It is interesting how divergent information can come together and bring a bit of clarity. A devastating medical diagnosis of a family member, the CoVid pandemic, and a William White blog post brought all these together for me and helped me see how interrelated we all truly are. Although our situations and circumstances may be very different, our human condition is very much the same.
In doing some research on coping with a terminal illness, I came across the book, Smiling through your tears: Anticipatory Grief by Harriet Hodges and Lois Krahn. At the same time, this blog post by William White arrived in my inbox discussing how families deal with a loved one involved in substance use: http://www.williamwhitepapers.com/blog/2014/01/anticipatory-grief-and-family-recovery.html As I studied the news. I found discussions on how we as a society are coping with CoVid 19.An underlying theme of grieving for something that has not yet happened emerged connecting these concepts and ideas.
Grief is often viewed as a response to the death of a loved one. But grief can be much more complicated and nuanced than the sadness we feel when someone dies. The grieving process can surround any loss or life change such as unemployment, military service, relocation, the end of a relationship, medical diagnoses, having a loved one involved in substance use, or coping with the effects of a pandemic.
As a society, many of us find ourselves grieving during CoVid, even if what we are grieving is not obvious and straightforward. Most of us have lost routines, connections and certainty about the future. This fearful anticipation is called “anticipatory grief.” We have a sense of unease that the world will never be the same with a lingering sense that the worst has not yet arrived.
Anticipatory grief begins the moment we hear the awful news. It is the rehearsal–the progressive letting go–that helps us prepare for the impending loss. It is a complex process of trying to anticipate what life will be like in the future. Life becomes a waiting game, sending us into a state of emotional limbo. The unpredictable timeline makes it hard to plan ahead and pace our emotional reserves in the face of this massive, unstoppable glacier of an unknown future. Flexing to adapt to constant change takes an enormous amount of energy.
In a recent blog, national recovery advocate, William White, stated “For families facing addiction of a family member, every unexpected absence, every late-night phone call and every knock on the door elicits images of injury and death. These feared tragedies are repeatedly visualized and experienced with each episode marking an increment of physical and emotional disengagement.”
Whether our uncertainty comes from the projected death of a loved one, the roller coaster of substance use, or planning for the unknown post pandemic “new normal,” anticipatory grief can be exhausting and difficult. Next week we discuss strategies for coping with anticipatory grief regardless of its source.
Waiting is hard. Lately, it seems that all we do is wait. We wait to see what our new CoVid reality will look like. We wait for the financial/employment ramifications of the shutdown. We wait to see our friends, family and neighbors again. We wait for the results of the upcoming election. We wait for it to seem like life isn’t on hold anymore. The uncertainty leaves us exhausted, weary and perhaps in despair.
How we handle the waiting depends at least in part in hope. Hope can mean various things. Hope can be a wish. “I hope it won’t rain today.” This hope indicates what we think should happen, even though we have no control. Hope can be an intention or motivation. “I hope I can complete this task.” This hope shows what we are working towards and believe we can accomplish. Hope gives us courage to keep going, protecting us from fear and anxiety. Hope gives us purpose and motivates us to go on. Hope shapes the way we live and the decisions we make. Lack of hope can cause us to feel stuck, unmotivated, and purposeless.
Currently, the world seems unstable and unpredictable. It is easy to become discouraged and fearful, feeling alone and isolated. Often people lose hope because they don’t think their situation will ever change or be different. They feel as if they have run out of options and there is no reason to keep trying.
As hard as it is for us to remain hopeful in this challenging time, it is especially important for those in recovery. During this time of quarantine and isolation, there has been an increase in substance use and mental health issues. Isolation, uncertainty, and lack of hope have had devastating effects on many in recovery. As a friend told me recently, “People in recovery are struggling right now. …The quarantine has caused a lot of relapses, even in strong people.”
So what can we do to assist our friends in recovery post quarantine? We can offer them hope. Hope is a powerful force in the recovery process. It is the belief that recovery is possible. The more hope a person has the more likely they are to begin and sustain recovery. If our friends in recovery have experienced a setback, we can encourage them that this is only a misstep and not a Grand Canyon fall back into addiction. We can be a positive force in their recovery by not giving up on them. Being with hopeful people, instills hope in those around them. We can help them recognize possibilities and steps forward that they may not have considered or can’t see them on their own. Our words and attitudes let them know we do not consider them to be beyond help. Even a simple smile, phone call or text can offer encouragement and strength. Recovery is possible and you can be a part of it. There is hope.
