I love the old song by the band, Faces entitled, Ooh La La. The song laments, “I wish I knew what I know now, when I was younger, I wish I knew what I know now, when I was stronger.” Relax and listen–and I’ll be surprised if you don’t agree it’s a toe tapper and a nostalgic reminder for all of us:
Addiction Treatment | From Sick Care to Health Care
I had the recent privilege of attending the 2nd Annual David E. Smith, M.D. Addiction Symposium in San Francisco. The event attracted addiction treatment professionals from all over the nation. We listened to seasoned clinicians and cutting edge thought leaders in addiction science and treatment on topics ranging from pharmacotherapy to spirituality. If I were to sum it all up in a nutshell, the common thread was that we actually are moving from sick care to health care with addiction treatment leading the way.
It’s All About Brain Health, Any Questions?
Good health starts with brain health.
Time and time again I heard ultra credible, mainstream people saying that addiction treatment is all about brain health and brain health is all about ensuring the essential nutrients of eating, exercising, thinking, feeling and sleeping well.
Something inside stood up and cheered as I heard for example, the addiction psychiatrist and trend setter, Daniel Amen, M.D. say things like, “Why is psychiatry the only discipline that doesn’t ever look at the brain–the organ it is treating?” and, “Why do I get recommendations for a colonoscopy but never for a non invasive brain scan when brain health is what it’s ALL about?”
Each talk surveyed the literature and as pointed out, the research gets edited and updated about every twenty minutes. But the bottom line was this; every vetted approach works a little bit, however if people are not practicing the good brain health practices of eating, exercising, mindfulness and sleep–fogettaboutit’.
What’s really changed in the way people think and talk about addiction treatment is that we’re getting calls to action–and I mean seriously–people standing up in solidarity and declaring we cannot practice addiction treatment in the compartmentalized, symptom suppression way we’ve been trying for decades. Rings a Herby Bell in my, “experience of one” in addiction recovery…Yes!
Monetize Wellness: NOW
I love my squishy brain…
As I sit here between thoughts and squeeze my palm sized, squishy brain the Amen Clinics distributes as marketing tools, I realize we really are on the brink of commitment to delivering a new paradigm of healthcare because we’re learning how to market and monetize wellness.
Yeah, there are a lot of fancy ways to get into the practices of this new paradigm–healthcare–and it takes what it takes. How about a “single photon emission tomography scan” or better known as the SPECT scan? A test that takes a snapshot of how the brain is working to determine what practices of–you guessed it; eating, exercising, thinking, feeling and sleeping well will best serve that brain.
So what about all the other high powered, high tech, biochemical/mechanical approaches that we’re so used to hearing about “curing” us? Fantastic stuff all of which can be used for the far end of the sick care spectrum when indicated. But for the remaining 85% plus of the population, let’s evangelize the brain health basics up the yin-yang and develop services and practices that offer healthcare to the masses, shall we?
Live Long and Drop Dead
What we’ve learned the hard way, (and another refreshing, repeated point stressed at the symposium) is the longer people are in addiction treatment, the better. Another way to think about it is that people need to stay inhealthcare for life, because nobody gets out alive. How we facilitate this current inconvenient truth remains in the storming and forming phases, but people, we have ignition!
As more people are taught by doctors, (Latin; to teach) to take on the “experiment of one” by practicing good brain health, my mentor and colleague, Mark Sisson‘s adage makes more and more sense; “Live long and drop dead.”
Take a hands-on approach to taking care of your brain
Okay, so while we’re still in the interim space of being sold on the idea that one’s gotta have symptoms before learning to take care of oneself with good brain health practices, it’s an important step toward a better way to be the self-regulating and self-healing humans we already are.
Here’s to the time when we all realize that symptoms are an indication we have not been “in” or practicing healthcare–a time when we’re all taking a hands-on approach to eating, exercising, thinking, feeling and sleeping well–as matters of fact and practice.
A special thanks to Dr. David Smith who has been writing, saying and practicing all of the above for decades and who will be an upcoming guest interview on Sober Conversations. My deepest gratitude to you, Dr. Smith for all of the gifts bestowed upon so many at your symposium. I look forward to learning more from you very soon.
28 years ago nearly to the day, I walked into the world of 12 Step meetings. I surely wasn’t immediately enamored with the slogan reciting, platitude-on-cue, regurgitating crew. I thought it to be some sort of cruel and unusual punishment for my transgressions and gotta admit, it took some doing for me to develop a taste for, “the rooms.”
