Tuesday, 10 January 2012

Will for Recovery

Have you known someone with the disease of addiction that appears to desperately want sobriety and recovery, yet cannot seem to stay sober? Perhaps this person has been through excellent treatment programs, has stayed in sober living, has even been seeing a therapist on occasion, but they still cannot stay sober. They have been afforded every opportunity to find the recovery that they so desperately want, and they cannot seem to get out of their own way to find it.
Working in a transitional sober living environment, I witness these characteristics often. I have given much thought as to why it is that someone who, I believe genuinely does want recovery, cannot stay sober more than a couple of months. Based on this experience, I wish to pass along some of my impressions and opinions as to what I believe is a major contributing factor to the relapsing behaviors of the person described above.
Let me be clear, these opinions pertain only to the individual who genuinely wants a lifestyle of sobriety and recovery. So often the addict will tell people they want sobriety, but they really only want to avoid the negative consequences of addiction. I am not referring to the negative consequence avoidant individual in this article. I am referring to the individual who knows they must be sober and in recovery in order to live a quality of life that will provide them with joy and serenity; they just do not know how to get there yet.
There are so many variables from individual to individual that it is difficult to point out one factor that has the most significant impact on everyone. However, there is one factor that seems to have a significant impact on the success of the recovering individual most of the time: the individual's will.
There seems to be two types of will that manifest themselves within an individual with the disease of addiction: one that is willful, and one that is willing. The difference between the two is staggering.
- "I need to do things my way"
- "I refuse to be forced into anything"
- "I don't need to do what I don't want to do"
- "You don't know what I know about myself"
- "I do things when I want to"
- "I choose my own destiny"
- "I am in control until I am not"
- "I can try"
- "Give me guidance"
- "Help me through the hard parts"
- "I don't know what's good for me anymore"
- "I will stick to my plan"
- "I live one day at a time"
- "I cannot control much of what happens"
It seems clear that the willful individual is inflexible and remains narcissistic in the belief that they are in control of their actions, when it is obvious that there actions continue to lead them back to active addiction. The willful individual has a deep sense of denial and avoidance that stems from a fear of letting go. Sometimes the willful individual can be persuaded to allow the willing individual to emerge. The willing individual allows for the opportunity of new experiences. New experiences can mean progress and growth.
It may seem as if I am referring to two different people, however I am not. Both the willful and the willing individual live within the person that desperately wants sobriety and recovery and cannot seem to find it.
When the willing person sets out to try something new, whether it be under the direction of a clinician or an idea that they learned about from a peer, they encounter a process called change management. The change process carries with it stress and anxiety that must be coped with if the change management process is to be effective. For the willing person in recovery, the stress is a major challenge. Stress is the very thing they have been using drugs, alcohol and acting out behaviors to avoid. When they encounter significant stressors in the change management process, the willing individual can quickly become the willful individual and may derail.
The Transtheoretical Model of behavior change, as developed by James O. Prochaska of the University of Rhode Island, describes the stages of change as a "process involving progress through a series of stages." (Prochaska, JO; Velicer, WF. The transtheoretical model of health behavior change. Am J Health Promot 1997)
Precontemplation- "people are not intending to take action in the foreseeable future, and are most likely unaware that their behavior is problematic"
Contemplation- "people are beginning to recognize that their behavior is problematic, and start to look at the pros and cons of their continued actions"
Preparation- "people are intending to take action in the immediate future, and may begin taking small steps towards change"
Action- "people have made specific overt modifications in their life style, and positive change has occurred"
Maintenance- "people are working to prevent relapse, a stage which can last indefinitely"
Termination- "individuals have zero temptation and 100% self-efficacy... they are sure they will not return to their old unhealthy habit as a way of coping"
At any point in the stages of change, the individual may "return from action or maintenance to an earlier stage" which is referred to as a relapse.
As is indicated in this model, if the recovering person makes an effort to progress with change because he/she is willing and then encounters substantial stressors which result in willfulness and relapse, it is possible that he/she does not revert all the way back to the beginning of the change process. From a cognitive behavior perspective, this type of relapse can be a positive step for the individual attempting the change because he/she may learn that the failure was not catastrophic and may be more willing to attempt the change again. With the help of a clinician and/or a peer support group, the individual will be more likely to become willing again.
Make no mistake; it is very difficult for an individual to shift from a state of willfulness to a state of willingness. Conversely, it is very easy to switch from willingness to willfulness. Then how does one engage an individual who is consumed by willfulness and attempt to guide them to willingness?
The answer here is simple and complex: the appropriate questions asked in a productive way will help the individual find willingness from a willful state. I understand that this is not the answer most are looking for. It is not possible to provide a generalized answer that will work for most people because everyone is unique in their thinking, reception, and experience. However, in general, it is helpful to positively reinforce the type of thinking that is willing. Eventually most people will seek the positive reinforcement and this will slowly move their thinking to that of willingness.
Those who are successful at building a long-term recovery lifestyle often make statements indicating their lives are better than they ever imagined. In my experience, many of those who are in long-term recovery from addiction often have more serenity and purpose in life than people that have never been afflicted by the disease. I think one of the primary reasons this occurs is because people learn to be willing.

Thursday, 5 January 2012

How Does Drug Addiction Happen?

Unless you've experienced it yourself, it's difficult to understand how addiction to drugs or alcohol can happen. Many people promote the misconception that all an addict or alcoholic needs to do is stop drinking or using drugs. However, it's never this simple and even the strongest people with incredible reserves of will power have been unable to stop using even when their lives were crumbling around them. Drug addiction can and does happen to anyone from any walk of life. The first part of helping to get someone you love treatment for addiction is to create an environment of understanding.

People use drugs or drink for many different reasons. Some might be self-medicating feelings of insecurity, social anxiety, stress, or even physical pain. Others might use recreationally or as a result of peer pressure from friends or family. Whatever the reasons may be, anyone who uses any drug can easily become addicted under the right (or wrong) circumstances. This is because addiction is both a physical and mental disease that occurs from one thing only: repeated drug use or drinking.

The first stage in drug addiction is tolerance. As a substance is introduced consistently into the body, the central nervous system will make changes in order to mitigate the effects of the drug. This develops a tolerance where the user needs more of the drug to achieve the same effect, i.e. to get high. This tolerance only exacerbates the problem because now more of the drug is being put into the system.

Tolerance invariably leads to physical dependence. Physical dependence occurs after a substance has been in the body consistently for so long that the changes made by the CNS become semi-permanent. This means that body then only operates normally when the drug is in the system. When the drug is suddenly reduced or withheld from the body, the central nervous system must make drastic changes in order to adapt. This is known as Withdrawal Syndrome or Detox, and in some cases stopping using a drug or alcohol can actually be fatal. For this reason, detox should always occur in a medically equipped facility once a person has progressed past tolerance to physical dependence and addiction.

True addiction features physical dependence coupled with a full set of physical, emotional and mental problems and conditions that can be extremely debilitating. In general, once physical dependence has set in, true addiction is differentiated by the appearance of three behaviors;

Control loss. People who are addicted show a loss of control over their drug use or drinking.

Obsession. Addicts obsess, think, plan and talk about drugs and using drugs constantly.

Continuation despite consequences. Even with the loss of loved ones, careers, financial difficulty and trouble with the law, an addict will often continue using despite these severe consequences.

No matter what the situation is or how addiction came to be, there is help available for anyone who needs it. Drug rehab centers and alcohol recovery programs are dedicated to providing a secure environment where people can get help and take back control of their lives again. In order to learn how you can help yourself or someone you care about who has a drug addiction or alcoholism problem, all you need to do is make one confidential phone call right now.