There is a widely held misconception about addiction to substances. Many believe that once a person becomes addicted, there is little hope for recovery and the obstacles to recovery are insurmountable with little likelihood of success.
Statistics do not support this idea. According to drugfree.org, there are an estimated 22 million people in the United States involved in substance misuse. It is estimated that there are more than 23 million people in recovery from substances. Other sources indicate that ten percent of American adults self-identify as being in long term recovery from substance use.
For those who have a family member or friend caught in addiction, the roller coaster of recovery is one of hope, relapse, disappointment, recovery; and then the cycle begins again. The ups and downs of this road make long-term recovery seem impossible. The behaviors often associated with substance use can be frustrating, disturbing, and infuriating for those around the person. The chemical changes in the brain associated with substance use can lead to personality changes -- life revolves around obtaining the substance. Recovery may seem hopeless, but the Institute of Drug Abuse tells us that addiction is a chronic relapsing disease in the same medical category as other chronic diseases such as diabetes or heart disease.
Just like diabetes and heat disease, substance use disorder is influenced by some genetic predispositions, environmental factors and lifestyle decisions. No one chooses to become addicted or to develop diabetes or heart disease, but lifestyle decisions can have long term, negative effects.
The treatment of any chronic disease begins with an accurate diagnosis, followed by research-based treatment and long-term follow-up and support. Successful treatment of chronic disease requires healthy lifestyle choices such as good nutrition, exercise, developing positive coping strategies and stress reduction as well as following the prescribed treatment plan. It may take time to find the most effective treatment for an individual. The treatment plan and medications may need to be adjusted to accommodate the patient’s individual needs and response.
Individuals treated for chronic disease know that environmental factors and personal choice may lead to setbacks. Returning to previous lifestyles do not contribute to successful treatment. New habits must be embraced. People treated for cardiovascular disease know returning to a high-fat diet and sedentary lifestyle may contribute to additional health risks. Diabetics know that food choices and lack of exercise affects weight gain and increased blood sugar. Those involved in substance use find that returning to the same environment contributes to recurring use, legal issues and negative health outcomes.
There is another misconception that the relapse rate for substance misuse is very high. Relapse is defined as the return of a disease or the signs and symptoms of a disease after a period of improvement. In reality, relapse rates for most chronic health issues are very similar. According to a 2014 study by the Journal of American Medical Associated, relapse rates for those with type 2 diabetes range from forty to sixty percent. Relapse rates for those with hypertension (high blood pressure) are between fifty and seventy percent. Surprisingly, relapse rates for those with substance use disorder are around forty to sixty percent as well.
Treatment for chronic disease is rarely a one-and-done episode. Success requires a commitment to follow treatment plans, engage in lifestyle change, and perseverance. With proper treatment and support, people with chronic illnesses can recover and lead fulfilling, productive lives. Treatment works. Recovery is possible.
Stories are powerful tools to communicate and promote understanding, empathy, and connection. Today’s story of recovery and hope from those who have overcome addiction describes the journey of Alicia, a single woman in her early thirties. Alicia has been in recovery since October 5, 2016. She has six sisters, two brothers and her parents were married for 50 years before her father passed away in 2015. She experienced a lot of adversity in her life, beginning with abuse suffered at the hands of a relative. This trauma affected her deeply, causing her to make many bad decisions, crippling her self-esteem. She struggled with substance use through her twenties, experiencing rehab, detox, recovery housing, and homeless shelters multiple times.
In her first significant period of recovery, she quit using, drinking, and smoking cigarettes. She ran her first half marathon, had her first back surgery, and started college all within one year. She successfully completed three years of college, but the old demons resurrected with catastrophic results. She fell back into her former lifestyle and dropped out of school. She went into detox twice and later was arrested. For some people, arrest is a wake-up call that life needs to change, but not for Alicia. This was yet another episode of misery and hopelessness causing her to fall farther into despair. She did not know how to cope.
