When people come to treatment or engage in some sort of addictions counselling, they sometimes feel a pressure to not have any urges to use.  Some people actually don’t have urges once they seek help but most do.  The ability to discuss this has not always been open.  I’ve watched many clients behave in ways and say certain things that show they are still ambivalent and think about either using or the culture of using.  But they don’t express what they are truly feeling because they want to be socially accepted; or they want to deny to even themselves that these feelings creep around underneath the surface.  There becomes a stigma in treatment that one should not have feelings or thoughts about using because why on earth would they be in treatment if they wanted to use.  This is all unsaid and gets reinforced even by practitioners that subconsciously feel like failures if their clients still want to use.  Much of this is due to a long time of poor knowledge of addiction, as well as, extreme judgment of addiction.

It needs to be more accepted that changing takes time.  Most people have either thoughts or dreams of using soon after they stop or enter treatment.  There is nothing “wrong” with this.  It might be disconcerting to those who just want it all to go away but it is also very normal.  Intense desires such as those that fuel the process of addiction are not shed overnight.   The other drawback to this unsaid phenomenon is that substance abusers trying to quit start to feel like failures when they have cravings and urges!  How debilitating!  You are not failing or bad at recovery if you have urges to use, even intense thoughts.  You are also not failing recovery if you lapse or relapse.  What? How so?  You do not have to go back to ground zero if you relapse.  You just need to turn around and observe what you just tripped on then keep on going.  Brush yourself off.  You do not have to delve deeper into a full-blown relapse or beat yourself up.  Natural feelings of guilt will arise as your behavior is going against your values of wanting to quit, but it does not have to carry deeper into shame.  Shame is feeling bad about yourself while guilt is feeling bad about your behavior.  Therefore, just having dreams, thoughts, and cravings to use does not mean you are doing recovery wrong.  It means you are a normal person trying to quit something that has had strong chemical and psychological holds on your whole person.  It also means it has been the number one way to cope and deal with everyday life and until your newly acquired skills are fully developed, you will sometimes want to resort back to what feels best.  But remember, just because you WANT to resort back and want to use, does not mean you HAVE TO use.

This idea or line of thinking that I am describing goes for so much more than just addiction.  In our society, we hold addiction to an unintelligently different standard of expectations for change.  Most people take a while to change behaviors/states such as anger, upset, smoking, eating, exercise, depression, anxiety, workaholism, sex, etc.  These same people relapse MANY TIMES!!  But for some reason people with substance abuse problems should get over them more quickly than everyone else who has unwanted, unhealthy behavior.  Interesting, huh?

Here at Crossroads we encourage clients to discuss both sides of their ambivalence: the side that wants to quit and the side that isn’t quite on board yet, or sometimes the side that really enjoys using and doesn’t want to stop.  Carl Jung (famous Depth psychologist) talks about a concept called Shadow which holds aspects of ourselves we suppress away that we don’t want to see or express.  Eventually, our shadow finds ways to be seen.  It is easier to reflect on the unwanted parts of us and get to know them.  Sometimes they will teach us things that no other part of ourselves could teach.  It is like the saying, “better the devil you know than the devil you don’t,” which illustrates the idea that you can do something about your shadow side of cravings and urges if you know them and explore them.  If you hide them and push them away they will find weird ways out that do not reach your conscious mind.  Basically you won’t know what you are up against.

My thoughts are you might as well talk about what you feel/experience because you are already feeling/experiencing it. Don’t be afraid to explore all parts of you because they all lead to healing.  Just because we have thoughts that scare us doesn’t mean those thoughts are who we are.  Those of you early in recovery or even long time in recovery, allow those thoughts to come to the surface and find a safe person to share them with.  Find a way to give them voice so that voice becomes less powerful. Do not feel like a failure, or that you won’t succeed in treatment or recovery because you have urges, thoughts, feelings, even yearnings about your using life.  You are always up against the choice of how you want to live your life and the more choices you make in one direction the more ingrained that way of life becomes.  It can always be changed.  So let yourself be open to the exploration process of all parts of you and there will be less shame.  Put it all on the table so you know what you are working with and you’ll be further along than if you didn’t.

Post written by: Jason McCarty, Outpatient Therapist

One of Crossroads employees, Monica Kraft, is getting her Masters of Social Work degree right now. She is currently in her practicum and researching some interesting things around mindfulness and addiction. One of these ideas is a process called urge-surfing. I hope she writes a longer more in depth article for the blog as I will not do it justice here. Urge-surfing is the process of allowing a craving or an urge to use to be fully felt without doing anything – without distracting yourself, without going and using. If we look at cravings as merely body sensations, the mind can also interpret them as just that. We do not need to make decisions or engage in behaviors just because we feel a certain way or have an urge to move. This is not an easy concept to embrace but it can be revolutionary for some that struggle with substance abuse;  you are no longer fighting with yourself by trying to “get rid of” your craving. Instead you ride it out like a wave and observe that experience like a surfer, until is subsides. This will create new learning for your whole body as well as your brain.

