering, like any other repeated behavior, will turn it into a habit. Just look at kids. Most younger kids constantly blame their brother or sister, friends, teachers, parents, and so on for their struggles.

Part Three: Are you making sense of a situation in a way that is responsive to reality?

Under the new program at Sunshine Coast, we stress two things. First, everyone interprets the world in a unique way; that is, everyone makes sense of the world differently. Secondly, each person makes decisions that determine the kind of life he gets.

Based on these two ideas, another technique you can use is to reflect on how you make sense of a situation. Last week we talked about taking time to think about a situation that upsets you—is there really any need to control it? But it’s also important to think about a situation in a way that will help you. When you are feeling frustrated because someone is or is not doing something that you want them to do, or life isn’t working out the way you want it to, ask yourself how you are interpreting the situation. If you are an alumni of Sunshine Coast, you may remember from your counselling this is what your counsellor asked you.

Say you are frustrated with your parents. You get yourself in financial trouble, and they refuse to help you out. You have no idea how to solve your finances other than by relying on your parents. You get angry and tell them, “It’s obvious you don’t care about me. I’m trying to get my life together, I run into a bit of trouble, and you don’t care enough about me to even help me out.”

So, the first question is about how you are making sense of this situation. Have you decided that how you interpret it is the truth; therefore, any other interpretation must be wrong? (This is a very common tactic, by the way.) What is your parents’ interpretation of the situation? Why did they decide not to help you? Is there some merit in how they are interpreting the situation?

The second question is based on the idea that you are the author of your life. Have you accepted that you are in charge of your life? Are you blaming others for your suffering; that is, is your financial problem your problem or your family’s? What are your other options if the family doesn’t help you out?

This is a simple example that probably doesn’t apply to you, even though it comes from a SCHC alumnus. But you likely have your own examples: getting irritated because you got put on hold by Revenue Canada, and you needed some information to finish your tax return; getting upset with a lover because she/he did not listen to you; getting upset with your boss; getting upset while driving because someone cut you off; getting upset with a delay at the airport because you are on a tight schedule; avoiding going to a doctor because you are afraid of what she/he might diagnose; putting off a phone call because you are afraid of how the other person might react; and so on and so on.

Part Four: Shifting how you make sense of the world

The real key to living comfortably in the grey area of life is to make sense of the world in a different way. Rather than feeling the need to take control to protect yourself, recovery demands that you accept that others will do as they choose (regardless of what you want them to do), and things will happen (regardless of whether you want them to).

Those in early recovery generally interpret the world as dangerous. Lovers can hurt them, employers can make them miserable, cars can break down, police can pull them over for a breathalyzer, families can refuse them financial help, friends can betray them, and so on. Because of this danger, they believe that they must protect themselves by controlling others and things. But despite the slickness of their control tactics (and addicts are quite famous for their slickness), this control rarely works out.

Recovery demands a different approach. The 12-step program suggests that addicts “let go and let God.” What AA/NA mean by this is that the addict has to practice giving up control. Life simply works out as it should, and what happens is what should happen—even if the addict does not like the way things work out. The 12-step program puts a great deal of emphasis on allowing a higher power take control because if the addict will allow this, then he or she no longer feels the need to control.

A technique from psychology is provided by the great psychiatrist Viktor Frankl. If you were at Sunshine Coast under the new program, you’ve already heard of it. Go about your day with this question in your head: “What does Life demand of me?” We’ve talked about this technique before, but it’s so good that we can’t emphasize it enough.

Here are some examples of asking life what it demands of you. You are in a hurry, and your car has a flat tire. So, rather than getting bent out of shape, what are your options? Your lover won’t listen to you. Rather than getting bent out of shape, perhaps it’s best to give your lover some time and space to settle down (a day, a week). You get to the airport and discover that your flight is delayed three hours. Rather than getting bent out of shape by this, what could you do the make this time most productive. It’s Sunday afternoon and you have nothing to do. Rather than getting bored, what could you do with this time? And so on.

Notice that each of these situations ends with what YOU could do.

Part Five: Attitude is Everything

In this article I have mentioned that the real key to giving up control—of learning to live comfortably in the key areas of life—is to change the way we make sense of the world. To achieve this, the 12 Steps suggests you “let go and let God.” Viktor Frankl said to ask Life what it demands of you.

Another technique is to change your attitude to life. Most people in active addiction and in early recovery don’t have a great attitude. This is not surprising; their lives are a catalogue of misery and suffering. And most are exhausted from the unrelenting demands of addiction. It’s not as if addicts can take a couple of months vacation from the addiction and go down to Florida for a break. Why would they take a positive attitude to life?

One of the keys to recovery, and to happiness, is to change things from being a chore to some positive effect:
• Cravings are a sign that you are recovering.
• A bad experience is an opportunity to learn and become stronger.
• Parents who refuse to give you money are giving you the space to be your own man.
• A severe illness is a sign that you’d better get on with the business of living.
• Addiction is a wake-up call that you’ve been missing out on life.
• Hitting a wall on your way to a goal is an opportunity to develop creativity and hardiness. (The basis for just about every Hollywood movie.)

