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October 31st, 2017

10/31/2017

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​Challenges and opportunities
 
A friend of mine shared her enthusiasm for the television series, Madame Secretary.   Since I choose to not have access to television service, I had never seen the show. Recently, I signed up for a trial membership of Netflix which gives me access to movies and past television shows.   I watched the first four episodes of Madam Secretary. The first thing I noticed was that the character who is asked to take the position of United States Secretary of State is not a career politician and seems to have no political ambitions or attachments to a title.  Her work history includes being an employee of an intelligence agency and then a college professor. Her husband is also a college professor.  The second thing I noticed about this character was that she and her husband have a strong, affectionate, mutually respectful relationship. They also have clear, strong core values, but are not attached to being right about how to approach particular issues.  They know, for example, that often they are stumbling through the job of parenting – with help – just as the rest of us parents do.
 
Last night I got an email from my good friend who has also been my primary care doctor since 1985 or 1986.  He is changing jobs which means that I will have to see someone else for my medical needs. We will, of course, retain our friendship.   I know that the only reason he would change jobs is because he thinks he can do something which is going to help the wider community.  He is not attached to making more money or having an important title.  He is a very spiritually driven man.
 
I would be less than honest if I suggested that my only thought was to be happy for my friend.  I am very happy for him. Yet, there is a part of me which selfishly is attached to working with this man as a partner in my medical care. I do not want to change.  Yet, I will change and I will stay open to the relationship with the new physician who I see at the Veterans Administration Hospital. 
 
Watching Madame Secretary and “observing” my reaction to having to change primary care doctors were opportunities to notice how I am doing with one of my primary spiritual goals – letting go of attachments.
 
I am happy to report that I am not where I used to be. On the other hand, there is much room for spiritual growth.   I noticed I was able to:
 
·      Both react and stand back and notice my reactions without judging myself.
·      Appreciate the moral values which guide both the character of Madame Secretary and my friend who has been my primary care doctor for all these years.
·      Affirm my belief that change always brings new opportunities.
·      Remind myself that while I want to honor my feelings they do not always reflect my core values. 
·      Remain committed to growing spiritually. For me this always means an internal struggle which is often far from comfortable.  
 
Letting go of attachments means that I let go of the belief that I can only be okay if X occurs. I could easily be attached to the belief that my health depends on seeing my friend. While I would prefer to keep the same doctor, I know I will adjust and be fine with the change.  As is true for the character on Madame Secretary, the change is a new opportunity to grow.
 
 
Written October 30, 2017
 
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Costuming

10/30/2017

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​Costuming
 
Halloween is this week. For many it is an opportunity to have fun exploring parts of oneself which their daily costume does not portray.
 
Historically, I refer to whatever clothes I am wearing as my costume. Early this morning I wore my gym costume.  When seeing clients. I will wear dress trousers, shirt and tie.  Friday, I worked in the yard in yet another costume.  Saturday night I put on what some call my penguin costume for the Gateway Medical Society Gala in Pittsburgh.  Many of the individuals attending this gala wore costumes which hide the scars of racism including the family history of being slaves. 
 
When my son was young, we had great fun selecting and making costumes although I think our best was the elephant costume made of this gray, fuzzy material.  When in this costume he was this gentle giant.    One of my friend’s young son will be Cookie Monster for Halloween. Another young man has this terrific Super Man costume.
 
Sometime, as adults, we confuse ourselves and each other with the persona associated with our costume.  It is easy to limit ourselves and each other to this one aspect or role.  I recall, when attending some training in California, we adults were invited to a center for adult play therapy.  At this center was a variety of playground equipment, other toys and boxes of costumes.  The goal was to revisit other parts of ourselves which opened us up to be more than we normally allowed ourselves to be. The theory was that if we did this we could be more successful in inviting clients to explore being more than the labels which they had been assigned and which they had accepted.   Since we were training to work for/with those with a history of addiction whose family members had become to think of as “just addicts” or “drunks” it was important that we remember that none of us can be contained by such labels.
 
