Rehab is easy, Recovery is hard – Making addiction treatment work

Here’s another article from Sarah Henderson, one of our readers who’s recovered from a long battle with eating disorders and is living with bipolar disorder. She’s very candid about her experiences with addiction treatment, which I like a lot, and her unique view on food addictions (or eating disorders) fills a nice gap  in my own knowledge. In this piece, she discusses issues about addiction treatment setting, independence, and the involvement of others in recovery. We’ve all heard that you can’t make someone overcome their addiction, and Sarah’s story shows that sometimes what does the trick is making them confront their own problems. As I’ve talked about in the past, I had a similar experience when I decided to own up  to my problems and asked my father to let me take care of finding treatment myself. It was the first time I’d really internalized that I was the final piece in this puzzle.

Rehab is Easy. Recovery is Hard.

At least, that’s been my experience. Throughout the the years I struggled with anorexia, bulimia, self-harm, drug abuse, and bipolar I had a very distinct pattern: get sick, make people worry, get very sick, go to therapy, get extremely sick, go to residential treatment. Once there, I’d battle the people who were trying to help, then slowly acquiesce, then start to be semi-okay, get my weight up, get my symptoms down, and get discharged. Then, I’d get sick.

And around and around we go.

I did this for about ten years. I went to hospital after hospital, RTC after RTC, therapist after therapist. I was kicked out of treatment in several places for various reasons: not cooperating, hindering other patients’ recovery efforts, refusing therapies or medications. At one point, I was even kicked out of my small private high school because I was so sick I was “disturbing” the other students.

There is a time in my illness when I would have been proud of these things. I would have seen them as showing how tough I was, how strong in my cause, how determined to go down fighting. Now, however, remembering these things only brings a sense of sadness, and heart-wrenching compassion for the pain that this girl was in, how much she had to have been hurting to continue to put herself in that situation.

At a certain point though, the cycle stopped. I had been to this one treatment center twice in one year- and been asked to leave both times. Finally, the person who had been funding my psychiatric revolving door decided that was the last time he was paying for inpatient care. The next time I decided to get super sick, I was on my own.

After getting out of inpatient that very last time, I continued to relapse. However, knowing that no one was going to swoop in and save me, toss me in treatment, and keep up my game, created a shift in my thinking. I didn’t really have the option of continuing to get sick; at least, if I wanted to live. Wanting to live was something I went back and forth on often. I went through two very uncomfortable, joyful, horrible, painful, gratifying, terrifying, and ultimately life-saving years in outpatient therapy stumbling my way towards recovery. That time was like a dance, getting sicker then better, back and forth, until little by little the better days outnumber the sicker ones. I don’t have a “clean date” like many people; I couldn’t tell you the last day I skipped a meal or purged or cut myself. All I know is that I’m recovered.

It took a long time and a lot of work to get here. And all those years that I spent in addiction treatment did NOT go to waste, despite how it may sound. I think for me- for many people- inpatient treatment lays foundation for recovery, plants the seeds of new behaviors, thoughts, and coping strategies. But it’s not until you leave that safe, rarefied environment that those seeds will sprout, and recovery can begin to flower. I always had this idea that RTC was supposed to cure me; that I should be able to walk out all whole and healed, no problems at all. And I was always pissed when it didn’t happen that way. Finally I figured out that’s not how it works. Treatment just gives you the tools and materials for recovery. YOU are responsible for building it.

I wish someone had told me that the very first time I went to inpatient. It’s an important thing to remember throughout the treatment process; the more you understand that you alone are accountable and responsible for your own health and recovery, the more likely you are to achieve it.

Final thoughts from Adi

Like I said in the beginning, I appreciate Sarah’s truthfulness about her experience. Additionally, I share some of her story, especially as it pertains to having to own up to her condition and lose some of the guidance, or maybe crutch, that had been there for so long. However, I think that this story is a great example of why it is true that while addiction stories can offer great inspiration and hope, addiction research looks at patterns in data that can offer insight no given story can give us.

For instance, Sarah says she that outpatient treatment let her truly put the tools that she learned about in residential treatment to use. In fact, she suggests that this is the role of outpatient treatment. In actuality though, addiction research shows that people do better if they’ve been to residential treatment, especially among more difficult cases, and that a structured transition, like moving from a residential treatment facility to sober-living or to outpatient, increases the chances of long-term sobriety.However, I don’t know of any research that shows that past experience at residential treatment predicts greater success at outpatient treatment. Everything I’ve seen shows that past failure at rehab predicts future failure, not success. That’s not to say that Sarah’s story doesn’t repeat, but as a rule, more difficult cases do better in residential, not outpatient.

