Yeshaia Blakeney Tag

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The Stigma of Addiction: Pros and Cons

One of the things that has been a great concern to the population at large when it comes to addiction–definitely the media, definitely the progressive end–is how we think about the world of addiction and the people going through the suffering involved with addiction. It is this stigma that comes along with the word “addict” or “alcoholic.” 

There are a lot of campaigns I see online like End the Stigma and people talking about their sobriety and what they have been through. Generally, I do not know if I would say I am a fan of that…but I definitely like people to do what they feel is right, whatever makes you feel good about yourself.

What Actually Creates the Stigma of Addiction?

I think that there is a misunderstanding of where the stigma from addiction comes from. 

What I would say is that the stigma from addiction does not come from the word “addict.” The stigma comes from when your brother steals your car battery out of your car because he has an addiction problem, and it pisses you off. 

So, the reason why there is a stigma around addiction is because the behaviors that come along, not all the time, for all eternity, but a lot of the behaviors that come along with a lot of people that have addictions are horrid. You cannot trust people. They steal from you. They lie to you. 

You try to have an authentic relationship, but they are incapable of having an authentic relationship. It is a giant pain in the ass to have a relationship with somebody that has an active addiction. 

That is where the stigma comes from. It is not the word “addict.” You can change the words all you want, but the reality of it is until addiction is not a pain in the ass, there is going to be a stigma associated with it.

Can the “Addiction Stigma” Be Useful?

Now, on the other hand, I understand what people mean because you want people to be able to overcome their shame of having addiction by being able to say, “I have this problem,” so they can get better. 

I agree with that, but on the other hand, you do kind of want some stigma against addiction. 

I am raising children in this world, and is it the worst thing if my kids think that to be addicted is not that great? 

I want my children to know addiction is not that great. So, I think we have a lot of confusion about what we mean when we talk about stigma, and even what exactly our goals are when we say “Bring down the stigma.” 

Does Changing Terminology Make a Difference?

Clearly, the goals are to be able to help people get better. I mean, that is simple, but I do not think we are going to do that by playing with language. 

I will give my funny example of this, “housekeeper.” It is an interesting word. To keep the house, I guess, is what it means. It is somewhat old-fashioned. It is not as old as “maid.” I very rarely hear people say, “Oh, this is my maid.” They say, “This is my housekeeper.” Now, the word changed somewhere from the ’80s and ’90s to now from “maid” to “housekeeper.” Prior to that, there was another word people used to use, it was called “servant,” right? Or the “help.” 

So, these words changed, but the reality of other people cleaning up other people’s shit for their whole lives is still the same. Do you want to reduce the stigma of the word “housekeeper”? Well, I do not know. Maybe we should take a look at whether it is cool that we have a society where a certain class of people, often of a certain race, spend their entire lives serving another class of people often of another race, if we really want to deal with the problem.

Is Language Distancing Us from What’s Really Happening?

I feel the same way about addiction. Addiction is a human phenomenon. People have been addicts and alcoholics for as long as people have been. 

So, yes, we want to acknowledge this is not a normal human part of life. We also want to acknowledge when it becomes a destructive addiction, it is not a good thing, and it should be somewhat stigmatized. 

There is another reason why I would not be so quick to get rid of the terms “addict” or “alcoholic”. 

We are in a time now with trigger warnings and people being very afraid of offending people with words–which is strange because we are in the most offensive times, in my opinion, that one could live in, but that is the hypocrisy of the time. 

So, people have a hard time identifying as: “Hi, my name is Shy. I am an alcoholic.” or “Hi, my name is Shy. I am an addict.” 

Whatever that is, and they go, “I do not want to identify because I am more than just an addict.” Of course, you are more than just an addict. I think everybody knows that, but what is the importance of identifying?

Well, in my mind, people are distancing themselves through language from the reality of what is actually happening. 

When I was in active addiction, it was not a thing that I suffered from, meaning it actually was in the realm of the anti-logical, of the being of me, not the just doing of me. 

I will give an example of this. My cousin Jason has been playing baseball since he was 5 years old. People that play baseball, people that really love baseball, could spot a baseball player even when they are not playing baseball. They go, “You are a baseball player.” Then he will go, “You are someone who often plays baseball.” “No, you are actually a baseball player. I see the way you walk, the way you talk, the way you wear your hat, in the ‘being’ sense of it is like a baseball player.”

