Scott - Treatment

Understanding addiction is part of my therapy as a survivor of childhood sexual abuse. Most survivors, including myself, have addictive behaviors to shield us from the demons of our trauma. Some of us are addicts. This is part three of a four part story about two men fighting to overcome their addictions, fighting for their lives.

The Men

Having previously been isolated by their trauma and self medication of emotional pain our climbers were subjected to intervention, a choice between total estrangement from their families or the immediate acceptance of treatment for their addictive behaviors. They were admitted to the same closed treatment facility, in a city far from home, to learn to live sober lives.

The men enter treatment together. Neither really believes he is an addict but the pressure their families placed them under left no choice. They both plan to endure treatment as the cost of getting on with their lives, but don’t actually discuss it with each other. Despite years of climbing together their conversations were generally about climbing, about techniques, about equipment, about the next climb. Now that they have the opportunity to talk they have little to say to each other. Both are ashamed but don’t know why and don’t want to discuss it.

There are other men and women in treatment with them and the men are shocked that others have similar stories to theirs. At first the men are mildly contemptuous and critical of their weak willed companions and keep their thoughts to themselves, but over the first week they grow increasingly irritated by the childish behavior they see around them. The men start making derisive comments quietly and then more and more openly. Even the staff becomes unbearable to them, treating them like little children by restricting privileges, but even more by allowing all the others to break rules without consequences. It’s so unfair.

The younger man reaches his breaking point and escapes the treatment center one evening and runs the city streets, for uncounted miles, until he is exhausted and sweating profusely. He has a special sense for when the police are in the vicinity and he avoids them, having one or two close calls. It’s beginning to rain as he enters a mall, sitting on a bench pondering what to do. He can’t call his family. The treatment staff restricts cell phone use and his phone is locked away. He has a moment of panic. What if the treatment center won’t take him back? That would be unbearable. He has no place to go, no money, no friends, he is alone. He was exhilarated during the run, but now he is dejected. Finally he persuades a passerby to let him use their cell phone. He calls the treatment center and they pick him up.

The men settle in to the routine of the treatment center. Up early, breakfast, morning meditation, cleaning their rooms, homework of reading about addiction and treatment, individual counseling, and group sessions, early to bed. At first the men are withdrawn, but the stories the others tell begin to have an impact on the men. Hearing about trauma, abuse, and neglect the men begin to understand why the other addicts behave as they do. Sometimes they find themselves wiping unexpected tears from their eyes. The men begin to open up and tell their own stories, and are amazed at the encouragement and support they receive.

The problem, as they share their thoughts and feelings, is that they begin to feel worse and worse. This treatment business is hard and they feel emotionally fragile. Sometimes they feel as if they will die. They have been strong, independent, self sufficient men and now they are acting like babies. They don’t understand. In individual counseling it comes out that the men have been using recreational drugs together for years and they are suffering physical withdrawal as well as experiencing unfamiliar, long suppressed negative emotions. They previously managed emotional challenges with drugs and the rock climbing. They need new coping skills to manage conflict and disappointment.

As weeks pass the men begin to feel safe in the treatment center. It has an exercise room which they desperately wanted to use for many hours as possible, day or night, but their access was limited. Now they are content with less than an hour of exercise daily. Despite occasional conflicts, one of which ends in a pushing match and a broken side table, the men are feeling comfortable with their companions and respect the treatment staff. Many of the staff are themselves addicts who have been in recovery for many years. They begin a new phase of treatment and begin anxious excursions to a bowling alley and to the mall where the younger man was picked up after his run. Gradually the men become more comfortable away from the safe haven of the treatment center, but they are increasingly aware and increasing worried about returning to the real world.

