Understanding How Addiction Hijacks Rationality

Jul 07 2022

How Long Do I Need Addiction Treatment?

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WHAT TO EXPECT:

One of the questions that people have when seeking treatment is: How long do I need to do it?

I’m always trying to empower people by thinking deeply about their questions.

If you put that question in perspective it’s more like: How long is it going to take for me to change? There isn’t an exact number of days that you can say.

Is 30 Days Enough for Addiction Treatment?

There’s a model out there for 30-day treatment.

But what is that based on?

Is that based on some science that people break addictions in 30 days? Absolutely not. It’s based on the way that insurance billing works. The 30-day treatment model may not provide the kind of change that people need.

The standard answer these days is recovery takes around 90 days. I think that has more to do with the amount of time that people can afford to spend away from the system of their lives. Most people can’t just drop out of their lives for six months or nine months unless they’re young and maybe have good insurance. Or have strong support from the family. Or possibly getting resources from the county or the city.

Our treatment program is 90 days. Still, the 90-day program is sort of a compromise. It’s trying to get people as much treatment as they can get realistically.

In my mind, 30 days means maybe you’re starting to sleep good. Maybe you’re feeling safe. You’re beginning to approach recovery, but you’re nowhere near where you need to be to move on. By 90 days, you should have built a decent foundation…not a solid foundation, but a decent foundation.

Effective Treatment: Engaging in Recovery

A lot of TV programs, they portray good treatment. But the goal of treatment is not to do treatment well. The goal of treatment is to engage people in recovery so they can do their lives well. That’s the real trick.

The immersive experience is upfront: experience with the recovery culture, knowledge and tools, understanding therapy, psychiatry, all the things you need. And then you really want to kind of move that person into life to build those peer and family support structures outside that they have forever. So that they can keep recovery sustainable.

Ninety days in relatively contained care, as I see it: first 30 days real contained, second 30 days less contained, and much more freedom in the third 30 days. Then you’re back in your life but with a lot of support and resources to help you along the way…

That’s really good treatment and it works phenomenally well when the circumstances lineup to be able to do that.

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Feb 15 2021

The Potential Fallout of Suboxone Treatment

Recovery Blog, Rehabilitation Process, The Future of Addiction

What to Expect:

Medication-Assisted Treatment (MAT) uses prescribed drugs to help individuals struggling with opioid addiction manage their withdrawal symptoms and stay engaged in treatment.
Suboxone (or Subutex) is popularly prescribed to save lives and reduce the harm of opioid addiction.
What are the potential long-term effects of Suboxone in an individual’s overall quality of life?

Understanding Medication-Assisted Treatment (MAT)

Opiate use in the United States is at a crisis level–too many people are dying from abusing and overdosing on these powerful drugs. Opiates are highly addictive and a single overdose can prove fatal.

As a result of the opiate epidemic, lives are needlessly lost or destroyed, families devastated, and the socio-economic impacts widespread.

In an effort to save lives, medications have been developed as a means of harm reduction.

Medication-Assisted Treatment (MAT) gives an individual struggling with opiate addiction a fighting chance to recover and return to a normal life. That being said, a simple medication is not going to solve all of one’s problems–it is often a starting point where extensive counseling and therapy is necessary.

But is MAT just substituting one drug for another?

Not necessarily.

Drugs like heroin are unregulated and dangerous. Even prescription opiates are very dangerous when not taken as directed.

MAT offers those struggling with opiate addiction safer, FDA-approved medications. MAT medications–like Suboxone–help reduce or eliminate withdrawal symptoms without producing that euphoric high.

Using Suboxone to Treat Opiate Addiction

Suboxone is one commonly prescribed medication to treat opiate addiction. It is actually a combination of two different drugs–buprenorphine and naloxone. Buprenorphine is a partial opioid agonist that blocks the brain’s opiate receptors to reduce urges. The effects are similar to an opioid, but weaker.

Naloxone is an opioid antagonist. It counters the effects of opioids in the system. In fact, Naloxone is a commonly used medication by first responders encountering an individual experiencing an opioid overdose.

Suboxone is usually self-administered once a day as a film or tablet placed under the tongue to dissolve.

Potential Future Challenges for Suboxone Users

As a result of the opiate crisis, we have a percentage of young people that are on some sort of opiate blocker or opiate substitute–the most common being Suboxone.

