The word Freedom, at times can be an illusion or a deception. The English Dictionary states it as “The condition or right of being able or allowed to do, say, think, etc. whatever you want to, without being controlled or limited: you could also say that freedom gives you the ability to make more choices”.
In this current climate, you hear a lot of people saying that “it feels like I am in prison”, or “I don’t know what to do with myself” or “I feel like I am being controlled and decisions are being made for me”. Another way of looking at it is that if the self-isolation does not happen, in the future people’s freedom may be jeopardized.
Nelson Mandela said that when he was on the island for many years, he wasn’t in Jail, as his mind was free. What he was saying is that jail is not four concrete walls, it is about the way that we think. It is also saying that we are fully capable of imprisoning ourselves and creating four concrete walls that seem impossible to penetrate.
This time we have to ourselves could be used as a time to reflect and make plans for our future. It could be a time to explore ourselves and maybe work out how it is possible to truly reach our potential. At times, everyday life can sometimes get in the way of that.
Maybe, the coronavirus, when it is over, will encourage everyone to appreciate their freedom, as at times we all are likely to take our freedom for granted, or perhaps we don’t know what it truly means.
Freedom and Substance Use
Clients often say that they use substances to escape, or that when they are high it sets them free. They say this, although they know it is an illusion. After all, you would look really stupid if you were serving a long sentence in prison, escaped and then returned the next day saying you wanted to come back! That’s what happens with substance use. Once the buzz has gone, you return to reality, and that’s the reality that you were trying to run away from.
It’s true that the buzz from substances allows you to create a different view of the world, but it is not possible to always have that view. It means that you wouldn’t be able to live in the real world, and after a while you may feel the way that some people are talking about in enforced self-isolation and being dictated to by external forces how to live your life. In the case of substance use, you will feel that the authority, or the dictator, is the substance.
Freedom is wonderful if you are clear what you do with it. Many people want to leave prison because they are sick of being told what to do. Many people seek treatment because they no longer want to be a slave to their poison.
When you leave prison you now have the option to make different choices. When you stop using, you have the freedom to make different choices. If you do not make different choices, the message you are giving yourself is that ‘I cannot manage my freedom’. This will inevitably lead to a relapse.
So, in this time of ‘self-isolation’, take time to explore what freedom means to you, ask yourself, ‘have I made the most of my freedom up to now?’ and ‘what is it I have to do to become the architect of my own universe?’.
The current “self-isolation” period that everyone is going through, is difficult for many. If you are in recovery, especially if it is an early stage for you, this could be a very vulnerable time for you. Although there are still support networks out there, many people are saying that they miss the face to face connection.
Human beings are designed to socialize so don’t feel weak if you are struggling as you are in the company of many who feel like this. What this may bring up for you is the feeling of isolation like when you were using substances, especially as everyone knows that using is about disconnection and recovery is about connection.
Now it is time to draw on your internal resources. Hopefully some of the blogs that I will write over the next few weeks, you will find supportive. You also have the option of picking up the phone to have a conversation with me if you feel vulnerable.
It is important that you are aware that your cravings are jumping for joy at the moment as they have been waiting for something like this to happen. It may feel like you have woken up a sleeping giant. Remember, your cravings need a justification to sell the thought of using to you. What may spring to your mind are justifications, such as boredom, loneliness, fear, etc. It’s important that you counteract these thoughts with a reality check. You have to forward your thinking and be clear about what the consequences of a relapse would be for you. It is not the first time you have had these justifications, and it won’t be the last.
It’s important that you are assertive around these cravings. They are like a school yard bully. The more you run, the faster they chase you. Your cravings may be telling you that you can’t cope with what is going on around you without picking up. Deep down you know that this thinking does not fit in to where you know you want to get to now.
Your cravings are not stronger than you, they are thoughts that lurk in your mind, which means that you hold control over them. Make sure that you activate the control you possess.
Resilience Recovery realises that the holiday season can be a challenging time of the year. Especially if this is your first holiday season in recovery. Everyone seems to be out celebrating. It can be a time of loneliness and isolation.
So, with that in mind we’re offering four special festive season group work sessions.
We’ll be exploring how to deal with your cravings, exploring your triggers, and talking about the loss and grieving of your substance of choice. It will be a space where you can talk and listen to others, but also to make plans about what you are going to put into your recovery in 2020. It will allow you to not only get through this challenging time, but to make resolutions on how you are going to engage in your recovery in 2020
The groups are educative and experiential.
