The Dangerous New Disease in Needle Park

From The Fix:

Since the start of the AIDS epidemic in the early 1980s, public health professionals have made impressive progress in developing prevention programs that stop HIV and hepatitis C in injection drug users; thousands of lives have been saved. But there’s a less recognized—and growing—danger with the potential to wreak havoc on the bodies of drug users and to burden the healthcare system with steep financial costs…

Read More Here

Change is less scary if we take our recovery one day at a time.

I received this comment about change on an article that I wrote about getting through post-acute withdrawal from alcohol and other drugs:

I am 3 days clean, and after reading this. I feel totally hopeless and want to go blow my brains out. Exercising, eating healthy, none of that is me and will never happen. I give the fuck up.

Here was my response:

Hi L…..,
Recovery is about changing many things, but it doesn’t have to happen all at once. That’s why we say, “One day at a time.” When you decide to really change your life, things will get better.
In the meantime, good luck and best wishes.

So many of us felt that way when we looked too far ahead during those first few days and weeks!  They say around the rooms that “recovery is simple; all you have to change is everything.” The prospect of making changes in our lives can seem so daunting that folks who aren't yet committed to recovery often find it a great excuse to go back out and drink or use other drugs. Change is scary, but it doesn't need to be terrifying.

As I wrote to the young woman, in recovery we say “One Day At A Time.” Thinking about all the details of any major project can be alarming, especially for us addicts. We’re accustomed to thinking no farther ahead than the next drink, or the next meet-up with the guy down on the corner. Ask us to consider big changes early on, and many of us are just not emotionally able to handle the prospect.

All I have to do is stay clean and sober today. If I can do that, I can make some plans. I can go to a meeting this evening. Between now and then I can get a little laundry done, buy some groceries, and call another recovering person. (Oh yeah, maybe I’d better take a shower, too.) After the meeting, maybe someone will want to go for coffee. Then I’ll come home, thankful for one more day, and crawl into bed. Tomorrow will be another day.

Obviously, we do have to make some long-term plans, and when the time is right we can do that. But worrying about the details of our future is a good way to (and a good excuse for) deciding we’d be better off doing what we used to do. At least we know how to do that. All too well.

The secret is to make little changes. It gets us used to change and gives us practice. As long as we stay clean and sober and work our program, one day at a time, the bigger changes will happen — often without our even noticing.

Geographic Cures and Denial

Q. I've heard people at meetings refer to “geographicals,” or “geographical cures.” What's that about?

Hand-drawn map of North America, 1811 -- Library of Congress, Geography and Map Division

A geographical cure is an attempt to avoid the reality of our addiction by changing location.  They are a form of denial, a defense mechanism in which we are faced with a fact that is too uncomfortable to accept and so we convince ourselves that it is not true despite what may be overwhelming evidence.

Excuses are a major form of denial. We learn their usefulness as small children: “She hit me first!” We usually grow out of that phase, but for addicts the need to make excuses and convince ourselves and others that we're really okay is our way of protecting the addiction. We say things like, “If you were married to that bitch,” or “If you'd seen the things I've seen…,” all of which, we have convinced ourselves, justify our drinking, drugging or whatever we may prefer not to look at too closely. (If we did, we might have to do something about it.)

So, when things get rough, we sometimes convince ourselves that all we need is a fresh start in a new place, and we'll be able to get our lives back under control. However, unless our geographical cure has also involved detox, treatment and a program of recovery, we discover that it doesn't take long for the things that we thought we'd left behind to hop out of the trees and right onto our backs again.

We failed to consider one of life's major truths: No Matter Where You Go, There You Are!  We need to change our way of living, not where we live.

Hitting the road doesn't solve our problems, it just means that we have to face them in a strange place, among strangers.  If, however, we decide to get out of the old neighborhood and get some help, that's not necessarily such a bad idea.

I Don’t Need A Program, I Can Recover On My Own

One of the prime goals of treatment is to give us confidence in our ability to overcome our addiction.  We need to be careful, however, to insure that we’re not overconfident.  Confidence in our ability to work a program of recovery successfully is essential, but overconfidence is a free ticket back to where we came from.

Overconfidence is perfectly understandable.  After we get the alcohol and/or other drugs out of our system, get a little

Lonesome road to...what?

exercise, some rest and a few square meals under our belts, we’re probably going to feel better than we’ve felt in years.  We may begin to think, if we’re not careful, that we’re cured and ready to head back out into the “real world.”  At that point, the insistence of therapists and other staff that we need more time is likely to fall on at least partially deaf ears.  After all, don’t we know our own bodies?  Don’t we know how we feel?