The first crisis we may face in the future of addiction is the vast number of individuals taking Suboxone or Subutex for up to 10 years. We don’t really understand the long-term effects of these drugs.

We don’t know how these medications affect people’s development. What happens when an 18-year-old is put on Suboxone. How will it affect their development as they reach the mid-20s? Maybe it’s hardly at all. Maybe it’s a big deal. BUT…we don’t know for sure.

Will it be a future challenge?

Will people start having mental health challenges as they reach their 30s, 40s, or beyond? Can it be related to Suboxone?

And then there is the issue of getting off Suboxone. It’s well known coming off Suboxone is harder than kicking heroin. So, Suboxone may be saving an individual’s life, but the detox and resulting depression can last months if not years.

So, in a nutshell, we are putting a band-aid on a gaping wound to help save a life. If we don’t tend to that “wound” with counseling, treatment, and teaching life skills, that “band-aid” may save lives, but not QUALITY of lives.

Will we have the capability to deal with these issues? If we think proactively, there certainly is a potential.

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Oct 30 2020

Boundaries, Assertiveness, and the Right to Say “NO”

1. In Recovery you need to have boundaries, assertiveness, and use your right to say “NO”

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

What to expect in this episode:

2. People that can’t handle boundaries, are going to leave your life relatively quickly

3. How to be a little more authentic and assertive

4. What happens when you start to draw boundaries

In Recovery you need to have boundaries, assertiveness, and use your right to say “NO”

Usually, people don’t want to be in a relationship because they don’t want to be with that person anymore. The question that the party asks that is being broken up with is usually, Why? But they don’t mean it. Because nine times out of 10 there’s only one answer because I don’t want to be with you anymore.

Human beings are naturally kind of narcissistic.

So somebody breaks up with me, and I love them, and they don’t love me that I don’t understand. But I do understand because there are people who have loved me who I didn’t love in the same way. So I get that, right? We have all of these complicated interactions that require a lot of clarity, about what my rights are. And when I do that, it’s sort of like cleaning my room.

People that can’t handle boundaries, are going to leave your life relatively quickly.

You’re going to attract people that have good boundaries, and so, your whole life system changes real quickly when you begin to do that. It’s hard work and it’s uncomfortable.

I usually start back when people smoke before they vape I used to start with people with cigarettes because there’s a whole game of cigarettes and everybody smokes. And a lot of them don’t have any money. So ever got the cigarettes, it’s like, you know? if it’s not Newport’s. Now, they’ll come up to you and be like, “Oh man, can I bump a cigarette.” you know, and it’s like, eventually, like, Oh, my God, I’m giving away all my cigarettes, you know, what do I do? So you start making excuses. You know, so people come down and say, “Look, I get a cigarette.” and you say, “It was my last one.” And that’s the common responsible distributed rehab.

If you don’t want to, you don’t want just say no, right?

You say, “Oh, it’s my last one. I left the box in my room.” you know, I’m not going to go up to get it, right. One of the things that I have people practice with cigarettes and things like this are plenty of examples, is say no without qualification. And if they keep harassing you about it, ask them if, if you have round heel the right to say no.

If you want to learn how to be a little more authentic and assertive, be honest with people.

If somebody wants something from you, and you don’t want to give it to them, and you can’t justify giving it to them, except for that you feel bad. That’s not a good reason to give somebody something most of the time, you know unless it’s saving their life or they’re hungry or something like this.

So basically, it’s training people how to be authentic.

I don’t want to do this. I don’t want to hang out with you. And training people how to say that. No, I’m not going to give you a cigarette. Why is your last one? No, it’s not my last one. So why aren’t you giving me a cigarette? Well, hang on before we go down this road of why I’m not giving you a cigarette. Can we agree, that I have the right to say no to you about it? If they say yes, that’s the end of the conversation, you say Oh, great, then we don’t need to discuss this other thing because you just get that I have the right to say no. If they say no, my direction will be just Walk away. If somebody doesn’t think you have the right to say no in a relationship, I would just walk away.

A great part of recovery is when you start drawing those boundaries and being respectfully assertive in your life, and seeing what it does for your life.