Restoration

Perhaps the most damaging characteristic of trauma and addiction is the isolation it inevitably produces. Addicts are obsessively secretive. Trauma victims outwardly display any behavior that keeps them safe, while suffering from incomprehensible inner turmoil. Neither of our men has the ability to manage conflict and disappointment and both would run at the earliest appearance of unwelcome emotions. It was almost impossible for them to form connections with others, even with family members, except to manipulate them in the service of addictive behaviors. Their inward focus was so powerful that they were oblivious of other people’s needs and irritated by the behavior of everyone around them. Despite displaying non-threatening or even pleasant demeanors, our men were devastatingly alone.

Fortunately treatment does not need to be voluntary, as it was for our climbers, to be effective. While lasting recovery requires the addict to take responsibility, the process can be started even without cooperation. The most effective treatment plans are tailored to the specific needs of the individual, but the best treatments have these elements in common.

1. The first goal of treatment is to detoxify.

Regardless of whether one’s subconscious mind believes some drug or behavior is absolutely essential for life, as much as food and air and water, addictive use and addictive behavior must end for recovery to begin. They mask underlying problems and supplant appropriate coping mechanisms. While “high” on our drug or addictive behavior our mood is artificially altered. We don’t know what we are feeling. Even our thoughts are counterfeits and we are disconnected from reality. Some trauma survivors dissociate from reality without benefit of drugs or addictive behavior. In response to overwhelming, irresolvable stress a part of the personality breaks off to contain the pain, to protect the rest of the person. This can happen to a child, for example, who knows that their caretaker is frighteningly dangerous but that they also need the caretaker to survive. Thus the brain manages contradictions that cannot coexist. To restore sanity, resolve shattering emotions, to become whole and healthy individuals our men must first discontinue medication and evict contrived thoughts and feelings.

Restrictions on our climbers removed both addictive behaviors and recreational drugs from their daily lives. Without artificial management of their moods, without drugs and climbing, the unpleasant emotions they had repressed inevitably surfaced. The fog through which they distractedly related to everyone around them had begun to lift.

2. The second goal of treatment is show they are not alone.

Our climbers discovered that there are others like them. They actually were not weak willed, unwanted, and useless. They were not sorry excuses for humanity. They were not inherently worthless and bad beyond redemption. Rather, their behaviors were normal responses to their trauma and their genetics.

For many addicts and trauma survivors the only safety is between their ears. The fight for recovery requires a measure of safety, a place to withdraw when the battle becomes ferocious, perhaps thinking calming thoughts of warm beaches and sunshine and waves, perhaps remembering happy times with joyful feelings. But that is insufficient because addicts are still secluded in their own heads and recovery never takes place alone. We all need to find safety in the company of trusted friends and family. The formation of a recovery team, the hope of companions on a journey of restoration, begins with a single profound and life changing thought, “I am not alone.”

Paradoxically as they began to get better, our climbers also started to feel worse, much worse. Long suppressed feelings surfaced, those same buried feelings which had previously overwhelmed them and stripped them of all defenses. Our men needed to feel the fullness of the pain they suppressed for so long, to learn that these terrible feelings would not crush them and cripple them and destroy them, and that when their emotions were processed and filed away they would never again dominate every waking moment. These men needed to learn that to get to the place of comfort and peace they would travel through the valley of the shadow of death. But not alone.

In recovery, we manage our emotions in a childish manner until we learn and practice mature behaviors.

Our men recognized the childish behavior swirling around them in treatment, without realizing that their own behavior was also childish. Newly surfaced unregulated emotions lead to a very strong desire to run and to use again. This was some of the hardest work that our men, though hardened physically by years of climbing, would ever do.

3. The third goal of treatment is to form a recovery team.

They are not alone. They need other people. They can be safe with other people. Learning to make connections with people who really understand them, have compassion for them, and genuinely like them is critical for our men to have long term sobriety and to thrive. Their therapists and their companions formed the core of our men’s recovery teams.