Her father died while she was in prison. She was released and running on a warrant when she unexpectedly reconnected with her family. They decided to support her unconditionally while she served nine months for a probation violation, and her life began to change. She was the first client to be accepted and complete the Gilead House program in Kokomo. She ran two half-marathons. She connected with the Quick Response Team in Tippecanoe County, and is now working as Certified Recovery Specialist here in White County. She returned to college and recently graduated with a bachelor’s degree in sociology with a concentration in criminal justice. She was accepted to graduate school to earn a Master’s degree in social work, which has always been her dream.
Her life has changed! She loves serving her community and has a passion for serving nonviolent drug offenders caught in the grip of the criminal justice system, advocating for them when they are unable to speak for themselves. The QRT has served as a springboard for what she will be doing in the future, and for that she is truly grateful.
Alicia’s story illustrates the difficulties of overcoming trauma, the cycle of substance use, the importance of continuing to reach out for help, and never giving up. Her life demonstrates the power of recovery, offering hope for those still in that lifestyle. For Alicia, her family, running marathons, the support of the Gilead House, and her passion to help others made the difference. Overcoming substance use is battle that is not easily won, but with treatment and support, recovery is possible! Thanks, Alicia for allowing us to share your story. For help recovering from substance use, please call the QRT at 765-490-0381.
Today’s column is written by Jason Padgett, Program Director with the Phoenix Paramedics Quick Response Team and Recovery Community Advocate. He shares his view of recovery and how communities can support this process. Jason’s vision of recovery is not only focused on helping an individual maintain sobriety, but also creating a community level of support that incorporates a wholistic view of recovery which includes all aspects of life. SAMSHA website https://www.samhsa.gov/find-help/recovery lists the four pillars of recovery as:
We soon realized that successful recovery systems were more than a checklist. Meaningful change requires learning from those who have gone before you, continuing dialogue with those in the field, and listening to the voices of those in recovery.
What we took away from those early conversations was the need for a philosophical change that is often articulated as ‘bringing recovery to practice’ or RTP. While there are several key components interwoven in the RTP ideology, the central theme revolves around all parties maintaining a focus on the optimal outcome for each individual: long term recovery. When we begin to see people as individuals, when we begin to believe that recovery is possible and work with those individuals toward reaching their full potential, allowing each person to choose their recovery path, we embrace the best practices to facilitate the goal of long term recovery.
We began to realize that Bill White is correct when he touts “there are multiple pathways to long term recovery and all are a cause for celebration.” There is no one correct way to recover. Some find success in 12-step programs, others prefer cognitive based therapies that focus on changing thinking and addressing triggers. Some embrace spiritually-based programs, while others find secular programs more helpful. Whatever path the individual chooses, we find that respect, peer support, addressing underlying trauma, and taking a wholistic approach are essential. People in the beginning stages of recovery are very fragile and easily discouraged. They need support and a “warm-handoff” to navigate the resources and services they need to be successful. More and more service providers have begun to embrace this idea and help their clients connect face-to-face with other services and resources.
If the above paragraph describes what a person seeking help for a substance use disorder experiences in your System of CARE, then you have likely brought Recovery to Practice; if not, it’s never too late for an overhaul.
Recovery Community Advocate
People involved in substance use find themselves facing some unexpected dangers during the corona virus pandemic. The first is their increased physical vulnerability to disease. People involved in substance use often have health conditions exacerbated by poor nutrition, COPD, cirrhosis, cardiovascular disease, HIV, Hep C and compromised immune systems which make them more vulnerable to severe illness and especially CoVid. Some people in recovery reside in communal living situations which increase their risk for exposure to the Coronavirus.
Nationally, the quarantine has seen a 50 to 70% increase in alcohol sales. Whether people are hoarding alcohol or actually using it to self-medicate remains to be seen. Mental health and substance use treatment providers express concern about the isolation during a pandemic and the ease of hiding a relapse or an increase in use.
According to Mike Thibideau, with Indiana Workplace Recovery, during the CoVid quarantine the Indiana Addiction hotlines went from 20 calls per week to 20 calls per day. The 211 resource helpline, which typically has 1000 mental health calls per day, is currently receiving 25,000.