A little territorial about how much of yourself your going to give, you suddenly start to get clear about who you are when you stop and start then you begin to have a sense of self, then you begin to have a moral code you made to feel good about yourself and you attract people around kind of people you want to hang out with, that also know how to say yes or no and appropriate wise. Next thing you know you got a different life.

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Oct 13 2020

The Role of People-Pleasing and Codependency in Addiction

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The Role of People-Pleasing and Codependency in Addiction

When you’re working with people that are in early recovery, they suffer from the same kind of orientations and disorders that exist in the culture at large, just usually in a more extreme way.

Over accommodation or people-pleasing

So one of the things that come across a lot is what we call over accommodation or people-pleasing, and it means sort of overextending the boundaries of myself in a way that causes me a deficit for the sake of the other, you know, psychologically call that kind of co-dependence, it’s on that spectrum. And it’s a really big deal.

“A lot of people that you find coming into recovery have felt that they’ve been living for the world and they don’t really get theirs. And so there’s becomes using drug and alcohol.”

Straightening out what your boundaries are

You know, the metaphor for me is like, okay, I do everything I’m supposed to do. I mean, the world asks of me during the day and at night, I hide in the closet and drink vodka and smoke meth, you know, or whatever it is, that’s for me, the rest of its for the world because the world’s been demanding on me since I was born. You can think about that dynamic. And so one of the things that needs to happen in treatment is you have to straighten that out.

You have to help people become more assertive.

Assertive is a tricky word. I don’t mean asserting your will on others. But I mean, being clear about what your boundaries are, and being clear about how to draw those boundaries in a way that’s effective in your life. So if you’ve been people-pleasing for a long time, you have to get clear about how to assert boundaries. And you have to be clear about what your rights are and asserting those boundaries. So where people are confused, is they’re confused about where their rights stop and start in the interpersonal reactions. I’ll give interactions.

When I was working in treatment

I remember I walked into a lobby, and there was a woman who I liked quite a bit, who was working there. And she said, “Hey, I sent you a Facebook friend request. Did you get it?” And I said, “Yeah, I got it. I saw that friend request.” And she said, “Well, are you going to friend me?” And I said, “No, I’m not going to accept your friend request.” And she gives me this look like you know, she’s offended. And she says, “Why not?” And I said, “Well, I don’t, you know, I don’t want to.” And she said, “Well, my roommate, who you know, she sent you a Facebook friend request, and you accepted that friend request.” And I said, “Yes, I did.” And what did she say? She said, “Why didn’t you accept my Facebook request?”

And you should know this a teaching from my mentor. When somebody says “why” to you and interpersonal reaction. They don’t really mean it. They don’t want to understand it. It’s really a complaint. Right? And so you go, is that a question or a complaint that “why”. I need to clarify that. But in that circumstance, I said, “Can I ask you a question?” She said, “Yeah.” And I said, “Do I have the right to decide who my Facebook friends are?” She said, “Yes.” I said, “Okay, good. We’re clear.”

Let me ask you another question. “Were you ever married?” She said, “Yes”. I said “Did you have a wedding?” She said “Yes.” I said, “Did you invite some people to your wedding?” She said, “Yes.” I said, “Were there other people you didn’t invite?” “So the other people I didn’t invite?”. “And did you ever have somebody who didn’t invite to your wedding come up to you after the wedding?” And say, “Why didn’t you invite me to your wedding?” And she said, “In fact, I did.” And I said “What did that feel like?” She said, “It didn’t feel good.” I said, “Great. Now you understand this interaction. Right?”

And now I’m being a little bit you know, humorous or whatever. But it’s an example of how we get confused in our boundaries of what we’re obligated to do. Where do my obligations stop and start? If I’m in a relationship with somebody, and I don’t want to be with them anymore, which is usually why people break up out of relationships, right?

Usually people don’t want to be in a relationship because they don’t want to be with that person anymore.

The question that the party asks that is being broken up with is usually “why”, but they don’t mean it. Because nine times out of ten there’s only one answer, “Because I don’t want to be with you anymore.” Obviously, on the other end, that’s hard for you to understand because human beings are naturally kind of narcissistic. And so somebody breaks up with me and I love them and they don’t love me that I don’t understand. But I do understand because there are people who have loved me who I didn’t love in the same way.