Friday,x I saw a young man who was grossly underweight, wearing pale skin, sunken eyes, stooped posture, dirty too large jeans and a shirt that barely covered the bones which were protruding from his chest   His costume screamed addict.  Yet, know that there is a strong, bright, kind young man who likes to love, laugh and be a contributing member of the community.  Another friend was taking this young man to facility where he would be able to detox under medical supervision.   Although he was fearful of letting go of the illusion of security of his addiction, he did allow his friend to leave him there. I have no idea if we will be able to allow himself to wear a different costume, but I know that he is much more than the addict costume would indicate. 
 
Whether or not we choose to use Halloween to explore parts of ourselves this year, we might remind ourselves that none of us are the costumes or roles we normally wear.  We are all much more and perhaps much less that our costumes might portray.
 
Saturday, I celebrated the penguin. Today?  Well, today is full of possibilities.
 
 
Written October 28, 2017
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Sunday Musings - October 29, 2017

10/29/2017

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​Sunday Musings – October 29, 2017
 
As so often seems to happens on Sunday morning when I sit down to write I am overwhelmed with feelings of gratitude.    As I think about the week and all those moments when minor nuisance issues made an appearance, I am aware of how easy it is to take the people and resources in my life for granted.   Last night I was at the Gateway Medical Society annual gala in Pittsburgh.  We gathered in a large room of people to honor a few of the African American doctors and other health care professionals while playing it forward to mentor and support aspiring high school, college and medical school students as they prepare to take their place in the healing community.
 
While driving to Pittsburgh I was listening to reports of gatherings and speeches of white nationalists – otherwise known as racists – groups who gathered in Tennessee and elsewhere to once again attempt to prove their worth at the expense of and on the backs of others.   The artificial construct of race continues to be used as an excuse to attempt to cover insecurity with the sheet which has been temporarily bleached but which contains the  fibers of our common ancestry. 
 
At the gala, I was again reminded of the power of “we” – of acknowledging that when we allow ourselves to honor the fact that we are all a part of a universal whole we are stronger, kinder, and more powerful.  Together we are more than we are individually.   I was aware of those I personally know who had invited me to again be a part of this celebration. Their presence in my life allow me to be more compete and to, thus, to be more than I could be without them.
 
Many will celebrate this “we” today by the name of God, Higher Power, Elohim, the Buddha, and a host of other names.  I do not think that we call this “we” – this I am – and what framework and rituals we use to celebrate and give thanks matters.  Together we can claim the power to respond to the insecurity which lies beneath racism and other forms of hate with love.  We can, as do all great teachers, embrace the Judas within ourselves and each other, smile and stand tall.  We can together heal and thrive.
 
Written October 29, 2015
 
 
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Who is the patient/client?

10/28/2017

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​Who is the patient/client?
 
This week the podcast of On Being is a conversation between the host, Krista Tippett and physician, Atul Gawande entitled  “What Matters in the End”.    One of the questions Dr. Gawande asks his patients is “What does a good day look like?”
 
Dr. Gaweande’s approach to the practice of the art of medicine follows the long standing goal of healing (note cure).  This approach was richly symbolized during the AIDS epidemic by a simple switch from identifying AIDS patients as those dying with AIDS to those living with AIDS.  This simple switch allowed a significant increase in the quality of life for many.  In those early days, prior to effective treatment, most of those living with AIDS would die  because of the illness, but the goal became to live until one died.   The community – largely the LGBT community in the beginning – created a very organized and loving system for providing practical help to those living with AIDS.  Each was assigned a buddy who would take the person to the doctor, help with many practical chores or just listen.
 
For some a good day is being able to stay in one’s home.  For some it is having a listening ear. For still others it is learning how to skype with one’s children or grandchildren.  For some it is having choices about treatment without feeling guilty or pressured to do anything to just stay alive even if there is no quality of life.
 
 
We counselors would do well to heed the sage advice of Dr. Gawande by asking our clients, “What does a good day look like for you?”  The answer may or may not meet the guidelines of Medicaid or some other insurance plans to have measurable goals which are consistent with the treatment plan.  The treatment objective the insurance company wants to see may be very different than the one the patient states.  In our role as counselors we may need to be creative and/or rethink  who the patient is.  Far too often, it is easy to fall into the trap of allowing insurance companies to act as if they are the patient/employer. My view is that the insurance company is the employee of the patient/client.  Even if the insurance company is Medicaid or Medicare, the employer is the client.  Our taxes pay for Medicaid and Medicare. 
 
