Roots of PTSD, Codependency, and Addiction

3291628045_03efb76f53_zMy 33rd year of recovery from alcohol addiction began Nov. 24, 2009. Needless to say to anyone living a spiritual quest, many emotions are stirred up during an anniversary.

In taking another 5th step, I realized that I had recreated the home of my childhood.  I had the good mommy role and my husband was the bad daddy. As I have stated here, he acted out his misery by having an affair and leaving me.

This experience has led me on the path of healing my childhood wounds. I was the oldest child–or rather–I was the youngest parent in that home. I took my duties so seriously that I taught myself to deny myself anything that would challenge my mother. In return, the power connected to this role of being the boss was my first addiction. One that I am only now giving up. That is why I call codependency the addiction of power. And I believe all addicts must go through this 2nd recovery–the recovery of codependency. I will always be codependent. It is about loving too much. But I know my pattern now and know when I need to redefine my boundaries.

What is PTSD? HelpGuide. org defines it:

“Post-traumatic stress disorder (PTSD) can develop following a event that threatens—or appears to threaten—your safety. Most people associate PTSD with rape and battle-scarred soldiers—and military combat is the most common cause in men—but any event (or series of events) that overwhelms you with feelings of hopelessness and helplessness can trigger PTSD, especially if the event feels unpredictable and uncontrollable.”

“PTSD can affect people who personally experience a threatening event, those who witness the event, or those who pick up the pieces afterwards, such as emergency workers. PTSD can also result from surgery performed on children so young they don’t understand what’s happening to them, or any event that leaves you emotionally shattered.”

In reading about Iraq veterans and PTSD, I identified immediately with the social isolation. I have done this all my life. Although I am a loner and am suspicious of anyone not content being alone, extreme isolation leads me to paranoia and discontent. I am learning a balance finally because I have now freed myself to talk about these feelings.

I have also identified the brain chemistry associated with my codependency. I have a separate blog about Codependency Recovery. Codependency recovery basics are: having healthy boundaries, learning assertiveness, identifying your core issue, finding out what hooks you, knowing that caregiving is a control issue, developing compassionate detachment, adding self nurturing activities, using relaxation techniques, developing mindfulness techniques to live in the moment, and identifying your triggers.

So I have begun learning how to reparent myself. I have created a separate blog about reparenting: The Free Road: Reparenting Ourselves.

I was thrilled to find Dennis Thombs’s book, Introduction to Addictive Behaviors. What I identified with was his belief that we used our addictions to combat feelings of anxiety (fear) that we never learned to process.

I will continue researching PTSD, codependency and addiction as I know that my addiction began when as a child. I didn’t l know how to deal with anxiety and fear. Instead I used feelings of power over people to feel better myself. Therefore, I believe codependency to be the addiction of power. By feeling control over others’ lives, I felt better able to control my own.

Photo credit.

Forcing Anyone to Hit Bottom Can Be a Death Sentence

Family at the Golden Gate BridgeToday is a reprint about tough love from a Facebook page. David Sheff writes about his struggle with this concept and the help he received from Al Anon. I agree that forcing others to hit bottom may be pronouncing a death sentence. I have seen hundreds of people over these 39+ years to be helped by repeated interventions and being court-ordered to recovery.

From David Sheff- the following is an excerpt–read the whole post at the link.

“I’ve edited this post. After reading some comments, I understand that I didn’t clearly express what angered me. My anger is toward the archaic and harmful view of those who tell people — who *insist* — that an addict must hit bottom before he or she can begin recovery.

It began yesterday. A father had written. He was in anguish. He told me that he had kicked his son out of the house. He’d been told that he had to have no communication with his son. He was told that he had to stop helping him in any way. He was told that his son had to be left isolated and alone so he would hit bottom.

