Category Archives: Psychological

NICE guidance on dual diagnosis 2016

This is not the first time that Dual Diagnosis has been discussed on this blog (you can read them all here).  However we now have official guidance from the National Institute of Clinical Excellence (NICE) on the issue.

My lovely friend Libby Ranzetta did an excellent synopsis that garnered praise on Twitter from the NICE guidelines chair themselves no less! ūüôā

Over to her summary detailed over at Alcohol Policy UK:

New NICE guidance on dual diagnosis was released in November 2016: Coexisting severe mental illness and substance misuse: community health and social care services.

The guidance and supporting tools and resources sets out how services for those dually diagnosed aged 14 and above should be improved to ‘provide a range of coordinated services that address people‚Äôs wider health and social care needs, as well as other issues such as employment and housing.’

NICE has also produced a guideline on coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings.

Context and definitions

NICE contextualises the guidance by stating that adults and young people with coexisting severe mental illness and substance misuse have some of the worst health, wellbeing and social outcomes (details here). It is not clear how many people in the UK experience dual diagnosis issues, partly because some people in this group do not use services or get relevant care or treatment (see previous post).

The Department of Health’s Refocusing the Care Programme Approach¬†identifies people with dual diagnosis¬†as one of the groups in need of an enhanced Care Programme Approach. That is because they are not being identified consistently and services are sometimes failing to provide the support they need. The policy highlights the need for a whole systems approach to their care, involving a range of services and organisations working together. This guideline, NICE claims, aims to address this need.

In announcing the guidance, Professor Alan Maryon-Davis, chair of the guideline committee, spoke frankly about the challenges coexisting substance misuse and mental health problems pose for patients and practitioners alike.

“People with dual diagnosis almost always have multiple needs ‚Äď often with physical health and social issues as well as their dual mental health and substance problem. They are often unemployed or struggling to hold onto a job. They may be in debt, homeless or poorly housed. They could even be in an abusive relationship.

To add to their woes, they are also more likely to be stereotyped and stigmatised. They are often regarded as unreliable, feckless, difficult to engage, aggressive or abusive.

As a result, they tend to get shunted around the various services they need support from with no-one wanting to take responsibility for them. This can all too easily lead to a downward spiral and sooner or later a crisis ‚Äď perhaps forcing them into A&E, or on the streets. They may even find themselves in the magistrate‚Äôs court.

This is why our NICE guideline is so desperately needed.”

For Guideline 58 the age cut-off for young people has been set at 14 to reflect the small numbers affected below this age and the fact that many early intervention services usually start at age 14. ‘Substance misuse’ refers to the use of legal or illicit drugs, including alcohol and medicine, in a way that causes mental or physical damage.

‘Severe mental illness’ includes a clinical diagnosis of:

  • schizophrenia, schizotypal and delusional disorders, or
  • bipolar affective disorder, or
  • severe depressive episodes with or without psychotic episodes.

NICE Recommendations

The guideline is arranged as series of detailed recommendations on the following:

  • first contact with services
  • referral to secondary care mental health services
  • the care plan: multi-agency approach to address physical health, social care, housing and other support needs
  • partnership working between specialist services, health, social care and other support services and commissioners
  • improving service delivery
  • maintaining contact between services and people with coexisting severe mental illness and substance misuse who use them

Drug and Alcohol Findings Bank has provided a summary of the key recommendations here.

Professor Maryon-Davis summed up two main messages from the recommendations:

“First, there has to be much wider recognition that this group of people, despite their complexities, have as much right to dedicated care and support as anyone else. They should not be turned away or left to flounder. Every effort should be made to help them benefit from the services they so badly need. Crucial to this is a non-judgmental, empathetic approach and the building up of mutual respect and trust.

And secondly, good communication is key! Staff working in mental health, substance misuse, primary care, social care, housing, employment, benefits, criminal justice and the voluntary sector need to have strong leadership to ensure that they are all working together as best they can. We recommend that this can be best achieved by having a dedicated care coordinators.”

What happens next

Substance misuse practitioners could be forgiven for saying they have heard these messages before; messages which have not made much difference to the way mental health services respond to dual diagnosis. Last year the Recovery Partnership’s Review of Alcohol Treatment Services¬†found a clear failure of services¬†to meet the needs of people with dual diagnosis, summarising the policy context for such failure as follows:

“National guidance on the management of this [dual diagnosis] group was first published by¬†the Department of Health in 2002. NICE published further guidance on psychosis¬†with coexisting substance misuse in 2011.