As we have discussed in previous columns, the opposite of addiction is connection. During the social distancing and sheltering in place, many folks in recovery and treatment for substance use find themselves isolated and alone. There is the increased financial stress of unemployment or working from home. With recovery meetings cancelled, many find themselves without accountability, bored, fearful and stressed. Any of these may become a trigger for the recurrence of substance use. In addition, isolation increases risk for overdose, experiencing dangerous withdrawal symptoms, reusing drug paraphernalia, and buying from unfamiliar dealers.
Many recovery groups have quickly turned to online platforms such as Zoom, Go to Meeting, Google Meet, and a variety of apps. Although virtual meetings have dramatically increased, there are some unexpected obstacles in accessing them. Many involved in substance use do not have access to the internet or previously accessed it in public spaces such as libraries, which may be closed. Those who live in rural areas may have limited internet access. People may have limited data minutes on their phones. Older people in recovery may not be comfortable or familiar with online platforms.
There have been some benefits from the increased online services. Some people prefer the online services because they can meet in the familiar environment of their home. Those who travel to services outside their community, find that online services reduce the transportation barrier. Phoenix Paramedic Solutions’ White County Quick Response Team has been surprised that some clients are much more receptive to virtual meetings and are more open when meeting online or by phone.
There are concerns about online confidentiality and security. Some of the HIPPA restrictions have been relaxed by the State of Indiana to allow mental health and substance use treatment professionals to continue to meet with clients online and over the phone. Some virtual participants have expressed concern about sharing personal stories when you don’t know who else is in the online room.
As we face our new normal post quarantine, we need to consider how recovery and treatment services for those involved in substance use will need to change and adapt. Will virtual and online services develop into an alternate way to support those in need of mental health and substance use services? How will communities address increased levels of mental health/substance use needs once the CoVid crisis is over? The future may be uncertain, but recovery is possible.
We live in a world full of stress, anxiety and worry. We develop coping strategies or habits to deal with everyday pressures. Some people become workaholics, using success to protect themselves. Others strive for control, spend hours in the gym, binge media, gamble, overeat, or view pornography to feel good. Some self-medicate with caffeine, nicotine, alcohol or other substances to get through the day.
We all use coping strategies to help us in our day-to-day life and to fulfill some basic longing or need within us or to rebound from difficulty, trauma, fears or anxiety. Some improve our health and help us lead productive, successful lives. These are often valued and encouraged as “self-care.” Other habits or coping strategies can be harmful, leading to negative consequences like isolation, debt, incarceration, or even death.
Some of us are able to keep these in balance, living productive lives. Others find themselves consumed with the thing intended to bring happiness and fulfilled desires. In reality, they find themselves led farther and farther from where they wanted to be. At the beginning, it may seem pleasant and harmless, without a hint of the long-term consequences, negative effects, or, in the case of substance use, the ongoing physical changes that make controlling a habit more difficult by the day.
But sometimes, repeating these habits over time can be less satisfying and more compulsive or obsessive. Without addressing underlying issues, challenges, and trauma, the innocent ways to cope become unconscious habits that can undermine our well-being. We repeat them over and over, attempting to fill what is missing, increasing the amounts and frequency without bringing satisfaction, always wanting more. We can create a dependency on an action, a person, or a substance.
But there are ways to intervene when habits grow to unhealthy levels. A variety of simple options can help avoid dangerous routines. Outdoor spaces that promote interaction, for example, provide a community alternative to excessive solitary distractions. Peer support groups, like the AA meetings we have addressed in recent articles allow people to share their concerns and find like-minded support. Our partners at NAMI (National Alliance on Mental Illness) are working to bring even more peer supports to our area.
Finding balance in coping with stress can be as simple as adding variety, human interaction, and service to others to our routines. Understanding that balance is important to a full life, and that everyone we meet is creating their own balance can help us be more empathetic to those who sometimes struggle to find the right mix. Most important, if we know that coping can create habits, habits can create ruts, and ruts can create obsessions, we can be sources of strength to those in our lives who may need help along the way. Before a person loses the ability to control their coping strategies, we can make a difference, helping to strike a balance.