The dad didn’t want to do it, but nothing else had worked. His son had relapsed again and again after a number of treatment programs. He said that he’d been told again and again that he was co-dependent and was contributing to his son’s addiction. And so, desperate and resigned and heartbroken, he shut the door on his son and told him that he’d have nothing further to do with him until– unless his child was clean and sober for a substantial period of time. When my son was using, I’d heard the same thing. Some rehab counselors and parents in Al-Anon meetings said that Nic had to hit bottom and drag himself into treatment if ever he would get and stay sober. More than once, I was told that I had to sever ties with Nic until he’d been clean for a year.

I didn’t know what to do. Like so many others, the father and I were desperate. Over time, I had been indoctrinated by counselors, therapists, and people in 12 step groups who espouse the concept of hitting bottom. They insisted on it. Anything short of allowing an addict to hit bottom is, they said, codependent and contributing to the addiction.

But Al-Anon doesn’t advocate this approach. Al-Anon is wonderful –it helped me. It doesn’t tell us to let a child or spouse or other loved one live on the street. It doesn’t tell us to give them ultimatums or cut off contact with them. My understanding of the program is that it can help us learn to take better care of ourselves and separate helping from enabling. In those meetings, we can learn from one another’s experiences, learn about addiction, learn how it can destroy families and how we must take care of and protect ourselves, and we can support one another. As far as I understand it, though, Al-Anon doesn’t advocate forsaking our addicted children, closing the door on them, and waiting for a catastrophe that will get them into treatment–if it doesn’t kill them. In Twelve Step meetings, some addicts in recovery do say they had to be allowed to hit bottom as a prerequisite to their recovery. It’s important to remember that it may have worked for them. However, it doesn’t for many. ANd it’s dangerous to assume that it will.

Over and over, in program after program, we’re told that we must kick our loved ones out and isolate them in order to get them into treatment, that they must hit bottom and drag themselves into treatment if ever they’ll fully embrace recovery. This warped and dangerous definition of tough love is killing people. Maybe instead of trusting the counselors and others who espouse hitting bottom, we should trust our instincts: Of course we must help a loved one who’s ill get into treatment. We must do everything we can. People say that addicts must want to go into treatment in order for them to stop using. It’s not true; research confirms that whatever brings a person into treatment, he or she has the same likelihood of getting and staying sober.

This doesn’t mean that we don’t set boundaries — we must protect ourselves and other family members. There are many circumstances in which it’s harmful and potentially dangerous to have a using addict living at home. It can be traumatic for parents and siblings. And we don’t want a child in their bedroom using drugs. But nor do we want a child on the streets. We want them safe. On the streets, their drug use will probably continue and it may escalate before they hit bottom. They may never hit bottom. The consequences can be catastrophic.”

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I Went to a Recovery Home in 1977 and It Gave Me the Foundation I Needed to Succeed

16097484060_3c9e39aa47_zIn 1977, being 3 months sober, I had an emotional crisis of feeling that I was on a high cliff and being afraid that I would fall or jump. It was a Sunday and I talked to AA members all day. Everyone I called was home and they helped me to decide that I wasn’t going crazy as I thought but that I needed more help in my recovery. Maranatha Home in Jacksonville, North Carolina was my salvation.

When I went to rehab, I had been sober for 3 months so had no need of detox. I also had been going to daily AA meetings so my rehab started with a foundation. I only drank alcohol. Today’s rehab client often comes to rehab needing detox from several substances. So much of the 30 day program is spent detoxing the client.

With a 90 day program many more benefits can be achieved. I have been supporting Chris Fiore’s work. His “Anthony’s Act” is a grassroots movement to get rehab extended to 90 days. His Facebook page has a petition I signed. The petition states: “We are asking congress to amend the Affordable Care to provide for a minimum of Ninety (90) days inpatient drug or alcohol treatment up to a maximum of One Hundred Eighty (180) days per year at a facility certified to provide such care by the Secretary of Health of the state in which it is located. Let’s give those suffering with addiction a real chance at recovery.”

Dr. David Sack has listed the benefits of having a longer rehab in an article he wrote in 2012 for Psych Central. The article was titled, “How Long is ‘Long-Term’ Drug Rehab?” He lists these benefits–

Detox Doesn’t Dominate. Depending on the individual and their drug history, detox may take up a significant portion of a 30-day drug rehab program. And while detox is a critical part of the process, it is not in itself treatment. With a longer treatment stay, clients still have several weeks or more following detox to engage in the deeper work of recovery.