Conclusion

Each of these positive ways of looking at problems can happen only with a positive attitude. This was one of Viktor Frankl’s key points. You are quite capable of developing this attitude; the key is whether you are willing to fight for a better life, whether you think that you are important enough to dig deep and overcome adversity. Sadly, many in recovery crash and burn when faced with real challenge.

By Geoff Thompson
Program Director
Sunshine Coast Health Center

Several of the alumni have been asking recently about the biology of addiction. One asked whether eating sugar was a sign that one was still in addiction (sugar is a mood-altering substance); another fellow asked if it were possible to be born an addict.

These questions are asking if addiction is mainly a biological condition. That is, is addiction mainly a disease or illness? There’s a lot of controversy about whether addiction is a disease or not. And this debate is a good thing, because it means that people are talking openly about what addiction is. There is energy on both sides of the debate, bringing in new life.  

This article will look at this debate. It’s interesting in itself; researchers and clinicians like to argue about these details. But for those in recovery, this is not an academic question, removed from life. The answer that you tell yourself will dictate, in large part, how you live your life in recovery.

Those who believe that addiction is a disease will likely have a different recovery plan than those who do not believe it is a disease.

If you believe addiction is a disease, then you face certain ‘realities’. For example, you have to come to terms with the ‘fact’ that the disease of addiction has no cure. Most people compare it with diabetes; others say it is a “brain disease” like depression. In either case, though, recovery demands daily treatment. This treatment may be through self-help programs such as Alcoholics Anonymous or SMART Recovery. It may be through long-term counseling. Or both.

Those who adhere to the disease model also believe that they will always have a dagger hanging over their heads. They have to learn to accept this situation, because having a slip means there is a real danger of again being overcome by the addiction—it’s the interaction of the drug with the brain that is the addict’s illness.

Those who do not believe addiction is a disease still have to deal with the effects of drugs on their brains. They know they will have to deal with cravings and other neurobiological effects. They know that they will likely have troubles if they are not true to themselves. But they don’t believe that they are only one drink or drug away from being plunged back into active addiction. This is because they do not believe that the substance is the problem; that is, they don’t believe that their brains are hijacked by the drug.

Generally, they believe that they will ‘recover’. Those who believe in the disease model, on the other hand, face the prospect that they will be in recovery for the rest of their lives.

So let’s examine some of the more public examples of the disease debate. As always, if you are in recovery you are the author of your life, so you’ll have to figure this out for yourself.

Part One: Alcoholics Anonymous and Disease

The Big Book of AA states that alcoholism is an “illness.” Of course, it’s a very strange illness, since the Big Book also says that alcoholism is “an illness which only a spiritual experience will conquer.” At one point, the book calls alcoholism a “spiritual disease.”

When we examine the meaning of the words illness and disease in the Big Book, it is obvious that they are not technical terms. Bill W. never took a medical course in his life and certainly knew nothing of Koch’s Postulates (or other illness definitions), which is how diseases have been identified scientifically for more than a century. (You can google Koch’s Postulates if you’re interested.)

So, if the Big Book doesn’t define illness or disease in a technical sense, then why does it use these words? Generally speaking, the Big Book uses the terms as metaphors. The early members of AA wanted to point out a couple of things about alcoholism. First, they knew that alcoholics reacted differently to alcohol than did non-alcoholics. They were also convinced that there must be a biological reason for this, which is why AA looked to Dr. William Silkworth and several other physicians as sources of scientific information.

Apart from the doctors’ opinions, they also knew that alcoholics were not particularly comfortable in the world; they had a “dis-ease.” The idea of ‘dis-ease’ provides a much better definition of how the Big Book uses the word.

As an aside, it is one of the more baffling things historically that AA became associated with the disease/illness model of addiction. AA is, after all, a bunch of alcoholics, not medical doctors. Most experts have suggested that the reason why the public links AA with disease was that AA received two major public awards.

The 1951 Lasker Award of the American Public Health Association was awarded to AA. The citation read, in part, “In emphasizing alcoholism as an illness, the social stigma associated with this condition is being blotted out.” The 1983 President’s Service Medal was presented to AA, praising Bill Wilson and Bob Smith for “helping each other to overcome the disease.” So the public latched on to these medical ideas, even though the Big Book clearly considers alcoholism as a “spiritual condition that requires a spiritual solution.”

Part Two: Dr. George Vaillant and Addiction Medicine

Perhaps the most famous addiction medical doctor (a psychiatrist), George Vaillant, says that addiction is a “disease.” Dr. Vaillant is a top-of-the-line researcher at Harvard University Medical School. In fact the medical doctors who specialize in addiction medicine state publicly in their association that addiction is a disease.

It’s interesting that because Dr. Vaillant knows so much, he is very open in saying that there are good reasons for not calling alcoholism a disease!