I would say if you have ever met somebody who is a really bad junkie, it has invaded more than just their activity. It has to do with their being. There is something kind of almost essential there where you go like, “Man, the way this person’s posture is and the way he kind of looks up at me It is like, he is kind of an archetypal junkie.” 

I am not saying that is great, and I realize that is probably somewhat offensive to go, “No, actually you are a junkie.” But I think it is that realization that you have, “Oh my God, I am a drug addict,” or at least “I am becoming a drug addict. I do not want to be that.” 

Not: “I do not want to do that anymore.” 

I do not want to BE that. I want to be someone else or something better.” 

So, I think when we get rid of those words, we are sort of white-washing the situation. 

I have sat with people with sleeve tattoos, out of the penitentiary, and in addiction programs, and I am like, “Hey, what are you here for? What is your drug of choice?” 

They go, “I am opiate-dependent.” 

I am like, “Opiate-dependent? Okay, doctor. What does that mean, you shoot heroin? You shoot dope? You do opium, right?” 

 I am not saying that to be offensive, I am saying it to get that person to connect to the reality of where they are at, and what they are becoming.

Being Comfortable with BEING

So, I think that… Because we live as a psychological society, we think about everything psychologically. We think about everything in kind of this far distance. We actually move away from the actuality of the being. 

Like, “No, I am an addict.”

And: “Guess what? Right now, I am not an addict. I have been sober 17 years. My ways of being who I am in the fibers, over time working on myself…I have not used for a long time.”

“I am no longer an addict. I can identify as I am an addict in recovery.” 

Or, “I am Shy. I am in recovery.” 

That is part of my being, too. I am a person in recovery. I am not doing recovery.

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The Need to Control and Addiction

One of the common things that I come across with people that are trying to recover. So I sort of look at more universal elements that mean the thing about addiction, is it’s not really appropriate, it’s not accurate. To say… oh addicts do this, addicts do that. Because there’s a huge amount of personality, and… diversity, in the addicted population. Right? I mean, people– people are not the same, at all. 

 

One of the things you want to understand is what are the characteristics, that you do seem to cross boundaries.

 

you can say, okay, those– these would definitely want to get to, and I’ve talked about in another piece, around people-pleasing which I see you know, something like 75%, of people over accommodated people-please. And they don’t have healthy boundaries and they don’t know how to assert themselves, to create a sense of self in their lives. [/vc_column_text]

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The other thing I see is issues around control.

 

 Human beings in general, addicts in particular, are people suffering from addiction, in particular, tend to be control freaks. And there are lots of ways that– that manifests.

Somebody who’s a control freak isn’t necessarily an overt control freak. 

 

Like if I look at myself, and I say, what are the ways that I defended against the world and attempted to predict and control outcomes so that I could feel safe? I was– I was never overtly controlling. As you can imagine, I did it with words… and rationale. Right, if you hear me speak… my biggest defense mechanism, the way to keep people away from me, was to understand what was happening around me, try to be predictive and to use a language, as a barrier.

I could hypnotize people with my speech, that was one of the ways that I maintain control. 

 

It’s why for me, it took me a long time to figure out how to do individual therapy, talk therapy because I’m good with words. And so I can… talk and talk and talk and talk and I’m not necess– you know, once I had worked on a lot of the shame, I can even talk about the issues but it wasn’t having a transformative impact.

The talk therapy, group therapy was really good for me. 

 

Group therapy I had so many eyes on me, that I couldn’t control… each person, because I got some you’re looking at me over here, and over here and this and it was too much. And so it made me more vulnerable, which is what I’m trying to do and try to let go of control.

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Moment of Grace

What to expect in this episode:

 

  1. When I first came into recovery it was like a giant mountain I didn’t know how to climb
  2. People were giving me info, love, encouragement, support, so I began The Climb
  3. You begin to plateau, but then you are granted a moment of grace – when all those burdens flip off your shoulders and become a foundation…

 

My Moment of Grace

When I first came into recovery, I just remember kind of walking into treatment and all this information that was given, and it was like a giant mountain and I was like “Whoa, how am I ever going to climb that thing?”