The past few articles have looked at local faith-based recovery organizations. Today the focus is on SMART recovery.
While AA and Living Free are spiritually-based recovery organizations, SMART recovery is secular and scientific in its philosophy and orientation. SMART recovery, like AA and Living Free, is an abstinence-based recovery system. AA and SMART recovery originally focused on alcoholism, but like Living Free, SMART recovery now includes any self-destructive habit or coping strategy such as substance use (prescription or illicit drugs), gambling or sexual addiction, or other problematic behaviors.
SMART Recovery stands for Self-Management and Recovery Training focusing on evidence-based, scientifically validated methods to empower individuals to change from self-destructive, unhappy coping skills/ habits to ones that are constructive and satisfying.
SMART recovery is a mental health and educational program based on cognitive behavioral therapy, motivational interviewing and mindfulness. SMART recovery holds that your mindset creates your feelings and influences your actions. By keeping your thoughts, emotions, and beliefs in check, individuals can be empowered to take responsibility for their own change.
SMART recovery does not apply labels to its members such as “alcoholic” or “addict”. SMART recovery does not believe you are powerless over addiction but the power to change lies within each individual.
Where AA has an emphasis on healing past experiences, SMART recovery focuses on the present and how to change your current thinking, emotions and behavior. They focus on changing present thinking and actions.
Instead of 12 steps, SMART recovery incorporates a four-point program:
(1) All people are motivated to survive, avoid pain and seek happiness. Habits or coping strategies are ways to pursue these goals. Some habits may seem helpful in the short-term but can cause long term damages and consequences to the person as well as those around him.
(2) SMART recovery offers specific strategies to overcome cravings and desires to fall back into ineffective ways of life.
(3). SMART recovery focuses on changing damaging belief systems (I’ve tried to quit before and it didn’t work. I need _____ to cope with life.), dealing with anger, guilt, anxiety and low self-esteem, and then developing behavioral patterns to overcome them.
(4) SMART recovery encourages participants to become involved in enjoyable, healthy, productive activities that replace their problematic coping strategies, and have the commitment and perseverance to continue.
SMART recovery has many online resources. There are online group meetings for those struggling with addiction, as well as their friends and family members. There are short 4 to 6-minute videos explaining the process, tool kits that teach specific strategies to overcome destructive habits, 24/7 chat rooms, and online message boards. There are currently no SMART recovery meetings in White County, but SMART recovery resources can be accessed from a computer or smart phone.
SMART recovery does not prescribe a path of recovery but encourages each individual to find their own way. They support the use of Medically Assisted Treatment as well as other support groups such as AA.
After taking a several week break to discuss coping strategies related to sheltering in place, we return to our discussion of local recovery groups to help those involved in substance misuse.
Every person in recovery has a different situation, background and belief system. Just as there is no one-size-fits-all treatment plan for substance use disorder, there are a variety of recovery support groups to meet the varying needs of those in recovery.
Another support group that is meeting in White and Carroll counties is Lifeline Connection, a Living Free Community. Living Free is a national organization providing the curriculum for every Living Free Community, but each Living Free Community is run under local direction to meet their individual community’s needs.
According the Carroll County Lifeline Connection Website (cclifeline.org). “Our society is full of people who choose to live self-destructive lifestyles and endure every day the painful consequences of their choices. Everyone faces these situations at some time in life. Living Free small groups confront our mistaken thinking that keeps us involved in coping strategies that are not helpful or healing.”
The Living Free website lists the following components of recovery from any self-destructive habit:
Living Free has a much more Christian focus than AA’s focus on “a higher power as you understand him.” But religious belief is not required or expected of the participants. Eleanor Estes, who was instrumental in bringing Living Free to White County, indicated that she has had atheists and agnostics attend and benefit from the classes.
Where AA focuses on recovery from alcoholism, Living Free looks on a broader scale, addressing many forms of unhealthy coping strategies. Their goal is to guide individuals in discovering how to overcome harmful or destructive patterns. Their weekly classes include dealing with depression, anger, grief, PTSD, fear and finding peace. Living Free also supports families with classes on parenting, caring for aging parents, and restoring family relationships.
