addiction – Lessons Learned

On the Road to Change With Father Time and Gandhi

When I was in college, I got really bored with how my room looked. Changing the colors of my comforter or posters was not enough to make my restlessness go away. So, I rearranged my 3 pieces of furniture each quarter. This is a bigger deal than you think. As a smart control freak, I prepared for each move by cutting Post-It notes to represent each piece of furniture and placed it on a graph paper blueprint that I had drawn to scale. (No, I’m not kidding.) I have repeated that behavior in the 7 places and 6 classrooms I’ve lived in since then.

But, that doesn’t mean I’m good at accepting change or easily ready to make changes to myself. Anxiety and depression are characterized by the overwhelming feeling of being stuck, being unable to change how things are now in order to make things better later. Change is not easy. Maybe that is why there are just as many steps to change as there are to grief.

Cracking Open the Window to Leap Through

Grad school provided me with two memorable frameworks with which to approach counseling. My homeroom-esque class with the best professor and mentor a loud, know-it-all needed (shout out to the one and only Dr. Victoria Junior) came with an introduction to Johari’s Window. In my practice, it is common for clients to reach out for help for problems that border panes 1 and 2. My clients know there is something not right but just can’t quite articulate the problem. In order to crack that window wide open, we work to crawl, walk, run, retreat, and regroup through the stages of change. (The names of the stages are mine, not the clinical terms.)

Substance abuse and addiction training required the ultimate textbook for understanding all change. This is literally the textbook on the stages of change.

Problem? What Problem? There are not enough examples, videos, PowerPoint presentations, or tantrums to get you to see there is a problem. The bad news? Your loved ones must continue to beat their heads against the wall and fill the air with their voices despite its apparent lack of efficacy. The good news? Something is getting through at a subconscious level that is prepping you to proceed to stage two.
Oh, That Problem? It’s Not a Problem. Deaf ears are now more like selective hearing. You have gotten the message that there is something in your lives getting in the way of an angst-free existence. But, at this stage, the problem is YOURS; your loved one believes it is manageable.
OK, My Problem is a Problem. Time to buy colored pencils, Post-It notes, and erasers.
Hiro from Heroes when he learned to stop time

Lots of erasers. You are ready to put a plan in place. We have one stage left before the plan is put into action, but we have a plan!
I Did It! Despite the fact that change has been working, albeit at an uncomfortably slow pace, it is clear to everyone that you are making new choices. New behaviors are obvious and should be applauded by all onlookers. Don’t be surprised if physical exhaustion accompanies all of this psychological and emotional change.
That Worked..Kinda. Although change may vastly improve your physical and mental health, it is not always easy to maintain. People need to meet the NEW YOU. You need to see how the new you interacts with your old friends and family. An occasional appearance from your stage 1, 2, 3, or 4 self is to be expected, not shamed.

Spark Note Summary

Just because you seek out doing things differently, doesn’t mean you are ready for a change. Anxiety and depression don’t start overnight or disappear in the daylight. There is a process to learning how to see your problems even before you start to address them. Your best friend on this journey is time. Just ask Gandhi, “Live as if you were to die tomorrow. Learn as if you were to live forever.”

LeVar Burton, Accidental Therapist Extraordinaire

Click here to bask in the nostalgia of the theme song!

Before the costume designers of Star Trek: The Next Generation chose an 80s banana clip for a futuristic visor, LaVar Burton was the host of Reading Rainbow. Each episode had a theme similar to ones that my son has in his pre-K class…space, animals, transportation, etc. Books were read to us by famous celebrities like Kermit the Frog. LeVar Burton took us on “field trips” to a fire house or farm. But, the best part of each episode was at the very end. A child just like me, a cute, book-loving precocious child, would tell us all about a favorite book. These were heartfelt testimonials that always ended with the phrase, “But, you don’t have to take my word for it.” No? But, I do! You love books…I love books! We are virtual book club buddies!