However, the… situation¬†has not improved and may be worsening because budgets have been cut in mental¬†health services, and because mental health services are now commissioned by a¬†separate body (Clinical Commissioning Groups) from alcohol services (Public Health).¬†This represents a real blockage in the pathway of care for problem drinkers (and drug¬†users), a blockage that cannot be easily resolved at the local level.”

Other questions may relate to possible missed opportunities to address low level mental health problems and substance misuse. For instance Improving Access to Psychological Therapies (IAPT) services – which exist for those mild to moderate mental health difficulties, such as depression, anxiety and phobias – are not mentioned within the guidance. IAPT though may be considered an ideal setting for brief intervention given the link between alcohol misuse and problems such as anxiety and depression, yet few IAPT services appear to routinely deliver IBA (although guidance was released for IAPT roles in 2012).

In 2014 an analysis suggested cognitive based therapy (CBT) and/or motivational interviewing (MI) for comorbid alcohol use disorder and major depressive disorder produced small but robust beneficial effects on both depression and alcohol consumption – regardless of whether delivered by mental health or subtance misuse roles.

Commissioners and service providers though will now be expected to use Guideline 58 to improve the quality of care given to people with dual diagnosis involving severe mental health problems.¬†The Care Quality Commission (CQC)¬†use NICE guidelines and quality standards as evidence for inspections, to inform the award of good and outstanding ratings. CQC’s inspection regime and associated powers may well provide the impetus needed for real change to happen this time.

Guest Post: Finding the Link Between Substance Abuse and Schizophrenia

pt_figure_dopamine-pathways-in-schizophrenia_53127-pngI was contacted on email by Justin in November who said; “I am a recovering addict and content writer interested in providing a guest post article.¬† In my path to recovery I’ve taken to writing content about addiction, recovery and substance abuse through my treatment program.”¬† Here’s what he wrote about substance abuse and schizophrenia:

New studies have found a link between substance abuse and schizophrenia.  While the relationship between mental health and substance abuse is an incredibly complex one, a group of Denmark researchers have determined that abuse of virtually every type of drug can contribute to mental deterioration and eventual, schizophrenia.

A common misconception about schizophrenia is that those afflicted have split personality disorder or multiple personalities.  However, this has been determined false, as most people suffering from schizophrenia are non violent and lead fairly normal lives, posing no immediate threat to others. Per the National Institute of Mental Health:

‚ÄúSchizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.‚ÄĚ

Rather than split personality disorder, which is a separate diagnosis, those suffering from early onset schizophrenia can experience a decrease in mental processing, rational thinking and general mental well being.  Furthermore, in can take years for schizophrenia to fully develop and during this time, can manifest itself as more common mental health disorders like depression and anxiety.

So what environmental and societal factors can worsen these symptoms into full blown schizophrenia?

The new Denmark study has determined that substance abuse can not only trigger schizophrenia in people genetically at risk, but also increase the chances of developing schizophrenia by up to six times.

While the direct cause and effect relationship between substance abuse and schizophrenia is tremendously complex, the study found the following increases in risk:

  • Cannabis: 5.2 times
  • Alcohol: 3.4 times
  • Hallucinogenic drugs: 1.9 times
  • Sedatives: 1.7 times
  • Amphetamines: 1.24 times
  • Other substances: 2.8 times.

The study notes, while the effects are not often immediately noticed, symptoms of schizophrenia as it relates to drug abuse, often surface later in life: sometimes ten to fifteen years after the substance abuse diagnosis.

Mental health and substance abuse treatment centers often offer dual diagnosis programs for this exact reason, noting that symptoms of schizophrenia can be coupled with drug use.

A particularly worrisome finding of the study is the risk found with two of the most prevalent substances, marijuana and alcohol.  While marijuana is federally illegal, it is used medicinally and recreationally in many stages, including California.  A large factor in the correlation found between cannabis and schizophrenia is due to the fact that people can be exposed to it second hand.  That is to say, unlike most other substances (not smoked), marijuana can be introduced to people’s systems indirectly, simply by being in close proximity of someone that is using the drug.