These sort of research findings can help guide us towards the most probable path to success, after which point individual variability sort of takes over and works its magic. The hope is that as we get better and better at it, our addiction research will guide us towards more customized initial treatment selection. It’s how we make things work in our A3 Rehab-Finder.

Addiction stories – Anonymous no more: Sarah’s recovery is no secret

In case you haven’t noticed, I can’t stand the stigma I’m supposed to carry around as a recovered addict. People expect me to steal from them, or pull out a gun, or maybe just smoke some crystal meth at the dinner table. But guess what, I haven’t been that guy for almost 10 years now, and chances are, I’m never going back there again.

I received the following addiction story from a reader, another recovered addict (from an eating disorder mostly) apparently sick and tired of the misconception. I’m publishing it here with very few changes, and though I’m including it in our Addiction Stories category, I’ve started a new category now and it’s called Anonymous No More. It’s my personal opinion that if more recovered addicts stood-up and told the world that their previously sordid lives are now full and complex, just as they are meant to be, we’d see a lot less of the kind of misjudged treatment Sarah is referring to. So thank you Sarah Henderson for being the first one up to bat on All About Addiction. And here’s to all those who are going to follow everywhere – There’s no doubt in my mind that when it comes to inspiration, addiction stories do as good a job as research-based education.

Anonymous No More: Inside Stigma – A Patient’s Perspective

Hi, my name is Sarah. I’m Anorexic, Bulimic, and a Cutter.

You could call me these things. But they wouldn’t be accurate. Because I am not these things, these labels. And I am not in recovery from these things.

I am recovered.

From those things, I am recovered. I am bipolar, which requires ongoing management. But you wouldn’t know it if I didn’t tell you. I am not the stereotype, I am not the crazy person we all think of, ranting and raving on some street corner. I am like anyone else, except I take a few pills before I brush my teeth in the morning.

And yet.

I still catch flak all the time. For the taking meds, for going to therapy, for the eating disorder history, for the visible scars from years of cutting. People comment on them, I’ve lost jobs because of them. It’s like, what do you want? I used to cut myself. I don’t anymore. I used to starve and binge and purge. I don’t anymore. So eat lunch with me and stop looking at me like I’m going to vomit on the table any second. Deal with me as I am now, not as I was then.

And yes, I take medication for a chemical imbalance. Guess what? So do diabetics. Only their imbalance is in the pancreas, and mine is in my brain. That’s the difference that makes people freak. That’s where the stigma lies.

If you ask a poet, he’ll tell you the seat of the soul lies in the heart. If you ask a neurologist, he will rightly tell you that the seat of the soul lies in the brain. And anyone who’s ever experienced dementia will testify to that. It’s very possible to exist in your body without living in it. And it’s possible for the person you love to die long before their heart stops.

I believe that stigma comes from people’s instinctual knowledge that when you mess with the brain, you mess with the soul. It can be disturbing, it can be terrifying, it can be cruel. And most people just aren’t up for facing that. However, when you don’t face it, you also miss out on everything the other side has to offer: healing, resilience, clarity, and courage. And while they are some people who don’t come back from mental illness, the vast majority of us do. The other side is a beautiful place. And if you can get past the stigma, you can join us.

Closing “Addiction Stories” commentary from Adi

You’ll notice that Sarah considers herself a recovered addict. When it comes to my own drug use, I do the same, and I can tell you that there are quite a few people out there who strongly dislike it when I tell them that I think I’m done with my drug addiction. To me, this is all part of the same stigma equation – It doesn’t matter if others in recovery stigmatize you as having a problem for life or if the people doing it to you are ones who have never walked in your shoes. The bottom line is that I believe people can be “recovered” and though it probably doesn’t apply to everyone (nothing ever does), I think it likely applies to more people than you believe.

And that’s where working through the stigma is important, as we shed off the shackles of our current understanding and get to a clearing that is lighter and offers more freedom for each addict to use the tools that make the biggest difference for her. That way she can live her life after her recovery as she wishes with little judgment and consternation from those around her. And it shouldn’t matter if we’re talking about recovery from an eating disorder (like anorexia or bulimia), drug addiction, gambling, or sex addiction.

Doesn’t that sound nice?