It is also easy to fall into the trap of thinking that the professional licensing or credentialing board is the client. They are not.  It is their job to insure that the clinician is well trained and ready to do the job for which they are employed. It is also their job to guide the clinician in how to best serve their client.  What the client needs and wants may not always fall within the guidelines of the licensing or credentialing board.   The client may, for example, decide that they need to talk on an unsecured telephone line or email server.  The board may say that this is unethical.  One then has to make a decision about what is best for the client.  To be sure,  ethical rules are intended to protect the client and much of the time they may do so.  Some of the time they do not.
 
Dr. Gawande is very simply reminding himself and other clinicians:
 
  • The employer is the patient/client.
  • The clinician patient relationship is one between two (or more)  people and not between to roles.
  • The most important skills of the clinician may be the art of listening and loving.
 
Written October 27, 2017
 
 
 
 
 
 
 
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Addiction Treatment Based on Emotional Maturity

10/27/2017

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​Addiction Treatment based on emotional maturity
 
As readers of this blog know, I work for/with a variety of people who are living with a variety of illnesses or conditions.  This includes the disease of addiction. The opioid epidemic alone is claiming the lives of many thousands.  It is imperative that we continue to explore treatment programs to fit the needs of individual clients.  When seeing someone for individual therapy that can be relatively easy.  If seeing someone in residential or other group settings addicts are often divided into several groups including:
 
  • Those who are non-professional and have limited insurance or Medicaid benefits.
  • Those who have access to money and/or very good insurance. This may include high level management individuals, doctors, lawyers and certain other professionals.
  • Those specially designed for doctors, physicians, high level executives, or clergy.
  • Those who are incarcerated in a prison which offers substance abuse/addiction treatment.
  • Those divided by gender.
 
12 step recovery groups are open to all people who have a desire to stop their addictive behavior. In some geographical areas, there are meetings based on gender or sexual orientation.
 
I question whether the treatment community needs to explore treatment based, in part, on emotional age.   Emotional age of the addict may have little to do with chronological age, education, or professional status.   Consider the following emotional backgrounds:
 
  • Addicts who started using at a very early age.  These may have exhibited self-centered, addictive behavior long before they started using. This group frequently enters treatment at the emotional age during which they started using or even younger.
  • Addicts who started using at an early age but who had a lot of adult responsibilities and relatively healthy thinking prior to becoming addicted.
  • Addicts who had a healthy and well-developed emotional life and became addicted as a young or older adult following an accident or another traumatic event.
  • Addicts who functioned well academically and who remained emotionally dependent/immature in their adult lives. We all know adults who may have “successful” careers but who are taken care of or protected emotionally by spouses, secretaries, personal assistants, nurses and others.
 
There are many characteristics of those who become addicted. In my opinion, those who have a history of a healthy emotional and spiritual life prior to their active addiction have different treatment needs than those who did not have such a history.
 
Anyone who has worked extensively with veterans returning from combat duty know that all return scarred.  Yet, some will not experience debilitating mental health or acute post-traumatic stress syndrome symptoms when they return. These are generally the individuals who had healthy ways of coping with life on life terms prior to their combat experiences. These same individuals, during combat duty, and when safe to do so, were able to take a moment to enjoy a sunset, a moment with a friend, a special meal or other positive events.   They may or may not have used recreational drugs while serving in a combat area. but they will not continue to abuse recreational or prescribed drugs when they return. 
 
I appreciate the fact that in the 12 step program individuals have an opportunity to spend time with people from all backgrounds and levels of emotional maturity.  In treatment programs, we may have to more effectively teach individuals how to identify and select friends/a “we” who have a history of emotional maturity. We may want to also design residential treatment programs with more than one track based on emotional maturity, but which allow those with little or no emotional maturity to learn from those with emotional maturity.
 
Again, I welcome thoughts from readers on this topic.
 
 
Written October 26, 2017
 
 
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Goals of addiction treatment

10/26/2017

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​Goals of addiction treatment
 
I continue to explore new approaches to the treatment of addiction disorders.   As a certified addiction counselor, I am acutely aware the success rate of addiction treatment programs, including 12-step programs, is still much lower than desirable.
 