Groups run for three hours each with a 15 minute break.
There is an element of mindfulness, meditation and gentle yoga to compliment the substance use intervention element of the programme.
The groups will give you a range of tools and understanding to help you in your recovery.
This time of year is challenging for most people let alone those in recovery. Our groups can really help you get through two of the hardest days in the calendar - Christmas Eve and New Year’s Eve.
You can book in for one or two sessions or all four. This is one of those really useful gifts. Purchase for yourself or a friend. At times you or a loved one may not be aware that you need this gift at this time of the year.
Are you tired of trying the same old ways of looking at your addiction?
Are you weary of taking one step forward and two steps back?
Are you questioning the disease model or do you find yourself sometimes hiding behind it?
Perhaps you need a new perspective, a new way of looking at your drug or alcohol use. What if you don’t have an ‘illness’, what if you are in a dance, or a game with your endless desire to use, and sometimes you’re winning, and sometimes you feel like you’re losing. If this sounds like your experience, then read on!
Addiction as a dance
An alternative view is to see this dance as the relationship between you and your drug of choice. Relationships, as we know, come in many forms, some healthy, some unhealthy.
Take a marriage for example, two people fall in love, decide to spend their lives together and make vows to each other in front of witnesses, to love each other, honour and respect each other, forsaking all others for as long as they both live. Huge promises that cover many years ahead, that may hold many challenges, changes, not to mention the individual growth and maturity of each person.
As the years pass, the love changes, the things that were once endearing may now be irritating, desire may diminish, the ageing process may take each person in a different direction. Yet both parties may be reluctant to let go of the relationship, feeling more comfortable with what is familiar, fearing the unknown and creating numerous reasons to remain as they are, even though neither is happy. If you put your substance of choice in the place of the husband or wife, would these feelings and fears sound familiar?
Too much has happened
Imagine this marriage now becomes undermining, destructive even, where most exchanges are negative and critical. Finally, one or both decide that separation and divorce is the only way forward. The separation is difficult, full of sadness, sometimes the couple fight over belongings only to collapse into tears and then wonder if they have made the right decision. They remember the good times and wonder how it could have come to this. Sometimes they embrace, they make love one more time, then feel guilty, confused, regret and wish it could be any other way. Could they have done it differently, could they have been more aware of the other in order to avoid the ultimate divorce. Alas, they know too much has happened, things have gone too far and they will never have another honeymoon!
Does this sound anything like your relationship with drugs or alcohol?
Is the honeymoon well and truly over?
Has it become unhealthy, and yet you are reluctant to let go? Does familiarity feel more comfortable than the thought of change?
Is there more negativity, more abuse, more selfishness, less tolerance, less care in the relationship?
Or has it even become more like an abusive or violent relationship, where your partner strives to keep you away from others, to tell you that you need no one else, to say that all your needs can be met by only them, and to separate you from the world, and to change the way you view it.
Transition can be difficult.
Once you have made the decision to separate and divorce, as with the abusive relationship, the transition can be difficult, can even feel dangerous at times. You may often want to go back, to feel the familiarity, this is where you think you know who you are. You might feel lonely and yearn for the one who once made you feel so good. You might even go back for a night and indulge yourself even though in the morning it is difficult to get away. Then you might decide ‘never again’ and begin to mourn the loss of the great love that once was, but is now tainted and damaged, one that you had lost yourself in. The loss is so great, and the yearning almost overpowering with it’s seductive invitation and kindly, selective memories, enticing you with relief and a guarantee to change your view of the world.
Gradually build strength and resilience
So how do you get through?
How do you resist the yearning and craving?
What happens in a divorce, or at the end of any intense and long-standing relationship, such as substance misuse? Dealing with the loss, the accompanying changes perhaps to environment and associates, how do you spend your free time, what do you do at weekends, how do you sleep? You slowly and gradually build strength and resilience with help, with support and by doing things that perhaps you never thought you would! It can be a long journey, yet every day can bring a lovely surprise! Remember, some days, you may have to look for it.
Chris Robin 30 June 2019
Resistance – ‘The refusal to accept or comply with something’. (Oxford Living Dictionaries, 2018)
At times, it can be quite confusing when an individual comes into treatment to address their substance use, and then resist entering into the necessary transition towards taking control of their life. They state that they want to regain control of their substance use and are willing to do anything it takes yet resist the steps required to embark on this journey.