Bibliotherapy

Bibliotherapy is a real, accepted modality for treatment of some mental health issues. It started with the turn of the century when soldiers were given medical books to learn about their injuries. In the 1960s, bibliotherapy became an official modality under the American Library Association, and psychotherapists mainstreamed the practice as an additional tool during more traditional therapeutic treatment. As Lessons Learned begins adding an occasional book review, it is important to understand the mental health benefits of reading.

Pacing: Shakespeare wrote in poetry, iambic pentameter, for his audience to get caught up in the music of his words. Before you twitch into a mess of

Click here to hear modern day iambic pentameter.
horrible memories of school, it may help to understand that iambic pentameter is exactly the same cadence as the theme song from Gilligan’s Island. Prose also has an intentional rhythm. Short, choppy fragments mirror the mood of the character. Endlessly long sentences (see anything Faulkner wrote) drone you into a lull; “what did I just read in those two pages that were three sentences long?” Mental health practices of mindfulness and meditation help suffers of anxiety and PTSD, for example, use careful control of breath as a self-healing tool. Being whisked away into an author’s linguistic pacing can have the same benefits.
Guided imagery: All of my students will tell you I have a hard and fast rule about movie adaptations of books. I refuse to watch a movie in which I’ve read the book. I refuse to read the book if I’ve seen the movie. Case in point: I’ve seen all 8 Harry Potter movies without cracking the spine on any of the 7 novels on which they are based. My snobbery is based on protecting myself from dashed expectations. As I read any book, I imagine what the characters look like, how they speak, how they dress, etc. I like to use my internal CAD programming to design their homes and neighborhoods. Getting lost in the story is why reading a book with Fabio on the cover can be more healing than one with Dr. Phil on the cover. One of the most preeminent medical facilities, the Cleveland Clinic, has concluded: “Imagery can stimulate changes in bodily functions such as heart rate, blood pressure and respiratory patterns. It can help you tab inner strengths to find hope, courage and other qualities that can help you cope with a variety of conditions.”
Empathy: One of the major impacts of bibliotherapy is to see yourself, including your challenges, in a character. It is also extremely cathartic reading how someone just like you works on fighting mental illness without stigma or despite of it. This process, forming a bond with a character that reminds you of yourself, builds empathy. It also allows you to have empathy, not sympathy or pity, for yourself. Now that you are starting down the path of empathy for yourself, you have made the most difficult step in self-care: appreciating who you are without apology. Not sure what the difference is between empathy and sympathy? Watch this remarkable animated short.Spark Note Summary

Bibliotherapists are most often English majors with a depth of knowledge about “who” and “what”. Therapists are most often psychology majors with a depth of knowledge about “how” and “why”. As a woman with a bachelor degree in English Education and a master’s degree in psychology, I am your unicorn. As this blog takes on an occasional book review, have some faith in the magic of some more of the lessons I have learned.

The Happy Leopard (A Working Title)

Right now, my biopic would be rated PG13. That’s a cumulative rating. Like most of us, my 20’s were mostly R-rated, filled with inappropriate behaviors that matched my intoxication with freedom by living a time zone away from my parents. As the distance grew, so did the level of responsible, irresponsible behavior. I was never arrested. I didn’t get fired from my job as a new teacher. I also didn’t treat my body with the level of care and respect that I should have…and I knew it.

kundun — A child is believed to be the 14th incarnation of the Dalai Lama, whom the lamas called “Kundun.” The boy matures in both age and learning, especially after his mentor dies.

Surviving those years allowed me to calm down and earn a PG rating of life. Life’s spotlight intentionally shifted away from me as my levels of self-care and self-love began to match the care and love I had for others. I became your favorite underdog biopic. Think Rocky or Kundun.