Well, it’s a bit like the substances and behaviors we replaced, isn’t it? I mean who enjoys their first puff on a cigarette or first gulp of beer? Okay, maybe the beer…but you get my drift when I’m telling you that 12 Step meetings really do take some getting used to, or at least they did for this recovering skeptic. So now in retrospect, I look back and think, you know, if I’d walked into anything I was previously unfamiliar with like a Greek Orthodox mass or an IRS workshop for auditors, there’d be a learning curve and that, “welcome to change, buddy” feeling that’s always uncomfortable.
Clean and Sober
Clean and sober circa 1986
I’ll never forget my first 12 Step meeting. A traditional clean and sober, no-nonsense “closed” meeting of Alcoholics Anonymous. “Closed” meaning A.A. members only, or for those who have a drinking problem and, “have a desire to stop drinking.” I qualified.
In 1986 smoking cigarettes was still okay at meetings, so the coffee scented, smoke filled room–it was. I remember sitting next to men in camouflage jackets and hats presumably from the Vietnam War era as I was thinking this whole scene is a good enough reason to quit my shenanigans–and never go back.
Go back–I did not–for three years as I practiced the white knuckled, cold turkey shuffle and getting my dopamine without the dope from the then, current addiction; exercise. Then, I discovered how love, sex and finally, opiates could do the trick and I was off and running–on empty.
Back to the Rooms
I found my way back to the rooms by necessity and frankly, it was the go-to addiction recovery “modality.” Still is, even though there are many others. In retrospect, I would have also perked up to the harm reduction, brain science informed approaches available these days–and maybe then too!…but I don’t remember hearing about them. One reason…the brain science hadn’t been scienced’ yet…
But as all things unfold as they should, I learned to find meetings that worked for me. I’m an early bird, so a 6:15am meeting with other early morning sunshine worshipers; perfect. I like deep discussions and topics so how ’bout a Noon meeting on the campus of Stanford University where erudite recovering drunks hang? I swear-ta-god, that room was like being in the presence of the Dalai Lama on any given day. In one hour I may have heard from the resident, savant schizophrenic man to a recovering physics or English professor tell a story with aplomb–JUST the story and message I needed to hear like those song lyrics on the car radio that speak to you–right on time.
All of the rhetoric and what first sounded like sing-song, cryptic communication settled into a regular practice, a ritual around which the day and the week centered. The lessons learned, the insights and wisdom from these formerly assessed freaks turned out to be some of the most informing, how-to-live-life stuff in my life–and cherished relationships and lifelong friendships to boot. To think, a bunch of humans agreeing to meet regularly to get out of their own ways and talk about right thinking and right living. Miraculous.
To 12 Step or Not to 12 Step
Alright, so now in the year 2014 we have many ways of recovering from addiction in addition to the 12 Step path. For example, Dr. Tom Horvath’s, Smart Recovery speaks to millions of people. From secular to religious to community based approaches, really…isn’t it all the same approach–to take a look at how you’re taking a look at your life while surrounding yourself with people who are on the same path? For me, deep empathy and BELONGING are the central-most implications.
Most of the addiction treatment centers remain 12 Step based because it works. After all, the 12 Step approach was not for me…until it was. But what we’re finding when wedding the brain science with such programs, is that recovering people need a more robust wellness model including all aspects of mind, body and spirit fitness. ‘N that great news? Not either/or, but both/and. 12 Step programs not the whole picture, but as an integral part of the whole and now what we’re finding to be, bigger picture.
12 Step Meetings | Think Integrate
12 Step meetings and other mutual support groups can be integral parts of addiction recovery and wellness
In this day-and-age we’re hearing and reading a lot of friction around, “If AA is so hot, how come it only helps ___% of people?” And of course the answer is that its structure and language doesn’t speak to everyone and so like I had to do with finding different kinds of meetings, it seems to me the implication is to find a path that does work. 12 Step programs don’t care, really. What, are we all supposed to be Muslims or Catholics or atheists or short board surfers (certainly not the latter)? NO!!…but something tells me we’re all supposed to be on a path of our own choice to pursue right thinking and right living.
I see the day coming when addiction treatment paths will all be integrated and all include the various mutual support/aid groups in that integration. We’ll move away from “12 Step based or Non-12 Step based” to integrated, multidisciplinary approaches including suggestions for mutual support groups of one’s choice, because all of them–along with balanced lifestyle skills fostering wellness, work as an indispensable piece of the treatment puzzle.
Do you ever breakthrough a threshold, a tipping point where you just leave something behind that used to work, but that’s no longer working for you? Something that has either outlived its usefulness or is no longer pertinent? Yeah, more and more I’m feeling that way about the terms, “addicts and alcoholics” because of the implicit subjugation and negativity associated with them at every stage of recovery.
I did some admittedly unscientific, but revealing research not too long ago by calling random, mainstream, addiction treatment centers/organizations around the country. I did it to get an idea of what standard of care is out there compared to what the evidence based science says, and to get a sampling of what the current “group-think” is in the addiction treatment industry regarding addiction treatment’s third phase of care; continued care.