How can I overcome all this sugar??? The dilemma of food addiction

I’ve been asked by several people about the impact of sugar addiction and the possible ways for overcoming it.More cake please

The dilema of food addiction

Food addiction is especially difficult to fight because unlike drug addiction, you can’t simply stop eating, regardless of your willpower. This means that a person addicted to highly sweetened foods needs to figure out a way to continue eating without indulging in their favorite foods. This is a bit like telling an alcoholic they can only drink beer but not liquer, or telling a cocaine addict they can only smoke a little bit of crack every day…

My sugar addiction story

While there is very little research that I’m aware of regarding food addiction, I can share with you my story.

I’ve always been a huge fan of sugar. I love chocolate, soda, and ice-cream, and anything else that is loaded with sugar.
The soda habit I made myself quit a few years ago when I was trying to lose some weight and had started working out. I was very determined and when I realized just how many calories are in each can of soda, I told myself that I needed to reduce how much of it I drank. At the time, I would easily have 3-4 cans per day, and while I wasn’t able to completely cut soda out, I went down to 1 or less every day pretty quickly. My trick at the time was to remind myself that all that work I just did at the gym would easily be erased by having a single can of coke (my weakness).
Still, I was eating a lot of other stuff that was pretty bad for me, mostly without even realizing it.

It was only last year, possibly because of reading the article I’d talked about in my post about sugar addiction that I started really looking at what I was eating. It didn’t hurt that my girlfriend at the time was a health nut. I’d heard about the evils of High fructose corn syrup (HFC) before, but after reading the research, I realized that the stuff is perfectly engineered to make my body crave more and more sugar.

I’d already kicked drug use years ago; I wasn’t about to let sugar control me now…

When I started reading the labels of products, I was amazed. HFC is in almost everything!!! I was discovering that the bread I was eating, some of the deli meets I was putting on it, and nearly every drink I was having included the stuff. Without ever realizing, and with the wonderful help of the food manufacturing sector, I had become essentially dependent on this stuff. There is research that indicates that the make-up of HFC, which is a bit different than that of natural sugars, may contribute to obesity and cardiovascular disease. This evidence is not conclusive as of yet, but again, there’s also research that foods loaded with sweeteners in general can cause consumption patterns very similar to addiction.

My addiction advice

Thankfully, the are products who don’t contain HFC, and I’ve been doing my best over the last year to replace my old food choices with those.
Just to be clear, I still consume more sugar that I probably should. However, I feel that by removing this highly sweetened chemical from my diet, I am essentially allowing my body to now process the more natural sugars I’m consuming. In the long run, I’m hoping that this switch will work to reduce my overall dependence on sugar.

So, my advice, given the fact that we all need to continue eating:

Don’t try to remove sugar from your diet, especially because the artifical sweeteners have themselves been shown to produce consumption patterns that are unhealthy (at least in animals for now). Instead, start becoming aware of what you are putting in your body and reducing the consumption of sugar that way.

Most natural unprocessed sugar products have lower sucrose and fructose concentrations simply because they are not as heavily processed to remove impurities. Switching at least some of your consumption to these types of sugar will reduce at least some of your sugar intake without leaving you feeling like you had to make any major changes.

Goals are good as well. If you’re eating like I used to, you put 2-3 spoons of sugar in your coffee every morning; try reducing the amount of sugar you’re adding to foods by a small percentage (like 10-15%). Such a reduction won’t massively alter the taste of your foods but will get you on your way…

Question of the day:
Would you like to share your story of overcoming, or struggling with, addiction to sugary foods?
I’m sure all the readers will benefit from hearing others’ stories.

Drug use norms and expectations: Obsessions and compulsions in our society.

teensI used to always say, back in my using days, that speed (methamphetamine) was The American drug. Why? Meth makes its users sharper, more alert, and more focused, and it allowed me to spend entire nights up studying like I’d never been able to study before.

Unfortunately, like many other aspects of The American Dream, speed will also leave you spent before you know it, leaving the memories of those productive, focused, days far behind with little hope of coming back.

We live in a society that celebrates excess, be it in celebration or dedication to work, success, and achievement. Is it any wonder then that so many Americans turn whichever way they can to gain the edge that they feel they’re lacking when they compare themselves to those around them?

I read recently that many executives now keep a supply of medications like Adderall, Ritalin, and other attention deficit cures around for times when they need that extra push to stay up late and work.

We are skirting a dangerous line by putting out the message that everyone should be the best though of course, with no cheating… or at least no getting caught.

Teens are now using more and more prescription drugs while reducing, or at least not increasing, their use of many illicit, or illegal substances. How is this crisis we’re experiencing with our teens any different than the recent steroid stories exploding the mythic innocence of every American sport?