Alcohol on the other hand, tops the list, as it’s the most socially acceptable and easily obtainable substance given it’s legal place in American media and culture.

While the newly discovered findings presented by the Denmark study do not provide us with a black and white relationship between schizophrenia and substance abuse, the evidence is undeniable: The prolonged abuse of illicit drugs and alcohol increases the risk of developing schizophrenic tendencies and symptoms later in life.

Article courtesy of the team at Muse Treatment

Thank you Justin!

Friday Sober Jukebox – Ghosts in the Machine

ghosts-in-the-machineSo this feels like a timeless sober jukebox tune for a timeless post.¬† I’m actually writing this at the end of October 2016 because I have been struggling with some recurring demons – my ghosts in the machine as it were.

Coming from the family experience that I do I struggle with fear and anxiety pretty regularly and it settles for long periods of time and then flairs up again.¬† Invariably I think that I have more power than I do and that everything is my fault, everything will fall apart and it will all be my fault.¬† I listened to a Yoga Church podcast last night called ‘Step Out of Your Past and Into Your Now’ that got me thinking about this again as I struggle to get on top of another bout of raging anxiety and fear.

shadow-dancerMeadow and Laura McKowen were talking about the words that define their past and for me those two words, fear and anxiety, express it pretty succinctly.  They discussed coming up with an image that portrayed this and pretty similarly to Laura the one I landed on was shadow dancer.  I spent my entire life dancing to the tune of others to dodge the shadows of fear and anxiety Рeither my own or those of others around me.  No wonder I ended up in the bottom of a bottle!

This image and these words must then be honoured and let go in a ritual of some kind of your making.  To me it felt like I had to sit with them and not dance myself away from them and my shadow side.  To be honest the trigger events have prompted a great deal of soul searching and somatic discomfort so I feel like this has been part of the process and hence why it is time to move on from being stuck in these feelings.

explorerHaving created the image and words that defined the past the task was then to create ones to replace these for the future.  My brain was pretty fried by this point (or I was simply disassociating under the stress of it!) but with the help of MrHOF we came up with calm and fearless as the words and the image was explorer.

This image seemed fitting in terms of my internal exploring of more positive feelings and our external plans for travel as a family too ūüėČ

This is an ongoing process and I continue to have waves of emotional upheaval but like the waves of craving to drink they come less often and are less intense and I see them build to crescendo and break now so I’m making progress.¬† I recommend you give it a try what with the heralding of a new year not that long ago.

And now to one of my favourite albums ūüôā

Shame Backdraft

OLYMPUS DIGITAL CAMERA

So once again I’m listening to a Ruth Buczynski seminar about shame featuring Peter Levine, Ron Siegel, Kelly McGonigal and Bill O’Hanlon where I learn something new that feels very familiar.¬† It’s called ‘backdraft’ and is about the backlash that can happen when someone is feeling ashamed and is met by compassion.¬† It reminds me of that moment when I am close to tears and someone moves into hug me to which I respond “please don’t”.¬† It is almost a warning that you are in danger of killing me with kindness.¬† Sound familiar?

Over to the experts:

Most clinicians have witnessed how difficult memories resurface when a client feels truly seen, heard, and loved in therapy. A metaphor for this process is ‚Äúbackdraft.‚ÄĚ Backdraft occurs when a firefighter opens a door with a hot fire behind it. Oxygen rushes in, causing a burst of flame. Similarly, when the door of the heart is opened with compassion, intense pain can sometimes be released. Unconditional love reveals the conditions under which we were unloved in the past. Therefore, some clients, especially those with a history of childhood abuse or neglect, are fearful of compassion (Gilbert et al., 2011).

It is related to trauma and the belief held by the person that they are undeserving of kindness but in fact it is more than that.  They are perhaps so unused to compassion that they find the experience unsafe, threatening and dangerous.

Childhood trauma survivors may also equate self-compassion with self-pity or self-centeredness. They may have been told as children to ‚Äúget over yourself‚ÄĚ when they suffered and complained. It is important to understand that by entering into our emotional pain with kindness, we are less likely to wallow in self-pity. The reason is that self-compassion recognizes the shared nature of human suffering and avoids egocentrism. Sometimes only a few minutes is all that is needed to validate our pain and disentangle ourselves from it.