Healing the Brain. Research shows that the addicted brain can heal over time, but months or years of drug abuse cannot be undone in a few weeks. Brain scans of recovering addicts show that changes are still taking place three months or more after treatment. This is why many recovering addicts report clouded thinking, skills deficits and other issues even months into recovery.

Practical Application of New Skills. Going to drug rehab and “stepping down” to lower levels of care (such as outpatient treatment or a sober living environment) ensures that clients are not thrown back into society prematurely, nor are they sequestered away from the real world without opportunities to test their skills. With gradual increases in freedom, clients can begin applying their new skills with guidance and support from their treatment team.

New Habits Take Root. Recovery requires a change of lifestyle, not just putting an end to drug or alcohol use. It takes anywhere from three weeks to three months to form new habits. Recovering addicts who have already begun to integrate new habits into their daily lives, such as support group meetings, sober recreation, meditation, exercise and other recovery-related activities, will be able to make a smooth transition into life outside rehab.

Living the Relapse Prevention Plan. Every client should leave treatment with a relapse prevention plan. But the person who leaves treatment not only knowing their relapse triggers but also having experience working through them in real time will be that much more secure in their recovery. Spending time in intensive outpatient treatment or a sober living environment provides this type of real-world exposure along with ongoing structure and support. As a result, recovering addicts know how to deal with drug cravings, stress and other common causes of relapse and feel comfortable reaching out to their sponsor, self-help group or loved ones for support.

Healing Relationships. Long-term treatment allows clients to address the complexities of family dynamics, which often contributed to addictive patterns, and begin couples or family counseling, if needed.

Identify and Treat Co-Occurring Disorders. Roughly half of people suffering from drug and alcohol addictions also struggle with other addictions (e.g., sex, food, gambling) and/or mental health disorders (such as depression, anxiety, trauma and eating disorders). These co-occurring disorders do not always come to light early in treatment. In fact, it is often only after intensive therapy and 30-plus days of treatment that these issues surface. Left unidentified and untreated, these underlying problems often lead to relapse.

“Perhaps the greatest testament to the efficacy of long-term treatment can be found in drug rehabs for professionals. Physician health programs, for example, have documented five-year abstinence rates of 79 percent and return to work rates of 96 percent, with virtually no evidence of risk or harm to patients from participating physicians. These programs involve comprehensive treatment followed by long-term monitoring and support that often lasts upwards of five years. This model, which has proven effective for professionals in safety-sensitive occupations, is likely equally effective for others.” Photo credit.

The Double Whammy and Relapse Symptoms

12261705236_7710c765b8_zLiving with the “Double Whammy”–addiction and depression recovery, I have had to learn relapse prevention for both. Luckily for me, I decided in 1976 that I would go all in with addiction recovery. I elected at 3 months sober to go to a very modest home for alcoholic women. At the time, it was the fashion to go to country-club style treatment in North Carolina. But I know that I needed to be in that modest home. While there, we worked the first 3 steps and I found the God of my understanding. I have never had anything happen that was more important to me than staying sober.

But, I have been aware of the power of using the PAWS approach for relapse.

1. From Jeanene Swanson: ‘The Condition Many Recovering Addicts Don’t Know About”:

By definition, PAWS is a series of post-acute symptoms of recovery from dependence on benzodiazepines, barbiturates, and ethanol; opiates; and sometimes, antidepressants. Some commonly abused benzodiazepines are Valium, Xanax, and Ativan, and some opiate drugs of addiction are heroin, Vicodin, and OxyContin. Symptoms of PAWS include mood swings resembling an affective disorder, anhedonia (the inability to feel pleasure from anything beyond use of the drug), insomnia, extreme drug craving and obsession, anxiety and panic attacks, depression, suicidal ideation and suicide, and general cognitive impairment.