Probably not.  We spent a long time interfering with the chemistry of our brains.  We changed our thinking, ethics and lifestyle to accommodate a life of living from one fix, one drink, one line to the next.  In many cases, if not most, we’ve never lived what most people would think of as a “normal” life.  The chances are very good that we don’t even remember what that is any more, if we ever knew.

So how do we know we’re ready to go out and live one?  Where’s the proof that we really do know how we feel and how to take care of our bodies and minds?  What experience have we really had?  It’s an absolute fact that the longer an addict/alcoholic stays in treatment, the greater are their chances of avoiding relapse.  That is not only a matter of learning, it’s a matter of giving ourselves a chance to practice healthy living in a safe environment.

Time in treatment is golden.  If we spend a month longer in house and avoid another few years of using — or death — isn’t that a good trade?  If we spend a few months in a halfway house while we hone our sober living skills with aftercare, meetings and slow movement back into mainstream society, isn’t that better than finding out that we really don’t have the skills and ability we thought we had — the hard way?

If we were going to climb Mt. Everest, we’d get in shape over a period of months.  We’d get a guide, follow his or her directions, buy the right equipment, learn the necessary skills, and finally work our way up to higher and higher altitudes gradually, so that we were sure that we were ready to head for the summit when the weather was right.

Why should we pay less attention to the rest of our lives?

Do I Really Need A Program Of Recovery?

If there is one form of denial that is common to most folks who aren’t sure if they really want to stay clean and sober, it’s “I don’t need a program.  I can do it myself; all it takes is willpower;” or, “I have plenty of support at home, I don’t need to go to meetings.”  Hard on the heels of that idea is “I don’t like (insert 12-step program here), it’s too (insert excuse here).”

You don’t have to spend much time in recovery to hear folks make these statements, and if you work in the recovery field, you hear it all the time.  It usually doesn’t take too long for those people to fade out of sight, and sometimes we see them come back, weeks, months or years later, with a better attitude.

Often we don’t.

There are a couple of secrets to making it in recovery.  One is to do whatever we can to get over the habits, both mental and physical, that led us to, or reinforced the use of, our drugs of choice.  Without going into detail, some of those are:

  • using at certain times and in certain places, or with particular people
  • making excuses to justify our using (“I deserve it; If you were married to her, and so forth)
  • “drinking at” people, using booze or drugs to withdraw and let them know we don’t need them
  • always smoking a cigarette when we’re on the phone, if that’s the addiction we’re working on
  • we could continue the list ad infinitum.

The other — perhaps the biggest — secret, isn’t really a secret at all.  It’s bounced around the rooms all the time, but somehow some of us manage not to hear it.  That’s to keep an open mind!  If we don’t like what we’re hearing, we need to remember two things:

  • there are no rules in the 12-step rooms, only suggestions; no right and wrong way to do it, only ways that we have found — through 70-odd years of experience — work for most people; and
  • use common sense.

The common sense part is obviously open to interpretation.  For example, the “no romantic relationships in the first year” suggestion is a good one.  A new relationship is about the most distracting thing that can happen to anyone, and we don’t need distractions.  On the other hand, if we’re already in a relationship that hasn’t soured completely, that suggestion obviously doesn’t apply.   However, if we used with our partner, (or used them as an excuse to use) maybe we need to re-think that, too.

Another example would be the “Higher Power Issue.”  If you want the god of a particular religion as your higher power, that’s fine.  If you don’t, that’s fine too.  The thing is, we need to admit that we can’t do it alone, and surrendering to a higher power has terrific symbolism.  It works for a lot of people.

If it doesn’t work for you, great.  Just remember that part about not doing it alone.  It’s nearly impossible to recover without the support of other recovering people.  We need to remember, too, as long as we’re on the subject, that just as we have a right to choose what we believe is right for us, so do others.  So if they want to talk about their god, that’s OK.  It isn’t catching.  If we can’t be that flexible, we’re in trouble already.  After all, tolerance is the first step toward a spiritual life.

Ask yourself these questions: Do I really want to get clean and sober?  Do I want to have a full, satisfying life?  Do I want to improve my self-esteem, clean up some of the wreckage, and generally become a productive human being — or do I want to die in my active addiction?

That, my friend, is the most important question you will ever ask yourself.  Don’t answer too hastily.

Questions from Newcomers: Will it be harder to recover if you don’t believe in God?

If we believe in a loving god who cares what happens to us, looks after us, and answers prayers, the peace that our belief brings will unquestionably be a great support in recovery.  On the other hand, if we believe that a god will take care of us simply because we ask, without our putting any effort into our recovery process, then it is quite possible that believing could hinder our recovery.  Likewise, if we were raised to believe in a harsh, punishing god who will make us pay for our transgressions, we may find that we are emotionally unable to deal with the implications and may so totally reject the “God Thing” (as many of us call it) that we end up throwing our recovery out with our religious beliefs.