Now that I’m in my 40s, I am embracing the decade of f*#k-its. Like most of my compadres of the same age, my skin is stretched to the size that I’m comfortable in (metaphorically, of course) where attitude reign supreme whether deserved or imagined. Just like Patch Adams, I celebrate the parts of me that caused the insecurity of my 20s and played up the sensitive side that brought me love (husband and son) in my 30s.

Your Identity Acronym

In order to help clients, I need to understand their biopics. Most therapists focus on one theory, cognitive behavioral theory (CBT), systems theory, just to name some popular ones. But, working with real clients means understanding how thoughts, feelings, biology, and relationships all factor into WHY they need help and HOW to help them. Thank goodness for Arnold Lazarus and his multimodal therapy acronym, BASIC ID.

Behavior: No secret decoder ring necessary. Separate your thoughts from your actions. What are you DOING that is getting in the way of a goal? What can you DO to put yourself back on track? Basic Madlibs treatment plan: Give me a verb.
I won’t lie. It is still a lot of fun using inappropriate words to fill these out.
Affect: This one is difficult because it is dependent on your emotional intelligence. Not only is the challenge identifying your feelings, but in order to understand and treatment plan for the conflict leading you into therapy, you need to work on the triggers for those emotions. You also need to put those feelings on a sliding scale, rage to irritation, sadness to depression, etc. The chain link of BASIC ID actually begins here by connecting the behaviors with the emotions; it’s the old chicken or the egg, psychology style.
Sensations: The focus is on the mind-body connection. Hands tingling, heart racing, limbs that seem to be slogging through a sea of Elmer’s glue just to walk to the door…Your feelings may be easier to understand by discussing their physicality. It’s important to focus on how your body responds when relaxing. Practicing mindfulness is essential to this aspect of therapy.
Imagery: I tend to think in pictures, so this one is easy for me. But, as you combine your actions, emotions, and physicality, memories will begin to stir. Before you flinch…GOOD memories are vital to any treatment plan. Connecting to past success in dealing with current stress is a major focus of my practice. It’s easy to lose sight of how many obstacles you have overcome on your own when you have to seek help from a professional to solve your current problem. Tapping into the memories of the “you” who can slay giants, at age 6 or age 60, builds up great momentum toward success.
Cognitions: Keep in mind, BASIC ID is not a literal, step-by-step process. It’s a clever way for therapists (and clients who want to learn) to conceptualize the presenting problem and create a treatment plan for A WHOLE PERSON. Your self-talk, self-image, and self-concept are words with immense power.
Interpersonal functioning: So many of my clients come to me because someone else told them they have a problem. Your support network is key. Learning who to have cheering you on and with whom a relationship has run its course is important to managing life’s stressors. How much those people have contributed to your overall mental health, or lack thereof, is essential to creating a path to a strong version of yourself.
Biological dimension: Horrible wife confession: I often tease my husband about having low blood sugar when he is a few items short on the “Honey Do” list. It is impossible to parse out the difference between the sensations of illness or medical conditions and those attributed to mental health illnesses. Are you tired because you caught the flu from your son or are you depressed? The beauty of this method of diagnosis and treatment is the permission for therapists to consider both with dismissing either.

Spark Note Summary

People are beautifully complex. The treatment models that try to disqualify thoughts and amplify feelings or focus on relationships without figuring out real sensations are limiting. The healing process truly begins, and lasts, when you can understand and accept all parts of you and your life. It’s not magic. It’s pretty basic…

Opening Pandora’s Box

When Jacob was four months old, he was obsessed with the color blue. He grabbed anything and everything blue. He also gravitated to anything that was Mommy’s. We got him to eat fish, chicken, spicy foods, etc. by putting HIS food on MY plate. So, the combination of Mommy’s cup and the color blue gave us this adorable picture. Then, the clever makers of Budweiser came up with a delicious, cheap, beer with double the alcohol. Problem: the bottle was blue. That is how we got this other adorable picture. The parental challenge we face is how to explain to this sweet boy (one day too soon) that drinking is not cute….or fun…or cool…or anything permissable until he is 21 years old.