 

And there were people that were encouraging me and giving me information and giving me love and giving me care, and so I started to climb the mountain and I’m like “Whoa, this is – okay, I can do this”. And then it just felt like the progress was slow, it was like trying to climb a hill in roller skates, you know.

 

And everything felt so heavy, but there’s something that happens in that recovery journey. It’s not something that can be measured. It’s not scientific. It’s not in any manuals. It’s something close to grace and all of those things that are weighing you down, all of those burdens that are making you heavy and making you small and making you feel like you’ve never be able to stand up straight.

 

You’ll never be able to look yourself in the eyes. You’ll never be able to feel love, none of that. Something happens in an unmeasurable instant, at some point in that journey, where all of those rocks on top of you, all of those burdens, all of that weight, it just flips.

 

And suddenly, you have this new capacity, you have – you’re in touch with something different. I call it Hope, you can call it what you want and you’re able to travel up to the top of that hill. And once you get to the top of that hill and you’re standing on top of that mountain, once you’re there, there’s nothing to do but just dance, because you’re free and you’re dancing the dance of recovery.

 

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Things I Don’t Like About Contemporary Treatment: A Meditation From The Inside

Dr. Erich Fromm, one of my teachers, inspires the title, and much of the content here.

 

There is a huge shift transpiring in the field of drug and alcohol treatment, it is happening rapidly and systemically, it will be for the worst and difficult to reverse. Warning: the field of treatment is being infiltrated by people who are emotionally disconnected and un-empathetic towards the plight of the people they claim to serve.

 

What the treatment industry used to look like: A group of people who had an experience of transformation becoming missionaries and willing to do whatever it took to help addicts and alcoholics. Twelve step, spirituality, new clinical techniques, whatever helped people recover it was done with spirit, intention and legitimacy. I am not idealizing the past, there were always unscrupulous operators, but they were the exception rather than the rule (with some large scale exceptions in the 80’s treatment bubble).

 

What’s happening now is something different: salesmen, hustlers, and young wealthy kids who want to show their parents they can be successful, open treatment programs, for the wrong reasons and with no experience. Many Drs. And psychiatrists enter into the field as consultants or hired employees and get tempted by money and use their degrees as cache to become owners and operators of there own centers, these too tend not to be missionary healers, but more business savvy narcissists. What’s happening now in treatment is systemic, a result of the breakdown of ethics and spirit in the treatment field. All of this has come together in a near perfect storm to create an industry that seems to have lost its way. The new breed of treatment centers is looking at how to maximize profits, buy and sell addicts care, and become as large and efficient as possible. It is the wrong approach.

 

One of the contributing factors to this shift is the influx of narcissistic and egoistic personalities that own and operate treatment programs. Every day I hear about the shenanigans of the owners of large “successful” treatment programs. It is clear many of the owners of private rehabs have not done their own spiritual work. Many of these owners are pathological. They tend to have the psychological profile of compulsive gamblers: Mildly (or majorly) anti-social, grandiose, charismatic, addicted to the cycle of winning and loosing, self sabotaging, self-absorbed and lacking in empathy.

 

What makes this situation deeply troubling, as opposed to another unfortunate by-product of profit-centered capitalism, is that recovery once was a sacred field, largely due to Alcoholics Anonymous.

 

We have reached a moment in the field of treatment where events and industries have conspired to create the perfect storm. The issue is greed.

 

Treatment, when done correctly can be a profitable business, and treatment with a focus on profit (over care) can be insanely profitable. Treatment has now become an attractive field for those looking to make a quick buck. On some level what is happening is no different than what happened in the mortgage industry in the early 2000’s. The treatment bubble began to attract these characters (en masse) with the introduction of mental health coverage from insurance in conjunction with the capacity for huge online marketing efforts on Google.

 

How has this happened? There is a lot more money in the field than there was ten years ago. There is also, unfortunately, a growing customer base, as our country is in the midst of the worst heroin epidemic it has ever seen, and it is an epidemic affecting not only the lower, but also the middle and upper class that can afford to spend more on treatment. This has not gone unnoticed by venture capitalists, real estate investors, huge multinational corporations; they all see treatment as an industry they can capitalize on.