One of the things I want to inform my readers about in writing this blog is the process of addiction and the ways in which its development is often not under the control of the users, at least not the users likely to eventually develop into addicts. But, there’s also a different issue, the one having to do with what it is about our society that makes Americans so much more likely to turn to these substances in the first place???

It is estimated that more than a third (110 Million to be exact) of American have used at least one drug at some point in their lives. I don’t necessarily think that there is anything wrong per se with recreational drug use given the relatively low rates of addiction that develop from it. However, I think that drug use, even recreational use, that is meant to solve a problem or that is done as a normal part of life, is more likely to become problematic.

Some theories of addiction specifically assert that “self-medication”, as in using a drug to alleviate problems, especially psychological problems, can be a major indication of likely addiction potential. The problem is that the unsupervised use of the drug often does little to help the initial difficulties, and if anything, makes things worse as the drug user becomes more involved in the illegal drug culture. I probably don’t need to tell many of you about the social withdrawal and added psychological stress that goes along with becoming, or living with, a drug user.

My point is that we need to change the way we think about drugs in general. Drugs can be useful for many specific medical and psychological benefits, and possibly even for their recreational benefit (think Van Gough, or The Doors). But, in order to make sure that those we care about most don’t abuse and misuse drugs, we need to move away from the current attitude that seems to drive children and teens towards irresponsible, ill-informed, and dangerous drug use. By educating kids, not scaring them away from, the things that are dangerous for them.

You wouldn’t dream of teaching a child to look both ways before crossing the street by yelling at them that they better not EVER dream of setting a foot on the road without looking left first, would you?!

We teach our kids everything we think they need to know about life in order to prepare them for what’s ahead. Why is it that when it comes to drugs (and often sex), we shy away from bringing the subject up and still expect them to be well prepared when a friend says “Hey, want to pop one of these pills with me?”

There will always be those who for one reason or another are more likely to develop a problem with drugs regardless of how well prepared they are. Genetic influences on things such as low impulse control and sensation-seeking are known and are probably closely linked to some bad decision making. But even these people will benefit from being better prepared and more educated about their own choices so that when the time comes, even if a problem develops, they can hopefully acknowledge it, and deal with it, in a more capable, informed way.

We need to stop turning away from a problem and thinking it will solve itself. It’s time for us to look for answers and not rely on solutions appearing magically. They most likely won’t…

Question of the day:
Do you think that enforcement (of drug laws) or treatment (of heavy drug users)is the more effective way of dealing with the drug problem?

Give me SUGAR!!!! And a little food addiction on the side…

sugarSo while we’re sitting here talking about drug addiction, quite a bit of research in the last few years has looked into food, and specifically high-sugar-content foods, as a possibly addictive substance (food addiction).

The focus started when the new head of NIDA (The National Institute on Drug Abuse), Dr. Nora Volkow, who’s been doing research on obesity, took her seat a few years back. Since then, there have been quite a few papers showing that when given foods (or water) high in sugar content, animals develop behavioral patterns that are very similar to drug addiction.

This makes sense from an evolutionary stand point, since sugar gives our bodies carbs, which supply energy for our daily activities. However, it’s probably no secret that 50,000 (or even 1000) years ago, people weren’t consuming foods with refined sugars crammed into them (refined sugars have only been around for about 250 years). Back then, people needed all the energy they could get their hands on.

Unfortunately for us, evolution doesn’t move as quickly as our industrial and technological advances, which means we now get more of the high energy foods more easily, all while moving less and therefore putting out less energy.

The result? Atkins diets and the likes recommending low carb intake, which in actuality, should probably read “sufficient carb intake.”

A very recent paper has shown that even artificial sweeteners (specifically saccharin, see citation), may be able to induce these types of behaviors. In fact, saccharin sweetened water (and also sugar sweetened water) was chosen over cocaine, even for animals that already liked cocaine, and even when they were offered more and more cocaine!!! How’s that for amazing?!

What does this mean for food addiction?

Well for one thing, it means that if we want to battle the obesity problem in this country, we need to re-examine the availability of these high-sugar, high-calorie foods. But, it may also mean that low calorie foods that are artificially sweetened may soon be shown to be as bad for us…

I’m telling you, by the end of all of this, we’ll learn that growing your own vegetables and fruits is the only way to stay healthy. Come to think of it, even then, I know at least one person who may be addicted to fruits…

Question of the day:
Does your experience with high-sugar foods lead you to agree or disagree with these research findings???

Citation:
Magalie Lenoir., Fuschia Serre., Lauriane Cantin, Serge H. Ahmed (2007). Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698.