I am writing this blog on the precipice of Oktoberfest, the gateway holiday for the season of playing with friends and family. That season is also a time of overdoing and undersupervising. Fifteen years of teaching and eight years of counseling have given me a front row seat to substance use and abuse. Here are the secrets I have learned from the mouths of addicts and the families who love them.

Welcome to Drugs 101

There are some common physical and/or behavioral clues that you have a loved one who is building a relationship with an illegal substance. The illegal substances we are talking about include tobacco and alcohol because of the legal ages required to consume those products. Take a breath, moms and dads…here we go:

Tobacco: In 2011, the National Institutes of Health published a study that qualified tobacco as a gateway drug. The study talks about the changes in the brain caused by nicotine. The piece of the puzzle that I have seen is how many of my clients started smoking at the ages of 8 or 9 before they wind up facing a charge of marijuana possession. The connection is a straight line. Teaching your lungs how to inhale tobacco smoke will allow kids to hold in the smoke, and addictive chemicals, of marijuana and heroin. Now who misses Joe Camel?
Alcohol: I confess. I was so drunk at my sister’s bat mitzvah (when I was 16 years old) that I forgot to duck to allow the garage door to open when I left the house the next morning. My explanation is a cultural double-whammy: in the Jewish faith, you are an adult after your bar/bat mitzvah (traditionally at 13 years old), and it was common in my family to “not mind” when a teenager drank as long as it was with family. Sound familiar?
Some states have laws that permit a child younger than 21 years old to drink

The worry for parents is binge drinking. It should take approximately 4 hours, one drink per hour, to reach the legal limit of .08; binge drinking means you have been able to reach that level in half the time. Here is something you didn’t want to know: in order to avoid consequences from parents who use a breathalyzer regularly, I have had clients who snort alcohol or soak tampons in alcohol to put in their rectums to get drunk quickly. If we an only harness that kind of clever ingenuity for good, world hunger, cancer, and global warming would be fodder for history books
Marijuana: IT’S NOT THE SAME! If you learn nothing else, please accept that whatever you smoked in your youth is not nearly as potent as what is currently available. The incredible scientific advancements that enhance crops to feed poor communities and create generic medications that save all of our budgets were used by less honorable businessmen to engineer highly potent, increasingly more addictive marijuana. And, forget trying to remember the nicknames and codes you may have used to monitor what your child knows about this drug. You will not be more clever than they are. What you should remember is how thirsty you were, how lazy you were, and how badly your eyes burned. Then, when your child blames allergies and overwork at school for those symptoms, you will be appropriately curious. Fun factoid: children that suffer from ADHD often behave more hyperactive when under the influence of marijuana.
Heroin: Thanks to the rise in our insurance co-pays, economics drew tweens and teens to the street to chase their prescription pill highs with a more affordable drug. The average street price of “oxy” ranges from $10 to $25; a $2 balloon of heroin gets you the same high. This phenomenon is not new. Finding more affordable replacements for upper class drugs, like cocaine, is what led to the crack epidemic. Your kid is afraid of needles? No problem! Heroin can be smoked or snorted. It is a versatile drug that shows no signs of decreasing in popularity. The federal government is just starting to address the national epidemic by limiting the amount of scripts and refills doctors write for injury. Sorry, parents, but if your sweet boy or baby girl is an athlete, watch what happens after an injury. Gross factoid: opiates like heroin cause intense constipation. Complaints about stomach cramping or lack of success in the bathroom may be an indicator.
Adderral, Ritalin, Xanax, Percoset, Etc.: Name brands or generics, their prescriptions or yours, there is no problem with availability or opportunity for these drugs. My clients refer to “skittles” parties, friendly gatherings where everyone brings whatever pills available to put into a communal bowl for anyone to gamble with a handful. The concern for medical personnel is waiting for blood work in order to treat an overdose. That wait time can be lethal. Sadly, grandparents are the number one unwilling accomplices to this form of drug abuse based on the amount of pills they have in their homes and the amount of love they feel when their grandchildren visit.