 

One of the reasons this works is that when families or clients choose to come to treatment all they know is the marketing, not the treatment itself. Unlike a restaurant, customers cannot just try the product and decide if they like it and go somewhere else. Rehab is a big investment. From the outside (or the website) there seems to be no difference between genuine experience legitimate treatment, and large commercial insurance farms. Financial success in this industry has little to do the quality of treatment and everything to do with marketing. The more one can focus their resources on marketing the more clients one will get. It has become a marketing game to fill beds. As a result you see the greediest operators achieving enormous success, putting marketing first (over care). The clients who don’t get the care they need don’t have a voice because they disappear back to where they came from, or sometimes, tragically, die. No one takes responsibility, and the most vulnerable among us are being exploited.

 

And, we now have the recovering community itself getting involved. Which in many ways is a great thing, but when a recovering person in the first couple years of recovery without much experience or know how opens a treatment center, the core of the treatment matches the core of the founder: shaky, compromised and not yet fully integrated.

 

So what does good treatment look like? A good treatment center is one that exemplifies healthy living, strong ethics, strong boundaries, expertise (through experience) and lots of love. The men and women in the trenches of their recovery, with an interest in transitioning into the field of recovery, become counselors, therapists, techs; they go back to school learn their crafts and 10 years later they have worked their way to positions of power, legitimately.

 

The best of us in the field are those who feel an obligation to our fellow person, see ourselves in the people we help, recognize our own limitations, can empathize deeply with suffering, and have the strength to help create a safe and sacred place for those in need to recover.

 

The other day I was visiting with a young man who just opened a new treatment center. I was speaking with him and the clinical director for longer than I had anticipated.   It was clear he was excited about his new business and also clear that he was excited to be helping those who need it. We talked about ethics, spirit and fighting the trends of our industry. Treatment programs like his and mine, are becoming the exception. We are people first, we’ve done our own work, we have experience, we are small, smart, and we are values based. I am having these conversations more and more (with colleagues, with parents, with clients, with peers); there is a small underground group of us forming, perhaps a specter is haunting the treatment field: the specter of integrity![/vc_column_text]

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The Human Side of Treatment Behind the Opioid Epidemic: Ryan’s Story

I was working in residential treatment a few years back; one Friday night, a new resident, Ryan, approached me. He was a teenager, 5’6” with big, kind eyes, natural dark circles, and a face that turned red at every feeling or change in temperature. He asked, vulnerably, if he could speak with me. I took him to my office, we sat down and I asked, “What’s up?

 

I got out of Heroin detox two days ago. I’m 8 days sober. And I’m craving shooting heroin again.”

 

I could see that he was quite sincere and on the razors edge of going this way or that. I looked him in his eyes and asked him: “How are you going to use?” This question surprised him; I think he thought I was going to talk him out of it.

 

 

I’ll smoke it,” he said dryly.

“Do you have Heroin on you now?”

No,” he said.

I asked, “How will you get Heroin?”

“From my dealer” he responded, clearly getting impatient and annoyed.

I proceeded, “Do you have money?”

“Ten bucks” he answered.

I said “Give it to me,” and he did, and I put it in my pocket. “Do you have a cellphone?” I asked.

“No,” he was beginning to catch on to our game.

“How are you going to call him?” I pressed.

With some finality he said, “I’ll panhandle, get the money, I’ll call him from a payphone at the gas station, and get high.”

“So he will come drop it off and you’ll get high at the gas station?”

No.” Ryan said,  “my dealer doesn’t deliver, I’d have to take the bus to Inglewood and meet him.”

I continued, “After you meet him and get the dope where will you get high?”

“I’ll get some tinfoil and a straw from burger King and smoke it in the bathroom there.”

“And then what?” I asked accusingly.

“I’d be high,” he replied.

“And then what?” I asked.

“I’d go home,” he answered.

To your parents?” I asked.

“ No, they kicked me out. I’d come back here,” he admitted.

“To rehab?” I asked, “and then what?”

“I’d get sober,” he answered.

“You’d get sober? But you’re sober now!” I replied, too loud, revealing my inner judgement.

Yes but when I am High I really want to be sober,” he said.

Aha. “So let me get this right, in order for you to stay sober you have to get high?”