Listening to weekly podcasts such as “On Being” is one piece of my commitment to exploring new approaches to a variety of treatment issues including the treatment of addiction.  The October 19, 2017 On Being podcast features a conversation entitled “The Psychology of Self-Righteousness” between the host Krista Tippett and Dr. Jonathan Haidt.   Dr. Haidt is “the Thomas Cooley Professor of Ethical Leadership at New York University Stern School of Business.  He is the author of The Righteous Mind:  Why Good People Are Divided by Politics and Religion.
 
I could quote and discuss his observations and the results of his studies for many pages, but I want to focus on one concept he posited because I think it says a lot about building community and, thus, about some of the factors which are going to allow more addicts to join or rejoin the larger community.
 
Dr. Haidt states: “But one of the clearest differences between left and right, psychologically, is that the left is generally universalist, almost to a fault, and the right is parochial, often to a fault…. As my mother said about my grandfather, who was a labor organizer, ‘He loved humanity so much that he didn’t really have much time to care for his family.’”
 
One of the reasons that addiction is so destructive is it forces one to be self-centered.  It demands to be more important than core values, family members, jobs, and the larger community.  Recovery can demand the same level of devotion. One may attend a residential treatment program for a minimum of 30 days and then be advised to attend 12 step or other meetings daily, talk to a sponsor daily, share responsibility for a home group, and help others who are seeking recovery.   Many family members complain or observe the recovering addict is so busy helping the larger recovering community they do not have time for their family. They are essentially what Dr. Haidt calls universalists.   Those who have adopted this approach to recovery would state that a significant part of what keeps them in recovery is helping others stay in recovery.  When recovering addicts quit working their program and helping other addicts they often end up relapsing.  When recovering addicts leave residential treatment programs and rejoin their families or live on their own they often relapse.
 
Perhaps what Dr. Haidt is suggesting in terms of liberals and conservatives (left and right) holds true for the recovery person versus the active addict. The active addict is more parochial.  The recovering addict is more universalist.  While it may be true that the recovering addict is a more desirable community member who is doing good deeds and not committing criminal acts, he or she may not be a much better family members or friend than the active addict.
 
We professionals who are designing and implementing treatment program for addicts may need to rethink some aspects of the intended and unintended results of current approaches to addiction treatment.  Is it, for example, our intention to build a recovery community or to connect/reconnect those in recovery to their family, employers or others in the larger community?  Are these necessarily mutually exclusive goals? Can one find a balance between the two?
 
I will look forward to thoughts from readers about designing and implementing addiction treatment programs.
 
Written October 25, 2017
 
 
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From procrastination to active decision making

10/25/2017

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​From procrastination to active decision making
 
This morning I was facilitating a group for individuals in the process of reclaiming the life which active addiction to alcohol and other drugs had stolen from them.  One of the clients said he had a habit of procrastinating.   When I checked the primary definition of procrastination in the Oxford Dictionary I found, “The action of delaying or postponing something.”  One is making a decision.  Yet, to this client and many others with whom I have discussed this issue, it does not seem as if they are making a decision. They seem unaware  or not conscious of saying to themselves, “I am going to delay or postpone this action.”   It may be that that have practiced this behavior so long that it is a habit.  Habits are, of course, a necessary component of being able to function.  I do not have time to consider the steps necessary to get out of bed, brush my teeth, put in my contacts, relieve myself, get dressed, make a cup of coffee and do email before heading to the gym.  I have practiced these actions for many years.  I do not have to consider (1) whether I am going to engage in these morning activities or (2) the various muscles and steps required to complete each action.
 
If I ignore the internal or external alarm and remain in bed on successive mornings I will gradually build a habit. I no longer think about the fact that I am making a decision to have a very stressful day since I now have to rush and/or apologize to my children for not getting them up in time and then to my boss for again being late to work.  I may soon convince myself and attempt to convince others that I am unable to get myself out of bed at a scheduled time. While it may be true that (1) my internal clock is not designed to jump out of bed and cheerfully greet the day or (2) some medication or medical condition makes it very difficult for me to wake up, I am still capable of training myself to make some decisions which will make it possible for me to get out of bed at a certain hour.  Of course, I may need to work with a physician, attempt to negotiate a later work shift or make some other changes.
 
For me the important point is to practice allowing myself to take responsibility for decisions I have made in the past to form a habit.  As I accept that I am making a decision I have the power to make a different decision(s). A part of me may resist switching off the automatic button for a certain activity or way of thinking and instituting a new activity or way of thinking.   With practice, however, the new behavior will become a habit.
 