Honorable intentions, but…
After being funneled to a call center where people are generally scripted and salesy…I’d begin by asking about their plan for continued care, IE, what happens after people get discharged from their care. Each and every time for the dozen or so calls I made I’d hear some variation of a plan to “stay in touch.” From ongoing groups, to “recovery monitoring” by phone and drug testing, to alumni groups, etc. I’d then ask what the outcome studies showed for the continued care and invariably I was told on each and every call, “We don’t have long-term studies because addicts lie.” You know, they’re addicts and alcoholics… This, from organizations who really, do not offer or deliver the required third phase of modern addiction treatment; continued care. Huh?
I’m still flinching…
However, self-identifying with the terms addict and alcoholic still has utility for some people, no doubt about it. “Addict” is the root of the word addiction–bet you knew that. The Latin roots addictio and addicere aretranslated as, “a giving over, surrender or to assign.” Okay, that seems right…a giving over to a behavior I cannot control, I surrender and become assigned to a powerful force I cannot stop. So then it seems fitting and indeed, how it worked for me to surrender to something else, a power greater than myself to help me stop the behavior and get my life back. Self-identifying as an addict/alcoholic worked for me back in the day.
But I know it does not work that way for everybody and I’m wondering if it’s even necessary at all, I mean the identifying with “addict or alcoholic” in the year 2014.
I’ve said it before and I’ll say it again, I entirely appreciate AA and the 12 Step movement and I remain a proud member. Even all the years and years of going to meetings and listening to people identify themselves as liars, thieves, misfits and drunks. All part of the landscape to surrender in that context, but the trick is to see beyond those labels and know that people are much, much more than that. Regrettably, the terms, “addict and alcoholic” are associated with this entry level, cathartic process and therein lies the rub. Bill Wilson testified before Congress in 1967 and said AA has evolved like everything else, to have some good dogma and some bad dogma.
The Terms, “Addicts and Alcoholics” Have Gone Pejorative
So we got us a full fledged conundrum. People identify “addicts and alcoholics” with the symptoms and behavior of active addiction and then the treatment community does not offer what it says is required–continued care-and people relapse. See, I toldja so…they’re just addicts and alcoholics. More unscientific research: Does this piss anyone else off?
How do you spell: ARGH!!#!@?!!?
I think it’s time to surrender to the fact that these two terms, “addict and alcoholic” are part of the bad dogma. And I think to continue using the terms charged as they are, will not work for us if we’re interested in changing the conversation about addiction and helping more people.
We’ve moved from the term, “drug addiction” to the term, “substance use disorder” and we can do the same for the terms, “addict and alcoholic.”
Here’s what you and your family need to know…
I’m wondering what may have occurred nearly three decades ago if, when I was ready to hear it, an addiction expert approached me and said,
“Herby, the symptoms and behaviors you have consulted us about are born out of the fact that you have a brain disorder and disease and as a result, your mind, body and spirit are out of balance. It’s called addiction. Here’s the good news; addiction is treatable and manageable. Your brain, (the target organ of addiction) is not serving you as well as it could and we can help you to help yourself to improve your condition. Looking at your history, we see addiction is well established in your family and that’s one of the risk factors. There are three phases of care: 1. Detoxification and stabilization–a few weeks, 2. Rehabilitation–usually a few months to a year, and 3. Continued care–or maintaining your acquired wellness one day at a time–indefinitely. All three phases of care must be undertaken for addiction to be kept in remission as it is a chronic, relapsing illness much like diabetes and heart disease require diligent follow up. With initial education, treatment and ongoing wellness checks along with your disciplined self-care, you’ll be able to live a long, healthy life. Without treatment, including that for your family members, you and your family are at great risk for the addiction to worsen and the circumstances, quality and very existence of your lives to be in great danger.”
Would it have mattered? Would I still have needed to take on the hard line, bottom line, “I’m an addict and once an addict, always an addict” mantra having heard the above information? Difficult to say, but what does matter is that I don’t think it’s any longer necessary for people to carry a label charged with negativity when we know so much more. I think it matters that people can frame their conditions and healing in a much healthier and mainstream way. Yeah, just words, but we live in the language which is descriptive and generative and if words stop people from getting care, let’s change the words–or a least, talk about it.
It’s not that I don’t have the chronic illness of addiction anymore, it’s just that the terms, “addict and alcoholic” are anachronistic, pejorative and really no longer useful if we’re going to interest more people in the brain science and long-term solutions available to people and families with addiction. In one sense, continuing to use the terms addict and alcoholic is tantamount to labeling a person with diabetes, an “insulin abuser.” Doesn’t sound right, does it?
