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There are many important messages in this video - the most important of which is that fact that addiction does not discriminate. - Don't ever think that this can't happen to you.

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"If at first you don't succeed": Negating the 'chronic relapse' issue with addictions

This is the quote that gets me:

“After the first couple of times I went through, they basically told me that there was nothing they could do,” said Angella, a 17-year-old from the central Oregon city of Bend, who by freshman year in high school was drinking hard liquor every day, smoking pot and sampling a variety of harder drugs. “They were like, ‘Uh, I don’t think so.’ ”

The quote is from an article in the New York Times written by Benedict Carey in December of 2008 entitled "Drug Rehabilitation or Revolving Door" which explores evidenced based addiction treatment in different states throughout the country. It's a great article that explores how addiction treatment has evolved in the wake of the recent passage of the mental health parity laws which cover addiction treatment.

Oregon is one of the states that has ramped up practices to make treatment programs more accountable; others include Delaware and North Carolina.

Having worked in addictions, I can tell you that I cringe when hear quotes like the one above and also when I hear the term "chronic relapser". Sometimes patients will refer to themselves as chronic relapsers, other times it will come from the mouths of the professionals responsible for caring for them.

I struggle with this issue because there seems to be (or better yet - I interpret there to be) a finality to it. Like 'we've done everything we can' from the treatment providers perspective and a 'I've tried everything' from the patient's perspective. I always wonder about this - whether we've tried everything or whether we're missing something as well as how to reinforce the hope for the patient. Overcoming an addiction is not easy, overcoming a failed addiction treatment program just makes all of the emotions and symptoms underneath the addiction worse.

And is it a "treatment failure"? - I don't think so because even when patients leave programs and relapse, you can't take away information that they've learned. What you can do is look at where things went wrong and build on that knowledge. - Which is what you should also do when the dark cloud of "chronic relapser" hovers around your treatment center.

Ask your team 'what haven't we tried' or 'is there something underlying this addiction that maybe we're missing?' which is often the case with a traumatogenic addiction.
If you are a patient / addict struggling with an addiction, ask yourself 'what haven't I tried'? Don't give up, keep going. And if the issue is with a provider, see if you can explore that issue further. I frequently remind people that a counselor is only as good as what you feel comfortable telling them. If you feel like you do not have a good rapport with them, see if you can talk to them about that or ask them for a referral to another counselor.

I know that seeking treatment for an addiction requires a lot of inner strength as does trying to work through a relationship with a counselor so that you can get the support you need; in the end however, the life lessons you can gain from all of these experiences will support not only your recovery but also your relationships with those closest to you.
Keep going and remember the quote from Thomas H. Palmer:

"'Tis a lesson you should heed,
Try, try again.
If at first you don't succeed,
Try, try again."

Stay strong,

Speed Writing on the Whiteboard

If I have a complaint about all of the addiction clinics where I have ever worked, it is this: why is it so difficult to have a large whiteboard? (like 3' by 4' if not bigger)

Normally I would think this is me - just being a little too neurotic. But yesterday I had the opportunity to talk with someone (who is presently at one of the best rehab places in the country) who spoke of how hard it was to listen to a lecture because the counselor was going so fast. "I was trying to write everything down" my friend said "and the next thing I knew, the board was erased and there was something completely different up there."

I could relate because I do this too.
Talk really fast - write - connect - make diagram after diagram about the progression of addiction, triggers, relapse, psych symptoms, reasons to stay clean, negative effects of feelings, emotions, symptoms, and then swoosh - in a second it's all gone because I need more space.

"Okay, everyone have this memorized?" I usually say (right before I erase).
(This is where everyone laughs as they realize this challenge as well).
If I hear "wait" then I stop. and we review. If I don't then I leave whatever is related to my next subject in the hopes that this small transition will help.

I've had my colleagues walk into my group room after a group and say: "wow, what just happened here" after looking at all of the writing and diagrams.
It is one of the reasons this blog exists - because I wanted to make sure there was additional information - or more information if needed.