It is important to be aware of how difficult this can be for the client, as they are attempting to move away from a world they have created through their use of substances. The worker may think that the world they have created is chaotic, dangerous and unpredictable and want to support them to make it safer at least. But the client may understand their world completely differently and connect with it through familiarity.
Let us explore the scenario using the metaphor of Adam and his headphones!
As Adam leaves his house heading towards the tube station, the outside world is noisy and seems quite miserable. Taking in everything that is going on around him, the world seems busy and Adam is fully exposed to all of the activity surrounding him.
Remembering he has headphones in his pocket, he decides to listen to some music. He puts on the headphones and tunes in to one off the playlists on his phone. Within seconds, he is lost in the new world he has created. He finds himself bumping into people on the street, no longer fully aware of what is going on around him. He is rescued from accident by a passerby as he crosses the road without looking, his sense of safety having been compromised as he is lost in the sweet sounds coming through the headphones and filling his ears and mind.
Entering the tube station, the busy and mundane atmosphere blends into the background as he is elevated into a world where the music becomes the centre of the universe. He is so unaware of what is happening outside of his headset that he has to turn the music down when the train stops inside a tunnel to hear the announcement to explain what is going on. This tears Adam away from the intimate world that he’s created through his headphones and back into the real world.
How often have we heard somebody singing along to their music so loud, lost in their world and seemingly oblivious to their surroundings?
When we talk about ‘substances’, they also work in the same way. They allow an individual to build their own world that is intimate and private to them. Their view of the world changes when they use the substance as they can be whatever or whomever they want to be. There may be danger, chaos and unpredictability, but when compared to the real world, this is more familiar, better known. They may instead get a sense that the external world is predictable, chaotic and dangerous. The internal world that they have created allows them to wipe out the mundane and predictable regime of their external everyday lives. It’s called a ‘high’, and often it can feel irresistible.
So what if we were to remove Adam’s headphones and force him into the external world? Would he not respond with shock and irritation? Might he immediately replace his headphones?
THIS IS RESISTANCE!
In the field of substance misuse, the word "recovery" has been used by professionals and clients continually. It seems that the term may have been off relevance at the time it was created, but does it still hold the same significance and meaning in 2019?
In an era where peer mentors are being used extensively to fill the gaps in services, perhaps it is now time to re-visit this term, as many peer mentors have lived-in experience, and will tell you they are in recovery, as that is what they have been told.
It is important to state that this article is not about challenging models of treatment, as Resilience Recovery believes that all models of treatment benefit the client. The objective of this article is to address the language that is used that may disempower the client, and become a self-fulfilling prophecy.
The English Oxford dictionary definition of "recovery" is "A return to a normal state of health, mind, or strength."
In these terms, this seems a very positive place to be, until certain phrases are added to it in the context of substance use. An example of this is the term "relapsing condition". Surely if this term is frequently heard by a client, or frequently used by professionals it maybe becomes the expectation for both. It can create doubt for the client that their dream of sustaining abstinence is not going to last. In addition, it can normalise a relapse as inevitable and thereby provide a justification for both the client and the professional. This raises the question of how long a client is in recovery and can they ever be 'recovered'? This is a delicate issue in the area of substance use, but an important one as many peer mentors, for example, define themselves as "in recovery"
Certain treatment philosophies state that one will always be in recovery, which can raise anxiety and fear for many clients. Does this have to be the case? Could the client graduate to the next phase of the process, whereby recovery becomes a thing of the past thereby instilling hope, a goal, a destination?
The English Dictionary definition of "discovery" is 'The action or process of discovering or being discovered.'
The art of discovery begins at birth and continues throughout life. It is a myth that when an individual uses substances, the process of discovery stops. A client will continue to recognise many new things that fit into their frame of reference or change it. "Cognitive resonance" informs us that the behaviour that a client undertakes will be relevant to their world and surroundings, which tells us that learning and discovery, change and adaptation do not stop, rather they become relevant to a key aim and area of pursuit.
When a client enters a service, they do so with a wealth of knowledge. They have lived and survived their substance use and are now looking at interventions that allow them to either manage their substance use or make it become a thing of the past. They are looking to discover how to put the resources that they have always carried, into allowing them to enhance their quality of life. They may be continually fighting cravings and triggers to return to using and their identity and mask as a substance user have to be explored. They are starting to adjust to the external world on its terms. Much of this is often new and can, therefore, be daunting. Could this phase be more accurately described as the recovery process, during which it is essential that services users are reminded of their ELASTICITY in their ability to bounce back from adversity? Clients may have a weakness for substances but they are not weak people, on the contrary, their resourcefulness and resilience may have kept them alive and these skills are equally necessary for the next phase of their lives.