Self-compassion is often confused with narcissistic self-love, although research indicates that there is no link between narcissism and self-compassion (Neff, 2003; Neff & Vonk, 2009).¬† Victims of childhood trauma often do not have enough narcissism, feeling that meeting their own basic survival needs is a forbidden indulgence. Anxiety may arise from the looming possibility of breaking an invisible bond with a primary caregiver who thought the child should suffer for his or her misdeeds or bad nature. Self-deprivation becomes ‚Äúsafety behaviour‚ÄĚ (Gilbert & Proctor, 2006). It is a necessary compromise made by an abused child in order to survive, so the client becomes frightened, viscerally and unconsciously, when he or she breaks the contract. For this reason, sincere efforts by therapists to help abused or neglected clients may be met with resistance. These clients first need to contact their emotional pain, see how it originated through no fault of their own (‚Äúyou‚Äôre not to blame!‚ÄĚ), and then gradually bring the same tenderness to themselves that they are likely to give to other, vulnerable beings.

Three symptom clusters commonly found in post traumatic stress disorder (PTSD) are (1) arousal, (2) avoidance, and (3) intrusions. Interestingly, these three categories closely correspond to the stress response (fight‚Äďflight‚Äďfreeze) and to our reactions to internal stress (self-criticism, self-isolation, and self-absorption) mentioned earlier (see below).

PTSD symptom Stress Response Reactions to internal stress
Arousal Fight Self-criticism
Avoidance Flight Self-isolation
Intrusion Freeze Self-absorption

Together they point toward self-compassion as a healthy, alternative response to trauma. Self kindness can have a calming effect on autonomic hyperarousal, common humanity is an antidote to hiding in shame, and balanced, mindful awareness allows us to disentangle ourselves from intrusive memories and feelings. Research shows that people who lack self-compassion are likely to have critical mothers, to come from dysfunctional families, and to display insecure attachment patterns (Neff & McGeehee, 2010; Wei, Liao, Ku, & Shaffer, 2011). Childhood emotional abuse is associated with lower self compassion, and individuals with low self-compassion experience more emotional distress and are more likely to abuse alcohol or make a serious suicide attempt (Tanaka, Wekerle, Schmuck, Paglia-Boak, & the MAP Research Team, 2011; Vettese, Dyer, Li, & Wekerle, 2011).

These quotes are taken from a chapter of a book by Christopher Germer & Kristen Neff that you can read here:

germer-neff_-trauma

I found an excellent blog post about it here:

Mindful self-compassion and backdraft

So there you have the connection between shame and booze once again.  Low self compassion, higher emotional distress and greater levels of self-medication with alcohol.

If you are unsure of how self-compassionate you are you can score yourself here:

Test how self-compassionate you are

Unsurprisingly my score was low to middling but not as low as it used to be when I was drinking!  So how do we work on improving our low self-compassion?

The response is to teach ourselves how to take a self-compassion break

If you start to do this even if you are still drinking, the shift in self-perception may be enough to get you started on thinking about cutting down or stopping.¬† Give it a try – what have you got to lose? ūüôā

 

 

 

 

2017: Freedom & Liberation

Firstly Happy New Year to you from me! ūüôā What does one write about on the first day of a new year that holds so much promise and optimism?¬† I think the best place to start are with my words for 2017 which are freedom/liberation.¬† I think they stem from the discoveries I made as I approached 3 years sober.

Perhaps to appreciate my sense of freedom & liberation I have to revisit the life I left.¬† Once more Sally Brampton in ‘Shoot the Damn Dog‘ describes it more eloquently than I so I’m going to quote a passage from her book here.¬† The conversation between her and a friend could have been my ‘now sober self’ talking to my ‘old still-drinking self’ and so it feels really fitting for today and this post.