All of us have some experience in changing habits. The young man in group had clearly made decisions which allowed him to arrive at the treatment program on time this morning. His previous habits involved focusing on feeding his addiction.
 
Another young man talked about thought stopping – pausing in his thought process to think about and then decide what action he is going to take.  The “pause” is becoming a new habit.
 
Saying I “procrastinate” may make it seem as if one is a victim.  Saying, “I am making a new decision.” is the action of a person who has the power and will to change.
 
Written October 24, 2017
 
 
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Grandma says:  "Accept responsibility."

10/24/2017

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​Grandma says: “Accept responsibility.”
 
Grandma Fannie seemed to expect everyone in the family to make mistakes, “have a moment”, or otherwise provide evidence of one’s human imperfection.  She, however, expected one to accept responsibility for one’s actions.  I do not recall Grandma Fannie getting angry very often about some accident or some lapse in good judgments.  She was not, however, very tolerant of any attempt to blame one’s behavior on another person or event. 
 
I was thinking about her intolerance of failure to accept responsibility this past weekend when listening to various public officials blaming others for what seemed to me to be very obvious mistakes.   As was true for Grandma Fannie, I get very confused when public officials refuse to accept responsibility for saying something which was not heard as helpful or comforting.  Rather than saying they had not meant to convey the meaning that was heard by the intended recipients they blamed others for not hearing what they intended to convey.  
 
Just this morning what I wanted to convey to a client was heard as something else. The person with whom I was talking became angry.  I simply said that I was sorry that I had not spoken in a way which was clear to them. The fact that in my head what I was saying was very clear was immaterial. That is not what the person heard. 
 
We seem to be a nation where many are often convinced that there almost always has to be a victim and a perpetrator.  It is verboten to either admit one made a mistake or to be gracious when someone makes a mistake.
 
Grandma Fannie always seemed ready to have a plan B or to formulate a plan B. If I had failed to do my homework or some other task, the focus was on the options I now had to correct any ensuing problems - how to be more responsible in the future.  If Grandma Fannie tried something which did not work, it was important to attempt to identify what could be done in the future to avoid the same mistake
 
There are certainly situations in which a person did something which directly or indirectly caused me emotional harm or the loss of funds.  At times, I have attempted to recoup losses. Sometimes that attempt has been successful and sometimes it has not. In no case did the loss result in my having a terrible life or thinking that I was better than the person who caused me harm. I know that at times my behavior has caused harm to others.  Sometimes people forgave me. Sometimes they did not.
 
I believe we all need to be accountable for our actions and to know that our behavior –  positive and negative – affects others.  Very tragic things happen to us or our loved ones.  Life is not always fair or just.  We sometimes need to grieve and do what we can to prevent similar actions in the future.  Yet, even in our grief we can allow the support of others.  If, however, we are stuck in an angry, victim role we will not experience any of that support.
 
Grandma Fannie was focused on learning from mistakes and problem solving.  She had little time to dwell on being a victim.  She was determined that no matter what happened or did not happen for today she would do her best to be a person she could be proud of.
 
Thanks, Grandma Fannie.
 
 
Written October 23, 2017
 
 
 
 
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Sunday musings - October 22, 2017

10/23/2017

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​Sunday musings – October 22, 2017
 
Last Sunday I returned from my trip to Florida where I exchanged my car for another used car. Although I was disappointed to give up my 2012 Nissan Versa with only 44,000 miles on it and unhappy about needing to spend money for another car, I was also acutely aware that I am very blessed to be able to how have a safe car to drive. I had three days back in Wheeling to see clients, visit with a couple of friends and prepare for my scheduled trip to Texas to visit with my brother Ed and his wife Flo.  Two of our sisters and one brother-in-law also joined us.  Not surprising there were many references to our respective shared and very distinct histories growing up in the same, but different family.  Each of us share many of the same qualities and some similar experiences, but all of us had very unique relationships with our parents. Yet, for better or worse, our parents and all the ancestors which they brought with them continue to live through us. Although we have all added a unique stage and some nuanced choreography, there is a common core which we recognize as belonging to this group of humans known as the Pickett, Scott, Drake strain of humanoids.
 
