Treatment

On Anonymity in Recovery

Submitted by Bill: I was at a 12 step meeting a few days ago where one of the participants’ remarks showed that he had no real idea of what anonymity meant, or the reasons for it.  So I thought I’d weigh in with a few ideas on the subject.

I tell people that I have no anonymity; that I drank and drugged publicly and I consider it a privilege to recover publicly.  Despite that, however, I do not advertise my membership in a particular 12-step program.  I often mention attending meetings, in my writing and elsewhere, but not which meetings.  I speak knowledgeably about AA, NA, and other fellowships, but I don't talk about membership.  I have what I believe are good reasons for that, and I'd like to share my thoughts with you.

As I see it, there are two basic reasons for anonymity in a program of recovery: protection of the recovering alcoholic/addict, and protection of the program itself.

First of all, if we wanted to tell people we were members of AA, that would be our business, and ours only, provided that we did it on a personal level.  We might do so when speaking to people one-on-one, or in small groups under conditions where privacy can be presumed, because friendships are enhanced by such honesty under most conditions.  Then, too, that revelation might raise opportunities to bring the 12th Step into play.

Another area where we need to be careful is in speaking to outside groups.  We need to be sure that we're not thought to be speaking for a particular fellowship.  If we set ourselves up as some sort of recovering guru, how is the program going to look if, six months from now, one of those folks sees us passed out behind a dumpster, or in the ER being treated for an overdose?

Could happen.  If you don't think it could, speak to your sponsor.

There are excellent reasons, however, for us not breaking  your anonymity.  You might be hindered in your employment if word got out.  You might be an airline pilot with 20 years clean and sober who had neglected to tell the FAA about her problem — required by law — and lose your livelihood due to our big mouth.  It could simply be an issue that you find embarrassing.  It's no one else's business.  Our business is to keep what we have learned about others in the rooms to ourselves, period.  (Whether or not the airline pilot is behaving ethically in that situation is not the issue; it's our behavior we're discussing — and that is not a hypothetical example.)

The last, and perhaps best, reason that I can think of for sticking with the tradition of anonymity is humility.  It makes me just “another bozo on the bus.”  If I'm going try to be a guru, it's going to have to be on my own merits, not those of the program.  That's good for me and for the program, because my opinions often vary somewhat from more traditional positions.   When they do, I need to take the credit — and the criticism.

Anyway, those are a few of my thoughts about the issue, and I'm only speaking for myself.  Your mileage may vary.

1,000 New Jersey Residents are in Substance Abuse Treatment, Every Day

In New Jersey on any given day, nearly 1,000 people are in a clinic or hospital receiving substance abuse treatment. Most have entered a detox program (Sunrise Detox in Stirling services over 100 individuals every month) for what is typically a week to ten days of medically-supervised treatment. The initial detox is needed to stabilize them medically, so they can prepare for rehab or another treatment plan. The rest are in hospitals, also receiving detox before further treatment.

People are often surprised by the high numbers. Nearly 1,000 moms, dads, workers, professionals… one thousand New Jersey residents every day, getting treatment for a drug or alcohol addiction. Nearly half (42%) are in for heroin and prescription pain killers (heroin is an opiate, and many painkillers are synthetic opiates known as opioids, also highly addicting). Over 30% of the rest are in for alcohol abuse (dependency).

These data are from 2010. The trend lines for both alcohol and opiate abuse have increased dramatically since then, so today's numbers are likely to be even higher.

Adrian Hollywood Awarded Riley Regan Award by NJ EAPA

photo of family of Adrian Hollywood and NJ EAPA leadership

From left, (seated) Kevin O’Neill, past president NJ EAPA and CEAP of NJ Transit, Mark Hassell NJ EAPA Treasurer and EAP of United Airlines, (standing) Tom Garofola, NJ EAPA President, Hollywood family members Sheena Marie, Tara Margaret, and Kim Brown (the daughters and widow of Adrian Hollywood).

On April 19, 2013 the New Jersey Chapter of the Employee Assistance Professionals Association (EAPA) awarded the inaugural Riley Regan Award to Adrian Hollywood (deceased). Adrian was an employee assistance professional with a long history of dedication to serving the communities of New Jersey. Most recently, Adrian was known for his work with American Addiction Centers and NCADD.

The Riley Regan Award is dedicated to “the individual who exemplifies the service of an EAP”. At the same meeting, Barbara Martin, of Princeton Healthcare, was named the NJ EAP of the year.

Adrian was listed as an “Advocacy Leader” in the NCADD New Jersey directory, with the following description:

“Adrian Hollywood has worked for the past 13 years in the behavioral health community, primarily as a counselor. His most recent position, as a Treatment Consultant, enabled him to help individuals get placed in treatment throughout New Jersey and the rest of the country. Adrian has been a member of the New Jersey Employee Assistance Professionals since March 2010, working with hospitals, unions, and professional groups regarding addiction needs. Adrian feels strongly “it is my duty to stand for those in need and ease their obstacles in their communities.”