When clients have addressed their relationship with substances, they now have a platform to re-connect with the external world. They will soon discover things that were of no interest to them while they were using and with time their connection with substances will get less. They will learn to manage the trauma of what they put themselves through while they were using, and to develop strategies to manage feelings and emotive situations without using. Their previous life may have been about disconnection, but this phase is about reconnection.
That is not to say that they have to stop being vigilant about a lapse, but it does not have to be all-consuming or cast a shadow over each day because new activities, relationships, interests, understanding, and focus are present, their world has expanded. Perhaps this is more accurately described as the discovery rather than recovery informing the client that they are on a journey, they are maturing, engaging with all aspects of life, and using their numerous personal resources to do so.
In a recent treatment setting with a new peer mentor project, my first question to the service was "why are they always called recovery champions when they have completed treatment already?"
The ensuing discussion led to a new term for the service: DISCOVERY CHAMPIONS.
Whilst reading the heading of this short article, you’d be right in thinking there can’t be such thing as a recovery expert, as every individual’s recovery is unique.
Even so, when a client comes through your door, are they seen as the expert? It’s a term that is thrown around on a regular basis. It’s a statement that is hard to quantify because if they were an expert, they wouldn’t be asking for support and guidance and telling you that at this point in their life they feel stuck.
“Expert” can seem to be an arrogant or egotistic title in any circumstance. It is a hard title to live up to because it implies someone who knows everything about his or her subject matter. Knowledge gained over a period of years, because they have put in the time, research and experience, should instill some confidence and belief that they totally understand what they are talking about, and more importantly, they should know how to articulate their knowledge.
Recovery is often subjective; it has a different meaning depending on the philosophy or agenda of the treatment programme or the individual that is experiencing it. Whatever the situation, we feel it would be right to say, the aim of recovery should be to take control of your life in order to make positive, informed choices. They wouldn’t need to be in recovery if there wasn’t a problem.
To fix the plumbing you have to turn the water off and recovery means that I choose to be abstinent, I needed to “turn the water off”, however, Recovery per-se does not necessarily have to mean total abstinence for everyone forever, but turning the water off allows for proper analysis of the problem and time to sort the problem out. Recovery is about empowering the person with a problem to take back control of their life, their choices after that are theirs.
Going back to the client not being the expert.
The knowledge they have is phenomenal. They wouldn’t have survived their substance use if this weren’t the case. Could it be that at times the client can ill afford to tell themselves how much they really know as this knowledge gets in the way of carrying on their substance use. Its called ‘Cognitive Dissonance’ (the distance between what you know to be true and your actions)
Treatment allows a client to reflect on what they do know about themselves and their substance use, and to then learn new and challenging aspects of who they are. To get through this they will have to tap in to their expertise.
After years of doing this, would it be fair to say that they can become an expert of their own recovery. After all, they’re the ones that will be living it on a daily basis. If they relapse it is not because they didn’t know (every relapse, when examined and looked at in hindsight, was a collusion, a sort of delusion of the self, a flirtatious dance with the substance of one sort or another)
We don’t think it is possible for anyone to be an expert of somebody else’s recovery, as recovery is so personal, individual and unique. But it is possible to be an expert of your own recovery.
One of our jobs as drug workers, doctors, nurses, peer mentors etc is to support and train the client to become an expert of their recovery (that’s what we are experts in), so they can then set off on their recovery journey with confidence, and share their experience, expertise and understanding with others who are at the beginning of their journey.
In regard to substances, it is not unusual to see clients returning to services, and the interventions that are delivered may be no different than they experienced the last time they were in treatment. We have a responsibility as professionals to try something different, to allow the client to have hope that this time will not be the same as the last.
A friend of ours called Nick, was on a walking working holiday. While he was away a few of the people on one of the excursions took a minor wrong turn and got lost. Nick had to go and find them and get them back on the right path. He realised that he had only ever considered the negative aspect of losing your way. For instance, if you put a magnet next to a compass, it takes you to magnetic north rather than true north and bit-by-bit you end up going off course.