The reason I bring this up is the other day I was holding my son and had a very annoying itch in my ear that I desperately wanted to scratch. I couldn’t scratch it because I was trying to get him to sleep so as you can imagine, the itch became more intense. It made me think of addiction and urge-surfing right in that moment so I tried it. Instead of wanting it to go away or scratching it, I just felt it, observed it, and allowed it to be there with no action. Don’t get me wrong, it was partially driving me crazy and it felt like a bug was tickling my ear, but also just observing this as what it was allowed me to ride it out. I can’t actually recall if it went away totally but it certainly lessened from when it first began to itch.

The experience I had with my itchy ear helped me to better understand the internal process of addiction. I don’t mean to demean or lessen the intensity of addiction by comparing it to my itchy ear (smile) but in many ways it is similar. Ultimately, cravings are an experience in the mind/body. Addiction is also an experience. It’s not a disease in your body that forces you to use like a robot. It is something experiential. Therefore, in many ways, experiential approaches to overcoming cravings and addiction will be quite beneficial to a substance abuser. One may need to have some clean time under their belt to be able to withstand the urge-surfing, but it can eventually be a useful tool.

So is addiction one huge itch? No. Cravings are one big itch and addiction is the constant scratching. Just because any of us feel something compelling doesn’t mean we have to act and often times, if we wait it out, it goes away or subsides to a tolerable level. I would encourage you to start trying urge-surfing with things like an itch in your body, or a desire for a coffee or sweets, or a negative emotion. Instead of “doing something”, just feel it, let it wash over you, and know it’s only a sensation.

Post written by: Jason McCarty, Outpatient therapist

I was with a client the other day and felt that helplessness I sometimes feel working in addictions. This person wanted it all to stop and I wanted to help them. I discussed my frustrations with a colleague and was reminded that it takes time. Cravings won’t go away immediately. There is no quick fix. It is a process that takes time, commitment, and most of all, hope. If you are a parent or a service provider, being reminded that change takes time will help you have the space to actually help. I couldn’t “fix” that client that day and it wouldn’t even be beneficial for that person to be “fixed”. The change process is full of learning and growth that does not come easy. Addiction perpetuates a need for quick fixes and immediate gratification. As helpers, or family members of substance abusers, clients will do best with our consistent plugging away with them combined with the instillation of hope. People change. People can change. People do get clean.

If you are addicted, this mindset can also benefit you. Seeing the process a little more realistically will help to keep the discouragement at bay. Know that if you stay on the road to recovery and seek help, you will get clean. There might be ups and downs but that doesn’t mean you’re not going forward. Give yourself some time. Change is a combination of baby steps and periodic leaps. It takes time.

Post written by: Jason McCarty, Outpatient Therapist

In my work with substance abusers in residential treatment, I’ve noticed that the ability to initiate the recovery process is a two-decision process.  Before I get into that process I want to address a phenomenon that occurs with practitioners working in this field.  We often have clients who seem resistant to treatment or counselling and for the most part this is normal.  Not everyone comes to treatment super motivated, and some come to alleviate pressure from family and friends.  Some clients going through treatment or counselling will not comply with all programming or homework assignments and this is just where they are.  When clients are showing some of this resistance many of us assume they are “not yet ready for treatment,” or they “just aren’t finished using yet.”  For some clients this is true, but this assessment can sometimes be a mistake with others.

The client who actually isn’t ready for treatment did not choose to quit yet.  I even say that statement with caution because we don’t really know this.  People are complicated and our resistances are there to protect us, whether one calls it denial or something else.  Someone may go to treatment and come across a personality type in their counsellor that keeps them from moving forward with being open.  We all then decide that client isn’t ready.  This may or may not be true.  What is going on behind a person’s resistance and defenses is not knowable until it is.  We can make some general assumptions and logical inductions, but we don’t really know what is or isn’t motivating that person.  Let’s say that client did not make the choice to really quit, that his/her parents, spouse, friends, etc, pushed her/him to come to treatment.  That client has not yet made the first decision in the process of recovery.  The first decision is to stop and want a different life.

Isn’t that enough?  Wouldn’t that motivate someone to get clean?  No, not completely.  Someone could decide to stop, go to treatment, but not fully benefit.  They say they want to stop but yet, seem to be standing still.  There is an old adage in the addiction treatment community that if you want to change you have to change everything.  That can be quite scary to most people.

So what does the second decision consist of then?  The second decision is to move forward with doing the work. We talk quite often in the addiction treatment world of “doing the work”, and this really entails the examining, changing, and processing of one’s emotions, thoughts, behaviors, and relationships, to keep it simple. Doing the hard work sometimes is about being vulnerable enough to allow other human beings to help. Doing the hard work sometimes means exploring events of the past that continue to keep one stuck.  Doing the hard work sometimes means deciding who one wants to be.  Doing the hard work sometimes means taking medication.  Doing the hard work sometimes means taking more responsibility for one’s life.  Although I describe this as hard work, it can be, and usually is, very rewarding and transforming.  The pain that most people are in emotionally is about the fear of their pain, not the actual pain.  Facing our own demons and pain is not as painful or scary as the fear about having that pain.