The NCADD is a private nonprofit organization which advocates on behalf of those affected by drug and alcohol addiction and their families. The organization manages more than $22 million in addiction treatment funding, and operates the Substance Abuse Initiative (SAI), funded by the New Jersey Division of Family Development. The SAI  provides addiction and mental health clinical assessments and care coordination services to welfare recipients throughout the state of New Jersey.

NJ EAPA members John Moriarty and Jill Pulvirent

NJ EAPA member John F. Moriarty III of Sunrise Detox of Stirling, NJ (a substance abuse treatment facility in Morris County) with Jill Pulvirent, LCSW, an Outreach Specialist at American Addiction Centers and former friend and colleague of Adrian Hollywood.

 

Heroes in Recovery 6k Walk and Run South Florida

6K Walk and Run April 27, 2013 at Tradewinds Park, 3600 W. Sample Road, Coconut Creek, FL

The Heroes in Recovery 6K Walk and Run April 27, 2013 at Tradewinds Park, 3600 W. Sample Road, Coconut Creek, FL

What could be better than spending a spring morning having fun with friends and neighbors and getting some exercise? Supporting a worthwhile cause at the same time! Please join me on Saturday, April 27, 2013 for the “Heroes in Recovery South Florida 6K Run & Walk”.

The mission of Heroes in Recovery is to work to reduce the stigma associated with substance abuse treatment, to help raise awareness of the need for treatment, and to provide support to people in recovery. Heroes in Recovery hosts similar events across the nation. Money raised at the South Florida 6K Run/Walk will benefit Mount Bethel Human Services.

The Heroes in Recovery Run & Walk will run from 7:00am to 10:30 am at the Tradewinds Park in Coconut Creek. I will be there representing Sunrise Detox, to show our proud support of this worthy organization.

There are over 23 million people in America who need help with addictions and mental health issues. Only about 3 million actually seek treatment. Heroes in Recovery believes many more people would seek treatment if they didn't sense a social stigma associated with substance abuse and mental health disorders.

Events like the South Florida 6K Run & Walk raise community awareness of the wisdom of seeking treatment and help to remove that stigma. If addiction and mental health disorders treatment is viewed in a positive way, and accepted by the community, more people needing treatment will seek treatment. In other words, more lives can be saved.

Come join me on April 27th at the Tradewinds Park in Coconut Creek, for the Heroes in Recovery 6K Run & Walk. It's a great way to show our community's support of our friends and neighbors who are making the heroic effort to break the chains of addiction, to give themselves and their loved ones the great quality of life they deserve.

Things Clients Say In Detox — Denial On The Hoof

We thought we would list some of the things that we hear clients say.  You can substitute any drug for any other drug in any statement or comment.  Denial ain’t just a river in Africa, remember?

I don't even know why I'm here.  I'm not an addict.

You're here for some reason.  You didn't just walk in to see what it was like.  Some major problem in your life got you through the doors.  You may as well hang out for a while and see if we can help you with the problem — whatever it is.

Marijuana isn’t addictive, because there’s no withdrawal.

It is true that years ago there was no noticeable withdrawal from marijuana use, but in those days cannabis had only about 1/10th the active ingredients that today’s hybridized varieties have.  Even then, chronic users often had trouble quitting.

Today, there is acute withdrawal that involves irritability, sleeping difficulties, mood swings, loss of appetite and other issues.  We also know that there is a post-acute withdrawal syndrome (PAWS) that  includes depression and cognitive disorders, and that can last for many months.

I'll stop drinking, but I'm still going to smoke a blunt now and then.

Recovery requires abstaining from all mood-altering drugs.  We cannot pick and choose.  All drugs work on our reward system.  Addiction occurs when the reward system loses the ability to make us feel good without the extra stimulation of drugs.  If we continue to stimulate the reward system so that it cannot return to normal, then we will continue to have cravings.

I only drink wine or beer.

All ethyl alcohol (ethanol) affects the human body the same way, and one six-ounce glass of wine, one 12 ounce beer, and one shot of 80 proof liquor all contain roughly the same amount of alcohol.

I only drink on weekends.

It is not important when we drink.  What matters is how much, and why.  If we are waking up with a hangover, which is really alcohol withdrawal, we are drinking enough to cause changes in our brains, even if we only do it two or three days out of the week.  And are we really remaining totally abstinent the rest of the week, or are we having a couple to “relax” each evening?  If that is the case, why do we need alcohol to relax?

I only use (pick a drug) occasionally, so I won’t become addicted.

There are millions of addicts who have found out the hard way that, despite their denial, the occasions tend to get closer and closer together until they have merged, so that we need the drug to be comfortable.  When we are more comfortable under the influence of drugs than we are without them, we are well on the way to addiction.

Alcohol doesn’t bother me; I can drink all my buddies under the table.

Increasing tolerance for alcohol or any other drug is the first sign of addiction.  If we can drink, snort, swallow or shoot more than we used to be able to handle, we’re in trouble.

“I can take it or leave it.”  (I just choose to take it.)

Put it down and don’t touch it for two weeks.  Let us know how that works for you.  Try it again.  Learn anything about denial?