Suddenly she said, ‘Tell me about the drinking too much’.¬† I shrugged. ‘I drink too much, end of story’.¬† ‘Shall I tell you about my drinking? Would that help?’.¬† ‘If you like’.¬† I was awkward, unused to somebody being open about drinking.¬† I kept mine secret, even from my closest friends.¬† I liked to drink alone.¬† That way, I could drink as much as I liked.¬† That way, I was the only witness to my shame.¬† And I was ashamed.¬† Alcohol does that to you.¬†

Lulu said, ‘Every night, I promised myself that I wouldn’t drink the next day and every morning, when I woke up, I promised myself that I wouldn’t drink that day.¬† As I left the house to go to work, I promised myself, again, that I wouldn’t drink that day’….¬† I said nothing.¬† Those promises were familiar territory.¬† I had made them to myself, countless times.¬†

‘I’d get through the rest of the day somehow, but my mind was always fixed on alcohol.¬† Perhaps if I just had one drink, after that I stop completely.¬† Just one couldn’t hurt, could it?¬† Then I would decided that, no, I would be good.¬† I would go home, have a bath, make myself something nice to eat and have an early night so I’d be fresh for work the next day.¬† She looked at me, her eyes clear. ‘I knew that was what I was going to do.¬† But I still stopped at the off-licence and bought myself a bottle of wine and got straight into bed without washing or eating and I drank until I passed out.’¬† She grimaced at the memory.¬† ‘I don’t even like the taste of alcohol’.

Nor did I.¬† In fact, I’d come to hate it.¬† But I loved the effect, the way it stopped the pain, stopped me feeling.¬† She said, as if reading my mind, ‘I drank to change the way that I feel.’.¬† I wanted, right then, to change the way I felt, or how she was making me feel.¬† Even thinking about it made me want a drink.¬† What could be the harm in having one drink, to make me feel better? Perhaps she didn’t know what she was was talking about.¬† After all, it wasn’t as if she had been drinking that much.¬† I knew people who drank far more and they didn’t think they had a problem.¬† ‘It doesn’t sound too much’.

‘It’s not how much you drink.¬† It’s how you drink and why.’

‘I only drink because of the depression*.¬† If it wasn’t there, I wouldn’t drink, I laugh nervously.¬† ‘Or I wouldn’t drink so much’. [*You could change the word here to stress, anxiety, debt, work, family, children, boredom, need to get things done, all my friends do/partner does, insert your word(s) of choice].¬† ‘Seriously though, a drink doesn’t make it better.¬† It only makes it worse.¬† How much are you drinking?’¬† ‘A bottle of wine, perhaps two a day’.¬† ‘Can you stop?’¬† ‘Yes, no,’ I sighed.¬† ‘I don’t know …. No.¬† Well, I find it hard to stop.¬† But I’m not an alcoholic’.¬† Lulu’s smile curved.¬† ‘What’s an alcoholic?’¬† ‘Someone who sleeps on a park bench? Who passes out? Who gets violent? Who can’t hold down a job?’¬† Lulu’s smiled curved even higher.¬† ‘I am an alcoholic.’¬† I looked down at my hands.¬† Her voice was gentle.¬† ‘Sal, I know exactly how you feel.¬† I tried to do it on my own too, and it doesn’t work.¬† We need help.¬† We cannot do it on our own.’¬† ‘But you look so well, so happy.’¬† I shook my head.¬† ‘I don’t know.¬† Maybe I can stop on my own.¬† I’ve done it before’.

Lulu got up and hugged me.¬† ‘We’ve all done it before.¬† We’ve done it so many times we’re sick and tired of feeling sick and tired.¬† We all think we can do it on our own.¬† It’s just that we don’t have to.¬† We don’t have to be alone.’

I nodded.¬† For some reason, I wanted to cry. ‘OK’.

If this resonates for you too, know that you are not alone and if you are looking for freedom and liberation from booze you can always reach out and email me at ahangoverfreelife@gmail.com.¬† Or if you would like help to cut down or quit drinking I run an online course and you can use the link here to get a 25% discount 🙂¬†¬†

If I can do it, you can do it …….

 

 

Shoot the Damn Dog

shoot-the-damn-dogBack in June I blogged about the sad death of Sally Brampton and at the time added her book to my reading wish list.¬† ‘Shoot the damn dog‘ finally arrived from the library and oh my goodness what a beautiful book.¬† It should be mandatory reading for each and every one of us depressed, drinker or otherwise.

She was the most eloquent of writers and this book is poignant, honest, heartbreaking and brave.¬† She does for depression what we try to do out here about booze – tell our story in the hope that it helps someone else who recognises themselves in our words.¬† I saw myself in Sally’s experience and I could quote huge swathes of this book exclaiming ‘me too!’

I shall desist apart from to share brief excerpts as to why she wrote the book, her experience with booze and therapy.