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Sep 19 2020

The Moral Aspects of Treatment

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Remove the Moral Aspects of Addiction Treatment?

I talk a lot about the moral aspects of treatment and I am very resistant to removing morality from the conversation about addiction and recovery. I understand why people want to do that. It’s to bring down the stigma to address the confusion around the free will issues, for it to be covered by insurance, I agree with all that. I agree with the reasons. My hesitation is that there is a huge moral component to addiction and recovery, and let’s talk about what that looks like in recovery.

In recovery, the moments where we gain the most growth are the same moments where we gain the most growth in life.

One of the most pivotal moments of growth in my life, there are moments when I’m in a moral conflict and I’m not sure what to do. What is the right thing to do in this moment? If I’m in a marriage and I don’t know if this marriage is working and I have kids and I’m trying to figure out– I’m- some of them in this world conflict, what is the right thing for me to do? If I’m tempted to go into a career largely for money, but it’s not my passion, I’m in a moral conflict what is the right thing for me to do.

The most serious conflicts in our life are these moral conflicts with competing claims on each end.

The reason why I’m hesitant to remove that from the conversation is, it is the moral conflicts that induce inhuman beings the most important parts of ourselves. In order for me to wrestle with a moral conflict, I have to draw on all of these different parts of who I am and my personality. Right?

So a common conflict and treatment that happens is, my roommate snuck out and got drunk and I know. My roommate comes back and says, “Don’t tell anybody,” and suddenly there’s a couple of things happening.

One, I am asked to keep a secret. And in general, secrets, those kinds of secrets are not the healthiest things to keep inside of us.

Number two, I’m in this interesting quandary around loyalty to my friend, but on the other end I’m in an interesting quandary about being honest with the people that are helping me: counselors, therapists, the community at large and treatments. I have these competing claims. I also have me. I don’t want to be walking around with lies in myself. I don’t want my friend to get in trouble, which is a normal thing, but I don’t wanna be dishonest, and suddenly I’m in the midst of a moral conflict.

What somebody does in a predicament can be the make or break moment in somebody’s treatment experience.

When somebody can say, “Hey, you put me in a really bad position by asking me to keep your secret because you act it out and I’m not willing to co-sign that with you, and it wasn’t okay, and you need to go work this out because you’ve put me in a bad situation. You’ve put you in a bad situation. You’re an alcoholic who allegedly is here to get sober. I get that you don’t do this thing perfectly but you need to straighten this out,” right? That’s a high level response. That’s not the government’s fault, but imagine if somebody is used to cosigning everybody’s everything all the time in life, they’ve engaged in a program of recovery. They strike them, they built what we call a moral core, some center about what the right thing to do is. They’re challenged, they’re in the middle. They’re stuck there in the hallway. They don’t know whether to go left, whether to go right. Right? Suddenly it’s like, okay, and they have that conversation. You know what that does for me. That’s everything. That’s the turning point for people’s recovery.

The moment when you have the difficult conversation with your parents or your loved one that you’ve never had, we build that moral core.

Begin to put yourself in the equation. That’s where we get the most growth. Not only do we get that growth morally, we also get it psychologically. We are moral psychological beings that come hand-in-hand. Right? To be– if you meet somebody who’s evil, which is a moral term whether you believe in evil or not, but behaves in evil ways depending on their level of narcissism and the way in which they act out, you would have a difficult time saying, “Well, that person is mentally healthy. They’re just evil.” Right? In general, those things come together. Right?

So, you know, to use the extreme example. Adolf Hitler was not only evil. There’s such a thing exists. He was also mentally ill and a methamphetamine addict. Those things come together. So our moral behavior in our psychological wellness, they’re integrated with each other. We have to understand that. So we cannot remove morality from the equation of recovery addiction. We have to figure out how we incorporate that in the conversation about well-being, psychological well-being, spiritual well-being, etc.

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Aug 21 2020

Do You Need to Dumb it Down in Treatment?

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Do You Need to Dumb it Down in Treatment?

One of the things that’s common in some therapeutic communities, when it comes to recovery is telling people to dump it down. And I understand what they mean, but I don’t like it. Because I like to think.

If you learn to reason well, which is not about coming to the conclusion that I had before I started reasoning, that you’re actually trying to figure out the truth of the situation. That has been an incredible asset.