The 3 degrees of change concept, incorporated into a 10-12 week course, intentionally uses this principle of small changes that have a big impact over time in order to create a “new destination” that represents a good or better outcome. It aims to work with people that want to achieve change, but instead, end up repeating the past. This happens over and over again so that their past, present and future end up becoming a cycle of misery or of lost potential. The cause of this may be exasperated by the unhealthy relationship that the client has with their substance. It’s like a chicken and egg situation and people forget whether the cycle is caused by the substance use or that the substance use is the result of the related cycle of behaviour.
Well, our aim is to help people in this type of situation to make a small (3 degree change) so that they can disrupt the pattern of behaviour, become aware of it, and get support toward a new destination. Making a very small change is less frightening than doing something major and it could, with support and time, have a positive impact on the cycle of behaviour and the substance use.
Allied to making a 3 degree change is the principle of also making small changes to the environment around us and even making small changes to the processes that underpin our habits (those habits that we want to change and new habits that we want to form but struggle to embed into everyday life)
We provide the environment where change can take place i.e. the weekly group. The client identifies the cycle that they feel stuck in and want to break away from, they can then make the decision about the small change(s) that need to be made to allow them to see a new brighter future
The small change theory does have evidence behind it, whether its a change in our environment or minor change to a process, small changes have the impact of making us aware, getting our brains back inline and allowing us to have real choice e.g. if you always light up a cigarette on the way to work, try going to work via a different route. This can disrupt the process, and delay or even remove the environmental ‘cue’ to smoke on the way to work meaning you smoke one less cigarette that day. That small change can trigger a process that with the right help and support, could lead a person to stopping more of their cigarettes and over time quitting altogether. This is the concept and the power of a small change
Another, larger scale example from history, relates to the American service men using heroin during the Vietnam War. Approx. 20% of soldiers were addicted to heroin and the US government didn’t want them bringing their addictions home with them at the end of the war (for obvious reasons). They instituted a mass, in country, urine testing programme and detoxed those soldiers that tested positive before allowing them back to the US. They were given no other intervention except a detox and change of environment. On returning to the US, 5% relapsed within a year and approx. 12% after three years (further re-tests of a random sample of returning soldiers confirmed this). This finding was contrary to the prevailing wisdom at the time that considered heroin addiction as a permanent and irreversible condition (language that is very similar to the current use of the term Chronic, Relapsing Condition by many clinicians treating substance misuse use today)
For more information on the Vietnam study see one of the links below
Chris, our group facilitator devised this concept many years ago to support service users in addressing their relationship with substances. Let us know what you think.
ADDICTION. When a drug or alcohol user becomes a slave to their poison. When a drug or alcohol user chooses to make their willpower unemployed.
CONTRADICTION. When a drug or alcohol user keeps stating they are going to challenge their relationship with drugs or alcohol and stop using, yet never do. This then leaves room for the addiction to say to the contradiction, ” stop fighting me, you have been doing it for many years and you always end up using. Stop fighting against me, and join me. You know you want to. ” This is how the Addiction gets its muscles and gets stronger.
PREDICTION. If a user says they are going to do something with their addiction and they carry this out, it then lays a foundation to challenge the Addiction and inform it that it has been lying to them all these years. The individual can then say to the addiction, “I didn’t use today and I’m OK”. If they continue using the prediction they can guarantee it will lead to deterioration
JUSTIFICATION. It is not possible to use drugs or alcohol without creating some form of a justification
REASON. After years of using they will start to call the justification a reason and the addiction says to the user, “of course you’re using, you have a valid reason”, and they have now made the using legitimate.
DETERIORATION. if they keep on using in this way they will experience a level of deterioration whether it be physical, financial, mental, etc
PROCRASTINATION. When they are forever saying I will do it tomorrow.
The above is what keeps a client in their substance use. The list below is what they need to focus on if they want to address their substance use.
DETERMINATION. They will need this to overcome the obstacles they will face, and in order to do this, they will have to dip into their natural resources.
INFORMATION. To gather as much information as possible in order to counteract the information received from their drug or drink of choice, as much of this information is untrue.
TRANSFORMATION. To use the information gathered from above in order to initiate the changes needed to overcome their substance use.
MOTIVATION. The word “motive” is derived from this word. If they remember the original motive of why they decided to stop using Substances, it can give them an incentive not to lapse.
ACTION The client needs to remember that if you remove the ‘I’ from Action, you have “act on, and unless the client acts on what they need to do and not what they want to do, they will carry on using.
It is named the “ON CONCEPT” because everything ends in ON. But more importantly, if a client doesn’t understand the dynamics of their relationship with substances, their using will go ON and ON and ON.