I only have a couple of drinks at home, just to relax.

There is nothing wrong with that, unless we cannot relax without the drinks.  In that case we need to do some hard thinking.  We also we need to look at what we consider a “couple of drinks.”  A standard drink is one shot of 80-proof liquor, one six-ounce glass of wine, or one 12-ounce beer.  “Topping off” is cheating.  So is filling an iced-tea glass with ice and booze and calling it “a drink.”

My whole family drinks like me.

Alcoholism has a strong hereditary component, as do some other addictions.  Need we go on?

The bottom line is this: If drugs, including alcohol, are causing problems in our lives, whether they be hangovers, missing work, “discussions” with our spouses or partners, DUI’s, or any other issues, then they are a problem.  There are no two ways about it.  Either they cause problems or they don’t.  Then the big question becomes why we are continuing to do something that continues to cause us problems.

Now that is a good question — a very good question.

What is the Choice Model of Addiction?

In simple terms, the choice model of addiction contradicts the “disease” approach employed in 12 step treatment by stating that each individual is able to choose whether he or she uses drugs. Whilst some advocates of the 12 step approach will concede that drug use is initially a choice which then develops into a brain disease, supporters of the choice model refuse to accept that a disease has anything to do with addiction at all. They believe that choices were made to start using drugs, and therefore that choices can be made to stop. The debate between these two camps has raged for decades, and shows no signs of abating.

Read more at Everything Addiction – What is the Choice Model of Addiction?

NOTE: Sunrise Detox supports the disease model, but believes the important thing is recovery, not arguments.

How Many People Get Into Recovery And Then Relapse?

There are all sorts of numbers you hear bandied about, and none of them are really precise. Here’s why.

Relapse is difficult to measure. Obviously it occurs before we use. If we weren’t already in relapse, we wouldn’t use, would we? So if I don’t use, did I relapse or just come close?

Recovery is about making the physical, social and mental changes that take us away from our old ways of thinking and develop new ways of looking at the world that allow us to live relatively happy, healthy, sober lives. Recovery is a sliding scale, not an event, and we can move in either direction.

It is even possible to stop dead in our tracks and move in neither direction. Some of us stop using but do nothing to change. We call those folks dry drunks, and as the saying goes, “If you sober up a horse thief, all you get is a grumpy, more efficient horse thief.” If they use later on, does that count as a relapse, or were they never really in recovery?

It is reasonable to say that for people who started off making progress, relapse occurs when we begin sliding back to our old ways of thinking and behaving. Using simply makes it impossible to ignore any longer.  This brings up the obvious issue of measuring recovery. How do we do that?

Recovering people clearly move along the scale in a positive direction. Their attitudes improve, they exhibit willingness to change, and do so. They seek out positive relationships and nurture them. They become more truthful and compassionate. They recognize that false confidence is a trap, and try to remain realistic about their progress and prospects. They are willing to share what’s happening in their lives and accept feedback. They make an effort to become a part of the outside world, while retaining their connection to the recovering community. Finally, they help others to achieve the same goals.

Conversely, to the extent that they do not make those changes, or move in a negative direction along the scale of recovery, they are either not in recovery or are in relapse.

The second big issue is counting those who relapse “officially.” How do we do that? We know that a great many people who enter detox facilities do so more than once. But if they don’t return, are they still clean and sober? Did they move? Did their insurance run out? Did they get clean after going “cold turkey?” Did they die?

Many people think that the 12-step programs ought to be able to answer those questions. But how? That word “Anonymous” is a huge barrier. Who keeps the central database? Who takes and validates the surveys? How do we tell one drunk named Bill W. (a co-founder of AA) from another Bill W. who writes for Sunrise Detox? The figure we hear spoken  about in the rooms is usually in the 10 to 30% range for eventual recovery. Is it accurate? No way to tell.

A study by the National Institutes of Health (available here) is of little concrete help, but does point out other complications. How many people went into treatment facilities? How long was the treatment? How many people participated in AA or another self-help group? How many did both? How many used, but participated on a second try? How many of those who participated in groups on the first try relapsed, and how many went to treatment subsequently? You can go on and on with these combinations, and resolve little or nothing. The follow-ups on this particular study were done by phone. How many of those people simply lied out of embarrassment?

The same problem occurs with treatment facilities.  We only have contact with those who return, or who stay in touch.  We have no way of knowing what happened to the rest. A large chain of treatment centers estimates relapses at 70 to 90%, but how is that measured, and how many of those people subsequently get sober? Who knows?

The most accurate figure is probably in the 70% to 90% range. Addiction is a disease, and one of its symptoms is relapse. We can expect anything that is considered a “symptom” of a disease to occur more often than not, and for the numbers to be significant. It also gibes with our experiences in treatment and detox.

The important issue is not how many make it, but whether we, as individuals, are doing everything we can to insure that we continue to move in the right direction. One of those things is helping others to achieve sobriety. If we are doing our absolute best, then the chain builds itself, one link at a time, one day at a time.

And no one can answer that question but you.