Not everyone belongs on the recovery team. Not everyone understands addiction and recovery. Not everyone has compassion. Not everyone has other’s best interests at heart. In fact it is extremely important to know who is safe and who is not, and there are unsafe patterns of behavior and unsafe people to avoid. And finally, not everyone will be able to hear about complex feelings and excruciating pain without themselves being hurt. Some people, for example wives, while having an enormous investment in recovery, should not be on the recovery team of their spouses.

Addicts and trauma survivors often mislabel feelings. What they think as boredom may be depression. What they describe as irritation may be the edges of profound anger peeking out from behind their eyes. What they understand as disappointment may be feelings of huge betrayal. Especially as our men recognize their feelings for what they really are, and begin to express emotions they didn’t even know they had, it is important for them to respect boundaries. Their personal boundaries and the boundaries of those they interact with. This has never been the strength of our men.

Addicts trust no one. Recovering addicts trust everyone until that trust is breached and then they totally stop trusting again. Our men must find a balance between offering unsolicited trust and demanding that it first be earned.

My personal experience was that I had to trust others to lead me along an unfamiliar path, fraught with unseen risks and dangers, to an uncertain destination. Some experiences were good and some were bad, but trust grows on the journey. I started by trusting people to act according to their base nature, but now as I see them through clearer eyes, I trust their hearts. My recovery team is composed of fallible, contradictory people. Even if they hurt me, that injustice erupts from the wounded parts of their souls, and I can still depend on them to protect my back.

4. The fourth goal of treatment is to provide new coping skills.

Addicts generally blame everything and everyone around them for their problems and their behaviors. In one sense this is accurate. When we are not making conscious, considered decisions, we may be ceding control to our subconscious mind which merely reacts to external stimuli. We become autumn leaves dancing in the wind, subject to every breath of the capricious weather. Addicts, and indeed all of us, need to take responsibility for our own lives, to choose what we will do and how we will behave. To escape the bondage of past traumas and to move freely into a future of our own choosing. Seeking the next meal, the next breath of air, the next “hit” of our drug we can do little more than survive. To become fully human we must learn to live.

Our men need to recognize danger signs within them. Their recovery teams will see the potential of relapse much sooner, but with practice our men will become increasingly aware of risks. Our men need strategies to deal with conflict and disappointment; call a sponsor, call someone on the recovery team, deliberately remember happier times and practice thankfulness, intentionally feel forgiveness, make amends for past failings, do something enjoyable with other people, but don’t be alone. Our men must take responsibility for discovering what coping skills work best for them and take responsibility for practicing them.

Management of emotions is important to living but it is not wrong to have emotions. They are simply indicators of our condition. My father’s example falsely taught me that maturity was the lack of emotions, either good or bad. Now I understand maturity to be controlling my behavior, not suppressing my emotions. As a child my emotions were unregulated. As a result of trauma from childhood sexual abuse, I failed to learn how to manage emotions and tried not to feel them at all. Separating emotions from our conscious awareness not only is unhealthy but it leaves them intact and unprocessed in the subconscious. My behavior can still be influenced by emotions I don’t know I’m having. Some of these emotions were so powerful that when I began to feel them for the first time, as an adult, it felt like I was about to die. Gradually by allowing myself to feel, by realizing that I could feel the immense pain without dying, they became less and less painful. I was beginning to learn how to cope with emotional pain, with conflict, and with disappointment. I was beginning to mature.

When I asked my therapist how it would be possible to survive these emotions, even as an adult, he had a two word answer. “Joy strength.” The sad reality, at the same time as suppressing negative emotions, was that I was also restricting positive emotions. I had never consciously experienced unadulterated joy. Isolated and alone there is no joy. Joy is a product of being connected with other people, to have healthy relationships, to have intimate mutual sharing and love. Until this point I have been careful not to bring my Christian faith into this discussion, but now I must. While all that goes before is true for those of any faith, or of no faith, I believe that complete restoration, genuine freedom, and consummate joy only come from Jesus Christ.

Still, we cannot live forever in the cocoon of treatment facilities, however safe. What awaits?

Treatment