Spark Notes

There are hundreds of articles, books, and expert opinions on the topic of teen substance abuse. There are more drugs to discuss and tricks to spotting addiction to learn. It is important to know that you don’t need a family history to raise a child struggling with drug use or abuse. You just need a child to make a bad decision. Like most family problems, substance use and abuse are nobody’s fault and everyone’s responsibility. You can help correct that mistake like our mythological friend, Pandora…hope.

Huck Finn, Beowulf, and Star Wars

I started my student teaching nearly 20 years ago. My assignment was split between an accelerated sophomore English class and a regular junior English class. I was twenty years old, smart, cocky, and completely unprepared for what being in the classroom actually meant.

My sophomores had to read The Adventures of Huckleberry Finn. I had designed fantastic lesson plans surrounding the use of the n-word and the allusions to Shakespeare all to disguise how much I detested the book. I was not impressed with Twain’s satire despite my self-proclaimed coronation of the Queen of Sarcasm. I was not a fan of the protagonist’s introspection on the river. (My own introspective years came much later.) This teaching assignment was going to be painful; I was all creativity and no content.

My junior class assignment was the opposite. I struggled to find ways to interpret a complex text like Beowulf (which I learned to pronounce BAY-AH-WULF three days before the end of the unit) for regular level juniors. My students had the same opinion of this unit as I did, a necessary evil for both of us to move on to the next step in our education. My cooperating teacher had the answer for years; compare Beowulf to Star Wars as examples of mythic heroes. That plan also gave me the chance to shamelessly enjoy one of my favorite movies AND complete a daunting teaching unit. (First, don’t ask which Star Wars. This was twenty years ago; there was only one. Second, don’t worry about wasted time. There was a six page packet to fill out while watching to prove or disprove the monomyth’s applications.) The outcome of both of those experiences was a lesson learned that resulted in a blissful fifteen years as an educator and an insightful eight years as a therapist.

The Power of “And”

It was tricky to be a teacher and a student. That never changed. But, once I embraced that a teacher can remain a student AND learn from her students’ fresh approaches and reactions to material, I became an award-winning teacher. In therapy, the theory behind seeing how two seemingly polar opposites can be true is called dialectical behavioral therapy (DBT).

DBT is a treatment model used for chronic mental illnesses such as addiction, self-mutilation, eating disorders, and anxiety. Unlike previous posts, these struggles cannot be helped without professional interventions. The modality was created to help balance the contradictions imbedded into lifelong mental illness. DBT allows for the harmful effects of the illness to be incurable while making them manageable.

Similar to my post on group therapy, I will attempt to summarize the basics of this treatment modality which works to keep patients in a steady mental state. (Still, no Spark Notes.):

Stage 1: The focus of this stage is stabilization. Therapy is centered on safety and crisis intervention. The goal of this stage is to help people achieve some control over themselves despite the recurring messages they give themselves that life is out of control.
Stage 2: Despite more overall stability, behaviors characteristic of mental health issues may still be prevalent. Now is the time to investigate the origin of the pain. The goal of this stage is to help people process an experience instead of silencing or burying it.
Stage 3: This stage focuses on creating a new life under new terms; the individual is in charge of life, not the trauma. Optimistic exercises like goal-setting are the focus with the reminders that stability breeds happiness.
Stage 4: This stage is all about maintenance. The new “you” discovered is vulnerable to doubt. It is important to stay engaged in therapy even at this stage in order to have support when natural mistakes threaten to derail incredible progress.

Spark Note Summary

With the start of summer, adults want to be kids. Friction occurs when kids still need their role models to be adults. The answer is to live in a world of “and” by being both. Get dirty in the mud from summer rain AND be responsible enough not to trek it into the house. Show your kids who invented fun!