One of his major points is that medical experts don’t actually agree on what a disease is. They keep changing their minds whether, for example, ‘heart disease’ is a disease or a lifestyle problem. He lists several other objections, but the most important is that alcoholism is a “behavior.” In fact, he says, “alcoholism is often better treated by psychologists skilled in behavior therapy than by physicians with all their medical armamentarium.”

Although Vaillant is quite convinced that alcoholism is a medical issue, he also says “In other words, calling alcoholism a disease, rather than a behavior disorder, is a useful device both to persuade the alcoholic to admit his alcoholism and to provide a ticket for admission into the health care system. I willingly concede, however, that alcohol dependence lies on a continuum and that in scientific terms ‘behavior disorder’ will often be a happier semantic [word] choice than ‘disease’.”

To sum up, if addiction is a disease, it’s an odd one; and, technically, it is probably better to call it a behavior disorder. However, if alcoholics think they have a condition similar to heart disease or diabetes, then they will more likely ask for help. And if the public thinks it is a disease, then it won’t stigmatize addicts and think of them as criminals and irresponsible lay-abouts.

Part Three: Dr. Nora Volkow and Neuroscience

The July 16, 2007, issue of Time magazine said that addiction is a “disease,” because drugs “co-opt” the brain. The March 3, 2008, issue of Newsweek reported that drug use is a “disease,” because drugs “hijack” the brain, leaving the addict powerless.

The journalists who wrote for Time and Newsweek got their information from Nora Volkow and her colleagues. Dr. Volkow is the head of the National Institute of Drug Abuse (NIDA). NIDA is the US national institute of health concerned with ‘drugs’ (the other is the ‘alcohol’ institute of health). These institutions are funded by the federal US government, and are quite public that they consider addiction a disease.

Dr. Volkow’s perspective is a little different than Dr. Vaillant’s. Volkow is more specific, calling it not merely a disease, but a “brain disease.” It’s almost routine that when journalists want information, they ask NIDA, which is why Volkow shows up often on television and in newspapers and magazines.

Basically, she says that addiction is biological, a direct result of the effects of the substance interacting with the brain. The brain progressively deteriorates just as in any disease. From her point of view, because addiction is a disease, it will be ‘cured’. Through some medical procedure to be discovered, she is quite certain that we will eliminate the disease, just as we have essentially eliminated leprosy.

Of course, other brain scientists think Dr. Volkow’s belief in a cure is wishful thinking. One of their major arguments is that the brain is so complex that it will likely not be possible.

Part Four: Addiction as Not a Disease

So now we have shown the theories of two of the finest scientific minds studying addiction: Dr. George Vaillant of Harvard Medical School and Dr. Nora Volkow, who is head of one of the biggest drug research institutes in the world.

Both of these scientists tell us that addiction is, essentially, a disease. But other, equally competent researchers say it is not a disease. These anti-disease experts argue that although there may be a physical basis in the brain for drug use, this does not mean addiction is a disease, and many say it is not even an illness.

They provide lots of evidence for not considering addiction as a disease. William Miller, one of the gurus in the field, says that addiction is a matter of motivation. Bruce Alexander says that drug use is a response to not having a deep sense of belonging (remember Rat Park). Stanton Peele says that drug use is essentially a combination of lack of direction in life and an unhealthy environment. In fact, Stanton Peele wrote a book complaining about the medical professionals who were attempting to convince us that we’re all diseased. 

Conclusion

Thinking of addiction as a disease poses some problems. First, it eliminates sex, gambling, and other behaviors as addictions, because there is no substance to “hijack” the brain. They also point out that there are documented cases of alcoholics becoming social drinkers, something which seems impossible if addiction is a physical illness. And they point out that Dr. Lee Robins would not have found that most Vietnam Vets gave up the heroin on their own after they returned to the US if heroin had “hijacked” the soldiers’ brains.

And almost all psychology textbooks used in university show research that contradicts the idea that addiction is a physical illness.

Geoff Thompson, MA, CCC

Geoff Thompson, Program Director for Sunshine Coast Health Centre, discusses Aaron Antonovsky’s “Sense of Coherence” study and why those with a higher “S.O.C.” score are more likely to succeed in their recovery.

Geoff Thompson, MA, CCC

Geoff Thompson, Program Director for Sunshine Coast Health Centre, talks about the difficulty of defining what spirituality really is.

Cathy Patterson-Sterling, MA, RCC

Cathy Patterson-Sterling, Director of Family Services at Sunshine Coast Health Centre, talks about the label of “codependency.”

Cathy Patterson-Sterling, MA, RCC

Cathy Patterson-Sterling, Director of Family Services, discusses “PAWS” or Post-Accute Withdrawal Syndrome and the key points in an individual’s recovery where there may be a higher chance of relapse.

Geoff Thompson, MA, CCC

Geoff Thompson, Program Director for Sunshine Coast Health Centre, talks about Ernest Hemingway’s catch phrase, “… grace under pressure” and facing struggles in life heroically rather than as a victim.