Yeah, we’ve got to change the conversation about addiction by changing the language we use about it. A great way to start is to re-think the negative and outdated terms, “addicts and alcoholics.” In doing so, individuals and families can focus on the solution rather than worry about the stigma associated with living with a label. What am I suggesting we use to replace those terms? How about, “people?” People with addiction.
Besides not having the benefits of long term addiction recovery care, what do Corey Monteith (actor), Sid Vicious, Dee Dee Ramone, Kurt Cobain, Peter Farndon (Pretenders), Lenny Bruce, Jim Morrison, Billie Holiday, Paula Yates (INXS mate), Jimi Hendrix, Hillel Slovak (Chilli Peppers), Judy Garland, Elvis Presley, Chris Farley, John Belushi, Whitney Houston, Corey Haim (actor), Janis Joplin, Heath Ledger, Marilyn Monroe, River Phoenix, Dana Plato (actor), Anna Nicole Smith and Philip Seymour Hoffman have in common?
36,500 people died last year of drug overdose. That means on average, 100 will die today.
You know the answer. These sadly extinguished Hollywood Stars put a face on death by drug overdose–death from addiction. Multiply these 24 souls by the number, ONE THOUSAND FIVE HUNDRED and we’ll get to the ~ 36,500 number of the other nameless, faceless people who died the same way last year. More than 100 people will die of drug overdoses in this country: TODAY. I know, I know…all kinds of chatter about accidental death in some cases, but really, I mean REALLY, can we get serious?
So what’s up America? We know the risk factors for addiction, we know how to prevent and treat addiction and even maintain recovery, but something is STILL woefully missing/wrong. What is it?!
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
Could it possibly be that we just can’t have it both ways–we can’t have addiction recovery and no infrastructure in place to deliver the ongoing and necessary care spelled out by the brain science? That’s what the good docs say above, no?
To this point and for the most recent ultra sad example, I do not think it was possible for a former athlete like Philip Seymour Hoffman who just happened to have the disorder of addiction to somehow become morbidly obese, smoke cigarettes and NOT have it profoundly jeopardize his ability to prevent what eventually killed him. You want science? We’ve got science. Recovering from addiction while nurturing metabolic syndrome with awful eating habits while smoking cigarettes? C’mon.
Brain Science and Brain–Body Neurophysiology Don’t Lie
Brain science and neurophysiology confirm how important overall good health is in recovery.
NO, we cannot have it both ways by going to rehab for 4 weeks 23 years ago and then hammering ourselves with other forms of toxicity and deficiency and not expect these tragic outcomes! Sorry, but addiction just won’t let us do it as we see at least 100 times per day in this society.
Nor will our minds, bodies or spirits let us misuse and abuse them without some other symptom picture emerging. It’s just that the symptoms of addiction are expressed in this characteristic, threefold, mind, body and spirit way. This reinforces the fact that it is neurophysiologically IMPOSSIBLE to feed our systems toxic and deficient input and NOT have the system adapt its neurophysiology accordingly giving rise to craving, Reward Deficiency Syndrome and a ticket to relapse that can result in frank suicide or the, we’ll-never-know “whoops.” Let’s call it “parasuicide.” Someone explain the difference when science and experience have outlined the prevention, treatment and maintenance landscape so clearly. Neurophysiological adaptation due to risky lifestyle habits is what leads to the breeding ground for relapse and in the above mentioned cases, premature death.
So why the RANT? Because 100 people will die today and we can do something about it. Because the addiction epidemic is just a reflection of the bad health epidemic in this country and that’s because we’ve got it backwards. Health and wellness takes precedence and practice–not waiting to merely treat acute symptoms with drugs and surgery when the feces hits the fan. And finally because I’m really tired of seeing misinformed mainstream media perpetuate lies in order to stay hypnotized by the quick fix, harmful notions about addiction and all other adaptive lifestyle disorders.
Long Term Addiction Recovery Care | A Go-Brainer
What’s missing is long term addiction recovery care and services. The solution is implicit in the rant and that’s a “go-brainer.” Go-brainer because it’s all about brain health and practices that foster what’s required for a healthy mind, body and spirit; eating, moving, thinking and sleeping well–just for today.
Recovery Health Centers | Get Well and Stay Well–For Life
And how will this be delivered? In a health care system where people like Phil Hoffman can and will check-in for that initial intensive care and then on a regular basisbecause they are armed with the knowledge, the “just say know”–from the get-go–that their lives depend upon it. A place where they are given wellness intervention, mind, body, spirit tuneups from scheduled, predictable time-to-times to uphold wellness thresholds. From illness to maintained wellness–a place where integrated and multidisciplinary teams are dedicated to interest their practice members in the care of the human brain-body, in a proper diet, and in the cause and prevention of dis-ease and active addiction.