We tell newcomers that their god can be a tree, doorknob or the group because, in reality, religion is a non-issue when it comes to the nuts and bolts of recovery.  In order to have a shot at recovering, we need to acknowledge that “our best thinking got us here,” (to quote another recovery cliché) and accept that we really don’t know how to do it.  That, in turn, leads to the inescapable conclusion that we need to stop trying to do things our way and let someone else help us.  This can be really hard for addicts and alcoholics who spent years defending their every behavior, but it is absolutely essential if we are going to escape our active addictions.

If we decide that “God as we understood Him” is the god of the Jewish, Christian and Muslim faiths, or one or more of the many gods associated with the Hindu faith, or the Wiccan goddess, that’s fine.  We can turn our will and our life over to the care of that entity, in the sense that we become humble enough to trust the recovery process, and listen to people who know what they’re talking about.  The comfort that we get from our beliefs will be a help as long as we don’t think that religion is all we need.

Recovery is about being honest with ourselves and those around us, open — both in the sense of accepting input from others and letting them know a little about who we are — and willing to “go to any lengths” to develop the qualities we need in order to recover.  It is about learning forgiveness, compassion, tolerance (even of people who believe differently from us), humility, acceptance, and the other things that are involved in living with and around other people.  It is about eventually becoming able to re-enter society and live a functional, productive life.  The “spirituality” that we talk about in recovery is not religion, it is the development of the human spirit.  It is about becoming comfortable in our own skin — about not needing to turn our brains off in order to achieve a reasonable degree of comfort, happiness and, occasionally, joy.  It is about learning that we don’t have to feel good all the time, and appreciating the times that aren’t so good along with the better ones.  After all, aren't most of them — even the bad ones — better than when we were using alcohol and other drugs?  The difference is that, like the rest of humanity, we're actually present in our lives, not hiding from them.

We can see that it is quite possible to achieve the qualities needed for recovery without believing in a metaphysical presence.  That is not to say that belief is not desirable or helpful, if that’s where our head is coming from, but many of us have recovered successfully without religious beliefs.    We also need to be really careful to insure that our objection to the beliefs of others (which are really none of our business) doesn't become an excuse to avoid the recovery process.  That's killed a lot of addicts.  Denial isn't a river in Africa.

“To thine own self be true” is the key.  Most of us were square pegs.  We need to learn that it’s OK — that we don’t have to fit into openings made for other shapes, and that we don't need chemicals for lubrication.  Learning that, and appreciating ourselves for who and what we really are, is what recovery is all about.

Amateur Night

Sunset 2011

I was outside snapping this photo with my phone, and remembered it was New Year’s Eve, and thus the last sunset of 2011. That got me to thinking about how it would have been, “back in the day.”

I’d have been getting tuned up for the evening by now, slightly tipsy (to the extent that I wasn’t permanently tipsy, there at the end), and making jokes about “amateur night.”  That’s what we called New Year’s Eve, referring to all the drunks who couldn’t handle their liquor, and how dangerous it was to be on the road when they were rushing around looking for that last party where they could ring in the new.  That didn’t stop us from getting drunk, we just stayed home.

Drinking surrounds celebrations in our Western traditions.  I guess other traditions have their own ways of mood-altering to celebrate, and certainly we Westerners have a variety of recreational chemicals to hasten us on our way to “happiness,” but in our society alcohol is overwhelmingly the drug of choice.  We take to heart Ben Franklin’s declaration that “beer is proof that God loves us and wants us to be happy,” and on New Year’s Eve we don’t hesitate to travel other roads to happiness as well.

And you know what?  That’s OK for most of us.  The fact of the matter is that roughly 80% of folks don’t even want to get drunk when they drink.  They get the buzz, relax a little, and then just…stop drinking for the evening.  Those are the folks who walk away from a half-full glass of wine, an unfinished beer, and leave people like me a bit mystified and just the least bit annoyed.  At most any celebration that isn’t held in a bar, eighty out of a hundred of the guests will drink that way, or won’t drink at all.

The rest of us — well, we don’t fare so well.  One of the prime indications of a booze problem is getting more intoxicated than we intend to.  Another is the ability to drink “amateurs” under the table.  Both of those danger signs are well-known.  Despite that, I managed to remain happily unaware for about twenty-odd years.  But that was then.  These days I don’t worry about things like that.  I know that as long as I keep my head in the right place and do the things that have helped me stay sober over the years, I’ll be safe and happy this New Year’s Eve.

As long as I stay off the road, that is.  It’s Amateur Night, but now it’s the other pros that I worry about.