“The brain has tremendous capacity to heal, but it doesn’t heal quickly,” says Dr. David Sack, CEO of Promises Treatment Centers and Elements Behavioral Health. Sack says that in general, PAWS symptoms peak around four to eight weeks after quitting. As the body moves toward homeostasis, says Dr. Joseph Lee, Medical Director of the Hazelden Youth Continuum, it has to reach a “new kind of normal” in the process. Some people experience a more prolonged withdrawal, he says, “and it takes a long time to recalibrate.” In fact, instead of feeling better, many addicts in recovery feel worse.

Sack says that most addicts know about PAWS from their experience of quitting and then relapsing because they felt terrible, they just don’t have a name for it. “I felt mostly good for the first five months, then I really felt sort of down and fatalistic,” Parrish says. “I knew I would never drink again, and that was OK, but I felt like I would never heal.” She says it took about four months of feeling “sad and lost” for her to begin to feel like herself again. “In those four months I had episodes of contentment, but felt mostly just down.”

While making new friends, acquiring new coping skills, and getting used to life without drugs is indeed part of recovery, untreated symptoms of PAWS don’t have to be.

More here.

The depression relapse plan involves taking careful notice of your moods and your thoughts.

2. From John Flk-Williams: “What Can Help Prevent Depression Relapse?“:

Depression has an especially cruel season called relapse. It always happens after the worst seems to be over; hope like sunlight is restored; life without depression is in full bloom. Then suddenly it’s winter again. The more often it happened to me, the more impossible the goal of recovery seemed to become.

An especially bad relapse began a couple of months after I had gotten through cancer surgery on a sustained flow of energy and determination. I had been totally up for taking on the cancer surgery, although the diagnosis had initially terrified me. Worries about cancer had also stirred a depression so deep that I felt like giving up completely. I just decided I was going to live, and the new energy marked a powerful turnaround when it came. I’d swung back from despair and passivity to hope and action. I felt I could take on anything.

That spirit had a lot to do with a rapid physical recovery from surgery and also helped me achieve what I thought was a complete recovery from depression. I stayed on this roll for several weeks after the cancer period was over, but then things changed. I didn’t collapse into deep depression all at once. Instead, I started feeling the low-grade listlessness that’s called dysthymia.

This form of depression often filled in the periods between the major episodes, so recovery never seemed to happen. Those were the blah days, no edge, no excitement to anything. There was little motive to action, certainly nothing like “drive” to get things done. I was mostly aware of the deadening routines that filled each day. There was no surprise or shock or excitement – everything turned into an indifferent hum.

That’s what started happening after the recovery following surgery. I was slow to acknowledge the change. As usual, my wife immediately sensed it and started cautiously asking me about the shifting moods she noticed. I got irritable and denied that anything was different.

The truth is that I had a lot vested in the belief that I had gotten over depression. It became almost an article of faith that I had stopped it and could now be myself again. The problem was that I didn’t have a method for dealing with relapse. When I could no longer deny that depression had returned, I was completely demoralized.

More here.

3.  And, finally, check out from What…Me Sober?: “Where’s Your Stash”:

All us addicts have our stashes.  They may be alcohol, drugs, serial sex partners or emotional entanglements, the extra package of Little Debbies hidden in the closet, the credit card that we use for shopping sprees, an extra carton of smokes or bottle of vape … The list goes on and on.  As addicts we aren’t very good at hanging on to those things, but we never feel really secure unless we have that “insurance policy” that helps protect our addiction.

For an addict, that’s normal, but for people in recovery it can be a warning that we aren’t as sober as we might want to believe.  It might be the liquor cabinet for “when friends come over,” or that old bottle of painkillers that we hang onto “just in case” of that sudden toothache that just won’t respond to Advil. It may be an old lover that we cling to as a “friend,” and just don’t seem to be able to separate from entirely (even though there’s another new — or old — lover already on stage or in the wings). Fifteen old pairs of shoes we never wear?  Check.  Stacks of books in case we want to read them again?  Check. That old, mouldy bag of weed on the top closet shelf that we keep “to remind us of what we used to be?’  Check.  The humidor full of old, stale Cubans?  Check.  The nicotine addiction that we justify as “being better than….”  And so on, and so forth.