In addition to weekly classes, Living Free offers a thirteen-week recovery program called Stepping into Freedom, providing twice weekly classes to inmates of the county jail and can be a part of Carroll County court ordered treatment plans. Living Free is an evidence-based program claiming an 89% success rate.
Currently, in White County there are Living Free at two locations on Monday evenings. The classes run from eight to twelve weeks.
Dian and Ed Davis, directors of Carroll County Lifeline Connection and state leaders for Living Free, emphasize that “we want to meet people at their point of need. You don’t have to be at a certain level of maturity to benefit. You can come as you are. Our goal is to help people become the best version of themselves they can possibly be.” Living Free membership is open to anyone.
The Davis’ also mentioned that they are always looking for new facilitators. They need people who are stable, like-minded and have a heart for this volunteer ministry. Training is provided.
For more information on Living Free in White or Carroll County, please contact Ed or Dian Davis firstname.lastname@example.org or call them at 765-426-2062.
Over the past several weeks, we have looked at happiness and gratitude as we considered strategies to maintain our wellbeing in this challenging time of CoVid 19. Another factor that contributes to our welfare is the idea of resiliency.
Resiliency is the ability to overcome obstacles and setbacks in life, having the flexibility to adapt to challenging situations, and to bounce back stronger and wiser having overcome the difficulty. It’s a mindset that says, “I’m not going to let this disappointment or setback keep me down.” So instead of dwelling on a setback and letting ourselves get stuck, we accept the situation, pull ourselves up, and choose to move on
Negative, challenging situations happen to everyone. Why are some able overcome them and thrive, while others become paralyzed or stuck unable to move past the difficulty? There are many factors that contribute to resilience.
A big part of resilience is the ability to think differently about negative experiences. “It is not what happens to us but how we respond to what happens to us that has the greatest effect on the trajectory of our lives,” says Karen Reicich in her book The Resilience Factor. Recognizing how we think about our circumstances is the first step in becoming resilient. How we think about a situation determines our response. Often our first response to a negative situation is to feel helpless, hopeless and out of control, but these thoughts are not necessarily accurate. Taking the time to look carefully at our thinking helps us respond to them in a more resilient manner. Do we jump to conclusions? Focus on the negative? Assume we know what another person is thinking? Overgeneralize what is happening to all situations? Once we notice our thinking patterns, we can slow down by taking a deep breath or calming ourselves. Then ask: Is there a more accurate way to view the situation? Do the facts support my thinking? Can I develop a contingency plan in case what I am thinking happens? Using these strategies can help us feel more in control and able to deal with the situation.
Another important aspect of resilience is the ability to persist in spite of difficulty. It is critical to realize that setbacks may not indicate failure. Instead of seeing a challenge as a dead end, make it an opportunity to gain new knowledge and insight. When early attempts don’t work in dealing with a challenge, do we give up? In the years of developing the lightbulb, Thomas Edison is quoted as saying, “I have not failed. I’ve just found 10,000 ways that won’t work.” A less familiar Thomas Edison quote is, “Our greatest weakness lies in giving up. The most certain way to succeed is always to try, just one more time.” Viewing disappointments or failures as part of the learning process is critical. Every setback can be opportunity learn. Don’t allow mistakes or setback to paralyze you or cause you to give up and quit. Accept what happened, learn from it and move on.
Flexibility and being willing to embracing change are also key. Being able to adapt and adjust to change are essential skills to move with the flow of life. Viewing challenges as opportunities to learn and adventures to engage in problem solving, helps us continue forward. There’s always a hidden opportunity in challenges, we just need to be able to see it with fresh eyes.
We are not victims of our circumstances. Life rarely happens in a straight line. There are hills and valleys and unexpected curves along the way. How we think about difficulties determines our reactions. We can change our thinking, learn from mistakes, and move on. Focusing on successes, being flexible and embracing change, helps us learn resilience. It just takes practice. How can you practice resilience today?
Lynn Saylor is the AmeriCorps member working with the United Against Opioid Abuse Initiative alongside the White County United Way. She is a major facilitator of the United Council on Opioids serving White County and a regular contributor to local media.