The bottom line is that a 26 day intensive outpatient program (like a 28 day inpatient rehab program) always seems like a long time when in fact, it really isn't. Not when compared to years and years of drinking and drug use.

And the hard part is there's also a 'race against time' factor happening - as each new addict / alcoholic struggles with recovery and the challenges of being newly sober, here come the triggers, the challenges, the relationship struggles, the feelings that are frequently too difficult to manage alone when you're not sure how yet to ask for help, support, ideas, coping strategies or where the best meeting is.

"Which number is bigger?" I ask
(on a whiteboard, it looks like this)

24 days < or > 10 years

"10 years" is the response. It's not a difficult question. But more importantly are the ideas of time that are underneath the question - "when you are angry, sad, hurt, frustrated.... where does your head go?" - to the coping skill which has helped manage these feelings for the last 10 years because this is more familiar then the information presented rapidly over a 24 day period that has not yet sunk in.

There's so little time - and so much to do / discuss / feel / develop insight.
My goal would be to have more clinicians blog.

Recovery Reading

"Dennis has a drinking problem..."

This is a video from Sunday's celebrity apprentice when West Coast Choppers owner Jesse James confronts NBA star Dennis Rodman on his addiction to alcohol. Gentle - but firm.

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"They are us in crisis..."

This week I had the opportunity to meet a small group of patients who were interested in talking about their addictions but whom had not yet decided where to seek help.

As the group ended, one of the patients sat in a chair by the door and just started talking about her length of time sober and that she had relapsed after years of sobriety. On this day, she looked tired and defeated and looked sad as she said "I'm tired of helping everyone else....I'm a nurse".
"What kind of a Nurse?" I asked - I already knew what the answer was - not specifically, but I could tell it was something in acute care just by looking at how tired she seemed.

"Cardiac care" she said, "I'm retired now, but I worked in cardiac care for years".

I don't know why this affects me the way it does; probably because my mom was a nurse, my grandmother was a nurse, many of our friends were (or still are) nurses or physicians. We all have spent many years working in hospitals at all hours of the day and night.

Most of us have holidays off, vacation hours, extra time to spend with our families and friends. Some of my nursing friends in healthcare have an abundance of time to take off that just sits accumulating because there isn't coverage for them to leave or because they feel guilty leaving team members if they do - so they don't. I find that, in my present job, it's nice to not have to work on Christmas, but I remember those days when I did - when I was called in to meet with a patient at 2:00am because the ER was too busy or over-crowded. I know what it's like to leave a warm turkey dinner and throw on khakis and a shirt after the pager has gone off wondering why I even thought that I had the time to sit with my family and enjoy dinner. The turkey would sit and grow cold along with the mashed potatoes and veggies only to be reheated later around 8:00 am when I finally got relieved by the day shift.

I have never (ever) lost sight of the times I have spent sitting across from a homeless, suicidal patient who has no place to live, no where to go while I have left food on our table at home. And while I am grateful to have a place of my own, a roof over my head and food on the table, I am often more amazed at the immense amount of inner strength some of the patients I have seen have utilized to conquer the challenges they have faced.

Once I was at a meeting where a colleague of mine and I were trying to figure out how to explain the wide range of behavioral health symptoms and illnesses to our clinical teams. We wanted to stress the fact that there was often only a very fine line between the challenges faced by our patients and those faced by our colleagues or ourselves.

"They are us in crisis" she said; "we are them without a support system or a job".

I will never forget her words, and while I don't understand cardiac care, on Wednesday, I understood the look of pain - of giving so much and having nothing to show for it. I know that lifestyle and the immense amount of stress that goes with helping others. I know how easy it is to get lost in the problems, relationships and maladaptive coping skills that keep us so busy that we eventually get lost in ourselves.

I took the extra time to explain the importance of getting help to my new nurse friend, hoping she has the inner strength to reconnect with those who have supported her in the past.

My thoughts remain with her and the hundreds of thousands of healthcare professionals who spend hours in ER's, ICU's and acute care units in any one of the 6000 hospitals across the country who continue to work like nuts saving lives while I am home asleep.