 

 

Two days later, Ryan was on the street getting high. Ryan wanted to be sober. But he wanted to be high, also. By the eighth day in treatment and sober, he had run out of motivation to stay sober. Why did Ryan need to get high in order to stay sober? When he went into his memory he realized that when he was high, he found the motivation to get sober; the crisis of addiction created an energy, a desire in him to get well. Ryan was cutoff, he was stuck in his own thinking, and his thinking was cut off from the world. He was stuck in a narcissistic bubble of addiction. Ryan was rational, but his reasoning was driven by an unconscious craving to get high. He didn’t want to get high, that’s why he asked to talk to me, but it was almost as if once he engaged me he was sleep talking, unable to wake up and stay where it was safe and welcoming. Underneath the mechanics of Ryan’s thinking there was something else going on. Ryan was numb, and underneath his numbness was pain, fear and sadness.

 

I wonder if I had been able to break out of my role in that moment: warm and clever counselor and instead become loving and vulnerable with him, would the effect have been different? If I had held his hand, been there with him 2 or 3 hours or however long was necessary, listened to his pain, given him a hug, could I have broken through to a different part of him and changed his trajectory? As it was, I believe we were both stuck in our roles at the time, him the out-of-control addict in need of saving and me the young-smart-(slightly)-distant counselor. Ryan recovered from his condition; I am still working on mine.

 

Ryan ended up in treatment two weeks later and has been sober ever since. So it turns out he was right, he had to get high in order to get sober.[/vc_column_text]

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Is Addiction a Developmental Disorder? | Beyond the “Unbroken Brain”

In Maia Szlavavitz’s new book “The Unbroken Brain” Maia articulately lays out a subtle and nuanced idea: Addiction is a developmental disorder.

 

It is a beautiful (although not new) idea that bridges the gap between the brain disease model of addiction and the idea that addicts are selfish amoral people “model” of addiction. The idea that addiction is developmental in nature accounts for the vast majority of what we see in the addicted populations. Addiction as a developmental disorder posits that there is a correlation between addictive behavior and a stuck or disordered learning process. It also posits that the solution for addiction is growing, learning and changing. This is spot on and would seem obvious, except for some reason this view has not spread or been articulated well to the mainstream. It is important to note that this theory does not account for why some people who get stuck along the course of healthy development, also get stuck in a cycle of addiction, and others don’t, this remains a mystery.

The interesting question to ask about addiction as a developmental disorder is what type of developmental disorder is it?

 

In what areas are people stuck and or split? Is there a construct that can account for the diversity and totality of the stuck states we find in the addicted population? In fact, there is The Developmental Integrity Theory of Addiction. Dr. Charles Blakeney a Harvard psychologist (and proudly my father) and researcher hypothesized in 2002 that clients suffering from addiction were suffering from a state of dis-integration. The idea was that people with addiction had underlying developmental disturbances that kept them stuck in addictive cycles, put simply they weren’t whole. This dis-integration was due to certain parts of the self becoming stuck (not growing) in the course of development. When one part of the self is growing and another is not, it creates a split, a developmental disturbance that essentially if unaddressed manifests as stress, pain, anger, anxiety or cut-offness. The Developmental Integrity theory posits that people are medicating their splits with drugs, alcohol and other escapist behaviors. The theory goes beyond the Unbroken brain hypothesis and articulates specifically what types of developmental disorders lie underneath the addictive behaviors.

Integrity is when the parts of the self fit and flow, have a strength in character, and the potential for transformation. Underneath all addictive states is a dis-integration, a lack of fit flow, a lack of transformative potential. Dr. Blakeney engaged 700 people in the addicted population, and all 700 had the predicted dis-integration. It is important not to understate in a 10 yr. longitudinal study 100% of people who were tested coming into treatment had these predicted states of developmental spits or delays. The theory is quite revolutionary because for the first time there is a construct that accounts for the diversity we see in the addicted populations. It also gives treatment a whole new way to understand and treat addiction. The test can pinpoint clients underlying issues and prescribe the correct therapeutic approach.

Unbroken Brain has begun to popularize the idea that the causes of addiction are developmental, the question becomes, now that we are beginning to understand this, what are we going to do about it?[/vc_column_text]

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