Recovery is cognitive

In my recovery, in many ways, a lot of my recovery was cognitive. It was an intellectual endeavor. I was trying to reason whether or not this made sense to do. Now reason alone won’t do it.

I have to have some foundation, some axiom there. And my axioms are to live is better than to die and to be healthy is better than to be sick. I don’t know why that is. I can’t tell you why that is. It’s a choice that I make. It’s the foundation for the rest of my reasoning.

Once I start there I could build up reasons to get clean, that makes sense to me, reasons to do things I don’t want to do, reasons that I can transcend my ego desires.

A part of what I do when I work with people, is I try to harness that.

If you ask questions, and you’d like to learn, instead of telling people like, “Hey, dump it down. Don’t think. Just show up.”

You can actually harness that asset that people have and use it.

Now, the reason why people don’t like it is because people have the capacity to reason their way into what they want. But just means you’re not reasoning, good enough, well enough. It doesn’t mean don’t use your reason. It means use your reason better. Right? And that’s a huge part of recovery.

If you know, I need to make reasonable decisions to have a healthy life and if I don’t know how to think well, I can’t do it and there are techniques and ways to think well.

They don’t teach you that in school. You memorize a lot of facts in order to figure out how am I supposed to be in my relationship with this person when I’m in a moral conflict between using drugs and my parents, you know, coming into town next weekend. How do I weigh those competing claims and come to a decision, you know. We don’t teach people how to do that, but we can.

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Aug 01 2020

Mindfulness in Treatment: Getting to Know Yourself

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Mindfulness in Treatment: Getting to Know Yourself

The other area that’s important that’s come into the treatment field, when we’re looking at kind of how to recover and become whole and become healthy, is what I would say the Eastern practices and I’ll lose the categorize them as mindfulness and of yoga.

Mindfulness is around intention and attention.

If I meet somebody who’s suffering from addiction, demoralized, who’s ashamed, has some traumas in their background, often they’ll be sitting in my office, and you can kind of tell the level of trauma by body posture, and eye contact, and their ability to stay connected and intentional and paying attention in the interpersonal relationship.

The first thing that I have to do with this person is I’ve got to figure out how to help them feel safe.

That’s the beginning. You build on that a little at a time in relationship with them and groups and individual work in casual kind of covert, nurturing and caring in the hallway, this kind of thing.

Then eventually, when somebody is kind of here and they’re awake, that can take two, three months to blossom and start to change.

This is a great sign when their affect changes.

Then work on the directing people’s attention and having people being mindful of the things that they’re engaged in that’s right in front of them.

That goes to a very subtle level, eye contact, of focus, of being aware of what’s happening in my face and my shoulders, my neck and my back and that’s an endless route, both recovery and growth and wellness.

You can move deeper and deeper into the mindfulness attention and intention, by knowing what’s happening inside of your mind.

Not just of what’s happening outside of me, but what’s happening in the dark, creepy recesses of my unconscious mind. The whole thing about recovery to me is to help people to move deeper into a process and become deeper people.

Get addicted to getting to know myself and working on myself

Not just me, but working on myself in relationship to all the people that I care about, to understand myself in the context of my work.

That’s the “Wow. How can I be a better husband? How can I be a better father? How can I have a meaningful role in my work? How can I make a difference?”

That kind of thing and when you get a little bit obsessed and curious about that, then recovery is not that hard.

Then it’s this endless journey of getting to understand yourself, getting to understand the world, and interfacing with your reality in a way that’s meaningful, where you wake up and you look forward to it.

Those are like the deeper realms of recovery.

Getting to understand yourself schematically. How you process stress and all that stuff. And actually, it becomes fun. It doesn’t become this chore. Then it’s not about, you know, when can I leave treatment,. Then it’s about what are the other ways I can get to know myself and I can get to grow learn to change.

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Jul 15 2020

The Spiritual Element of Recovery

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The Spiritual Element of Recovery

In many programs, that you would go to, to engage in recovery from addiction, there’s a spiritual element to that program. So we have a spiritual program or something like this. And the most common spiritual traditions that they drawn are these Eastern traditions, Buddhism, the yoga, the mindfulness, meditation, these kinds of things. And honestly, I don’t think one can put into words the benefits of those practices.