Our stashes ought to tell us something, if we can manage to see through our denial.  They are definite signs that we haven’t been quite able to let go, to turn it over, to  really come to believe that we are addicts.  And the active addictions that we manage to ignore fall in there, too:  nicotine, kava, shopping, sexual acting out of various kinds, toxic relationships of all kinds, hoarding, any kind of mood-altering behavior done to make us feel better or forget our troubles instead of dealing with life on life’s terms.  All stashes.  We aren’t ready to let go and let…well, you know.

I put it to you that a stash means an active addiction isn’t far away; that we need to examine our behavior and attachments to the things of our past (and perhaps present) addictions.  Like they say, “A drug is a drug is a drug.”  And an addiction is never benign; sooner or later, someone always gets hurt.

More here.

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Evidence-Based Treatment Offers Real Hope to Suffering Addicts

3281480045_6115496013_zThe Affordable Care Act (Obamacare) is changing the addiction/mental health recovery field. The field is shifting away from self-help recovery methods toward a more measureable recovery program. The newer methods are known as evidence-based recovery options. A guide to these programs from SAMHSA (Substance Abuse and Mental Health Services Administration) is shown below in #4.

    1. From Brooke Feldman: “Multiple Pathways to Recovery: It is Time That We Lead The Way“:

Although history has shown us many examples of the oppressed becoming the oppressor, the emergence of this human habit in the addiction recovery communities is one that raises great concern.  Infighting within any social change movement is a common, perhaps even necessary stage, but when people’s lives and well-being are at stake, it seems to me that we ought to shorten this period by taking a step back to regroup and unite.  In addition to there being a clear urgent need to break down all silos and any either/or approaches to recovery, the strengths and skills of people in recovery make us ripe to tackle this human habit with a grace that could be a model for the world.  It is time that we lead the way.

The bottom line is this: there is no one recovery pathway, resource or strategy that works or doesn’t work for everybody.  No resource ought to be excluded if it works for even just one individual and their family, as should none be forced upon those for whom they do not work.

More here.

2. From theinfluence: “The Rehab Industry Needs Up Its Act. Here’s How“:

We’re far from that, however. Currently, at least 80% of American inpatient and outpatient drug-free rehab is dominated by the goal of getting patients to accept the ideology of 12-step programs and to attend as aftercare. To my mind, while 12-step programs do help some people, there is absolutely no reason that taxpayers or insurers should pay for the exact same social support and information that can be had for nothing at meetings.

Instead, treatment providers need to cull from their programs the elements that are redundant with 12-step groups—and instead offer evidence-based therapies like cognitive behavioral therapy and motivational enhancement therapy. Patients don’t have the option of getting these for free outside of formal treatment—and the role of treatment should be provide professional medical and psychological care, not self-help.

More here.

3.  From “Evidence-Based Substance Abuse Treatment“:

There are a number of potential problems with addiction treatments that are not evidence based:

* If there is no real evidence to back up the claims that an addiction treatment works then there is no reason for why it should work for the individual. This means that they may be wasting their time with a treatment option that is ineffective.
* Some people may only have one shot at recovery. If they choose an ineffective treatment option then this could mean that they have lost their chance to get sober.
* When people fail in a treatment option it can reduce their self efficacy, and this makes it harder for them to quit in the future. This is why it is so important to choose an option that is likely to be effective.
* Choosing options that are not evidence based can mean wasting time and money.
* Some treatment options might not only be ineffective but they could even be ultimately harmful to the individual.
* Treatments that are not evidence based can be used by scam artists to con people out of their money. Often these individuals are able to manipulate language so that their claims are not breaking any laws.
* Those treatments that are not evidence based can harm the reputation of the recovery treatments. This means that those individuals who need help may be reluctant to ask for it.

More here.

4.  SAMHSA: A Guide to Evidence-Based Practices (EBP)

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