Fortunately, the four siblings which gathered this weekend no longer feel a need to grade the positive and negative individual experiences which has shaped much of our adult life. Our strength, fierce work ethic, compassion, creativity and tenacity are reflections of the DNA which has been designed as carefully as the hooked rugs and intricately designed quilts which are part of our heritage. 
 
Gone is the questioning existential angst which plagued us as children.  Who are we? What shall become of us? Why do the adults in our lives behave as they do? How can we please or at least avoid the displeasure of our parents, our teachers and other adults? We have now for some scores of days, been those adults to which others look for guidance, approval, or as a backdrop for new/old dance that they are choreographing.
 
Ironically, the visit takes place within a national stage which is loud with the cries of he said, she said, and a string of accusations which are labeled as “lies, fake news, appropriate, inappropriate “and many other judgments which could easily have been lifted from a tape of the drama which often seem to dominate the childhood of my siblings and I.  It is as if a master teacher has designed to, once again, remind us that “this too shall and does past” and hasten us on that spiritual path which recognizes the blink of a life journey.  We are invited to join in this drama, but we decline while we smile, shake our heads, share stories, and toast to the past which is the present which shapes the future.
 
The prayer of our childhood, “Now I lay me down to sleep. If I should die before I wake, pray the Lord, my soul to keep.” and the prayer of Tiny Tim, “God bless us, every one.” today seems powerfully comforting.
 
We promise to gather again next year. God willing and the crek don’t rise.
 
Written October 22, 2017
 
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The challenge of self care for addicts

10/21/2017

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​The challenge of self-care for addicts
 
I think a lot about the challenges of self-care.  Whether one is dealing with addiction, a mental illness or the difficulty in making time for self-care while honoring all the other commitment which one has, it seems that self-care often is often last on the list of priorities. Today I want to address self-care for the addict.
 
I recall waking up one day many years ago and really seeing for the first time how physically out of shape I was.  Since that time, I have been very disciplined about exercising daily and most of the time making intentional decisions about my nutritional intake.
 
Later I made a clear decision to quit smoking cigarettes.
 
Changing habits of thought and behavior was possible for me because:
  • I know the mechanics of what works. I had the tools and already used them in other areas of my life.
  • I had a healthy support system.
  • I had a relatively low amount of stress – decent income, nice home, access to the gym, healthy food, and spiritual support.
  • I had a clear set of values which are very important to me.
 
Many of those with addictive disorders, especially alcohol and other drug addictions, begin their attempts at recovery with stress in every area of their lives.   They have a history of knowing that their drug of choice worked at least temporarily.
 
Most active addicts have by the time they begin recovery lost the support of families, their jobs or educational opportunities, and their homes. Many have grave physical health issues.   They are lonely, tired, hopeless, homeless and broke.
 
Those addicts lucky enough to get accepted into a quality residential treatment program may initially do well in that safe, supportive atmosphere. They are eating well, have a clean, safe place to sleep and a lot of support.  They are acutely aware that this level of assistance is temporary.  Soon many become anxious about what will happen when they leave. Some will get some level of support from quarter houses, half way houses or transition houses.  Those are intended to be temporary.   In the meantime, addicts are expected to work, pay off fines, get their licenses back, perhaps face additional legal charges and, in many cases, face the distrust of loved ones.
 
For some, prisons may seem like a preferable option. There they will have a place to sleep, food, a certain level of companionship (even with all the mistrust) and a way to get some extra income either via a prison job, from family members or preying on the more vulnerable ones in the prison.
 
For many returning to active addiction and waiting to die may seem like the best option.
 
For some, immersion in a 12-step recovery program will provide a framework and the support necessary for the spiritual and emotional aspects of recovery.  Many are unable to fully allow themselves to use this framework. Many soon quit working steps, quit using a sponsor and eventually quit attending meetings.  Many are limited because of geographical location and can only participate in telephone or on line meetings
 
This is the overall backdrop with which we, the community, of treatment providers and law enforcement must face if we are going to explore more effective ways to reduce either active addiction or the price of active addiction.
 
 
It is clear that if we the community want a higher success rate we must rethink the approach to treatment.  I will continue to explore these issues in future blogs.
 
Written October 18, 2017
 
 
 
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    Jimmy Pickett is a life student who happens to be a licensed counselor and an addiction counselor. He is a student of Buddhism with a background of Christianity and a Native American heritage.

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