Spiritual Psychology

There’s another spiritual tradition that’s more Western that I think is underutilized, which is spiritual psychology and it has to do with how the psyche works and it has to do with virtues. It’s sort of this mix of Greek thought, and philosophy and psychology.

That element is crucial because one of the things we’re addressing when we’re looking at recovery is who we are in the moral sphere. Because when you’re in your addiction, you feel demoralized and often ashamed of how you behave.

One of the things to try and figure out is how do I get in contact with my, let’s call it authentic self? And how can I be a better person? Which is a huge antidote against shame. If I feel like I’m being a good person over a period of time consistently, I usually don’t feel that a shame might take a while to get there. But we have to understand what it means to be a good person and that’s challenging. It’s a really complex philosophical issue and something that spiritual psychology looks at a lot.

The Ego- Self

In the moral sphere, the way that I think about that, is to think about a person as having a lower self, or you could call it -my great teacher, Dr. Rabbi Mordecai Finley calls it the ego-self- which is the, it’s a perfectly healthy part of the self for quick, unimportant decisions.

It’s the part of me that’s driving the car. That’s in chit chat on the elevator, that’s all ego-self. “Oh, would you like me to push this floor for you? Let me open the door.” You know, etiquette and basic memorized, mechanized ways of responding in the world. Ego self is great at that.

However, we needed to function. I don’t want to be looking at a doorknob thinking what do I do here? How do I go through this door? What does this mean, right? Ego-self is great with that kind of interaction that we have.

The ego-self is terrible, a complex interpersonal reaction.

And any deep relational interaction is complex. It’s going to be reactive, impulsive.So, one of the core parts of spiritual psychology is this question of being able to identify when I’m in my ego self and when that’s appropriate. And when I’m in my higher self.

The really tricky part about addiction is that you become confused about the difference between those two ways of thinking and you use inconsistent rational thought to rationalize and justify ego desires, if that makes sense.

An ego thought does not stand up to scrutiny.

If you ask your ego deep questions, it cannot give you deep answer. It doesn’t have deep answers. To figure out how to respond in accordance with the situation so that you can continue to build on the most important thing.

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Mar 17 2020

The Physical Aspects of Recovery

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One of the things I don’t talk about as much–but it’s so important–is the physical aspects of treating addiction.

Now this doesn’t necessarily pertain to people who are already “fitness freaks”. There’s a whole group of people that come into treatment and their primary coping tool is the gym and eating well. For those people, they’re not gonna get the same kind of relief from the gym beyond what they’ve already got. They’ve already dealt with the nutritional and physical aspects of their neurophysiology.

But there’s another huge group of people who have never paid attention to their body. And sometimes it shows.

Huge Amounts of Information Are Stored in the Body

And we know that traumas are stored in the body. Memories are stored in the body. We know you can tell a lot about how a person is doing based on their body language, energy, posture, and eye contact.

In order to have a full recovery, you have to take care of the body. Meaning: you have to be mindful and intentional about what you’re bringing into your body, what you’re eating, and what you’re drinking.

And you have to be mindful and intentional of the physical activity you’re engaging in to help the body reach close to a peak performance.

Of Course, Exercise Is Healthy, But Did You Know…

There are meditative exercises that exist. I think particularly swimming, biking, and running. Real rhythmic, physical activities, that open up different emotional spaces. When we’re in a deep depression emotions get locked in.

I’ve told a story about when I picked up bike riding. On my first long bike ride, I just broke out in tears. There was so much emotion that was stored in my body. Until my body was moving in a rhythmic way, I couldn’t get to it.

One of the big ways to relieve that stress and anxiety is to start to take care of your body more. The way to do that well is to find an exercise routine that actually works for you. I do biking, it’s really hard for me to lift weights in the morning, and frankly I don’t enjoy it. And I don’t like gyms. I like to be outside. So, biking is great for me.

I wake up early in the morning and I jump on a bicycle. And it’s an automatic warm up; I kind of ease into that exercise. And, for me, it’s great because I’m kind of like, rusty in the morning. Biking, to me, brings this rhythmic, meditative thinking that just blows the thoughts and anxieties right out of my mind.

Of course, you have to find the exercise that’s right for you.

The physical components of recovery cannot be understated. It’s not my area of expertise. There are people who know much more about it than me, but it’s definitely worth talking about.

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