To quit and be successful, these two decisions might need to be revisited or renewed often in early recovery.  It is also important to determine what one needs in order to follow through with both decisions.  Sometimes that is support from others.  Other times it is letting go.  I have watched clients stay “on deck” like a batter on a baseball team and not step up to the plate.  It is like they are in a holding cell.  This assessment is not a negative judgment toward those clients, it’s just where they are.  I wonder, “what does this person need to move into the batter’s box?”  They’ve obviously decided to play this game (i.e. recovery, treatment, counselling) but they sure are having a hard time “getting in there.”  As practitioners it is our job to help them navigate fears and hesitations so they can step in when they are ready.  Once they make that choice, the recovery process becomes a lot more doable.  There is no cure here, or arrival, but the second choice is necessary in the way any of us change something about our lives – we actually have to DO something.

Lastly, I want to say this is my own observation in doing this work for several years.  The change process is quite complicated and this portrayal is only an aspect.  Take it for what it is worth.

Two Decisions:

1. To Stop
2. To Do the Work (actually start changing)

Post written by:  Jason McCarty, Outpatient Therapist

Two summers ago we had Dr. Gabor Mate come speak in Kelowna.  At that time he was a doctor in the downtown eastside of Vancouver, and had recently written a book entitled, In the Realm of Hungry Ghosts: Close Encounters with Addiction. He is an engaging speaker and thought provoking man.  In his book he has worked hard in 426 pages to bring a human face to addiction, and show that it is a complicated phenomenon – but that ultimately, it comes down to some pretty basic human needs.  I encourage anyone who wrestles with addiction, or has a loved one who is addicted, to read his book.

I pick it up from time to time to be re-energized and motivated to take on this daunting task of helping people overcome their addiction.  Today I read a paragraph that I would like to share.  It describes well Crossroads’ bio-psycho-social-spiritual philosophy.  It also helps to really show the existential reasons for continued, chronic use.

Mate (2008) writes, “Like patterns in a tapestry, recurring themes emerge in my interviews with addicts: the drug as emotional anesthetic; as an antidote to a frightful feeling of emptiness; as a tonic against fatigue, boredom, alienation and a sense of personal inadequacy; as stress reliever and social lubrication. And, as in Stephen Reid’s description, the drug may – if only for a brief instant – open the portals of spiritual transcendence.  In places high and low these themes blight the lives of hungry ghosts everywhere”(p. 32).

I like his use of the word “themes.”  As human beings we are all faced with these themes in our lives.  None of us are exempt from these struggles and none of us make it out unscathed.  Further, we all have found imperfect ways of coping with these major human needs and experiences.  Addiction to drugs and alcohol is only one imperfect way of answering these needs.  We all have mini-addictions that are there to gain our attention and let us know we are missing something.  Overcoming addiction and leading healthy lives is about listening – listening to the finger pointing of addiction in all of us.  The finger is pointing at you and your needs.  When we ignore this, we are “addicted”; when we pay attention, we are free.

Written by Jason McCarty, Outpatient Therapist

Book Review
Mindful Recovery A Spiritual Path to Healing from Addiction
By Thomas Bien PhD and Beverly Bien, M.Ed. John Wiley & Sons, 2002

“Addiction is at its core a way of avoiding life rather than being aware of it”.

Mindful Recovery, with a foreword by noted addiction researcher, G. Alan Marlatt, offers helpful information and practical exercises to anyone interested in combining a mindful practice, based on Buddhist philosophy, with cognitive behavioural elements. “10 Doorways” are detailed, to help a person cultivate a more peaceful happy life, these include; meditation, life story awareness, journaling, harmony with nature, working with dreams, love, work, the transformation of negative emotions, and living with present moment awareness.

Mindful Recovery offers a helpful guide to recovery from addictions, by helping to create more, ‘moment to moment’ awareness. We are encouraged to be observers of ourselves, to watch our thoughts and body sensations from a detached and non-judgemental perspective. In this way, it is possible, to learn to tolerate emotional discomfort, as well as cravings, and urges as impermanent conditions or as a passing wave. A new life-style created in mindfulness, discourages addiction/relapse.

Information from this book, more specifically, material from the “10 Doorways” has been adapted to create a series of new workshops in our residential treatment programs to help clients understand and practice the concepts of mindfulness. Conscious awareness and inner understanding form a basis from which to free ourselves from unconscious and destructive behaviour patterns. By bringing breath and awareness to what ails us, we can transform ourselves and our relationships, and find purpose, meaning and fulfillment in ordinary life.

Written by Monica Kraft