So why am I writing this book?¬† I’m writing it because although I dislike the confessional, I was (and continue to be) so repulsed by the stigma around depression that I determined I must stand up and be counted, not hide away in shame. …… I wish I could say it was bravery that drove me to pin myself like a butterfly to the pages of a national newspaper, but it was actually anger.¬† I admit that my anger took me by surprise.¬† But then, so did depression.¬† I had never thought about its implications, or its consequences.¬† The more I inhabited it, the more I came to see the fear and shame surrounding it.¬† The more depressives I met, the more I came to understand¬† that we are not simply fighting an illness, but the attitudes that surround it.”¬† Replace the word depression with alcoholism and all of that could have been said by me, here.¬† I share her anger at how those of us who become alcohol dependent can at times feel stigmatised and ashamed.

I am drunk, I think, because I learned to use alcohol to try to crush my pain…… I learned that alcohol is the best anaesthetic in the world.¬† If I drank, I did not feel……. And I knew, in that part of my brain that was still robustly sane, that alcohol would not free me from the pain, except temporarily.¬† I knew that alcohol was a depressive, that I was taking an anti-depressive pill with one hand and a bottled depressive with the other.¬† And I also knew that I was trying to kill myself.¬† Alcoholism is a slow, ugly form of suicide.

As my shrink explained, ‘ You have to find your way into alcoholism which means drinking sufficient amounts to develop a dependency.¬† Why you do that is open to interpretation.¬† But once you have developed a dependency, you have an addiction not only to alcohol but also to a pattern of behaviour.¬† The only way out of addiction is to stop the substance abuse, and to learn new ways of behaviour.’¬† Shrinks call depressive drinking, ‘self-medication’.¬† I could stop for a day, a week or a month.¬† I could stop drinking for 3 months or even six.¬† Stopping is easy.¬† Staying stopped is overwhelmingly difficult if you are drinking to stop pain.”

Every addiction is a manifestation of emotional distress.  Nobody becomes an alcoholic or a binge eater because they love alcohol or food, they simply use excess alcohol or food to dull the pain that they are unable to express in words.  Most of this, of course, is unconscious.  If I am in emotional pain, my instinct is to take it away.  My way of doing that is to drink, as I have learned that it relieves (if only temporarily) my pain.  I have learned a disorderly habit of behaviour, that, once learned, is difficult to dismantle.  It is a condition, an emotional illness or a behavioural disorder.  It is, if you like, an inappropriate response to difficulty or pain.  It is the messenger, not the message.  Now that I am well again, perhaps I could drink again.  It is simply a risk that I am not prepared to take.

Yes to all of the above.

Looking at our own selves is horribly difficult to do, requiring a level of honesty and humility that can at times feel unbearable.¬† Few people are prepared to engage with it fully but without it, I truly believe that we cannot be happy…..¬† Therapy helped, but it is not magic.¬† It does not change our thoughts and behaviours.¬† It only teaches us what they might be.¬† It does not work unless we take from it what we have learned and put it into action.¬† So it is not, as so many people seem to think, a piece of indulgent navel gazing.¬† Nor is it about blaming the parents.¬† It is, I’d say, quite the opposite.¬† It is about understanding and accepting our parents.

There is a saying, ‘it’s never too late to have a happy childhood‘.¬† I’d rephrase that.¬† I’d say, it’s never too late to stop a difficult childhood from turning us into unhappy adults.¬† A difficult childhood may have set up a series of behaviours and responses that leads us to repeat those same patterns in our adult lives.¬† That does not mean that we have to continue those patterns.

I was given a birthday card with those exact words on during the first years of my recovery not just by one person but two – MrHOF and my sister.¬† The identical card by two different people, who are both very close to me and know me very well, on the same birthday!¬† It is on the wall above my desk …..

There is so much wisdom in this book I really do urge you to go read it in it’s entirety .

Friday Sober Inspiration: Drama to No Drama

karpman-drama-triangleSo I read a Veronica Valli post about recovery red flags recently that really resonated.  And then as happens I was watching a video series from Ruth Buczynski looking at shame, anger and conflict and suddenly I found myself taking a very sharp breath in as the two subjects collided in a way that caused a psychological shift in my thinking.

The expression that Veronica used that has been rattling around my brain ever since I read it is this:

If I’m okay with me, I don’t have to make you not okay

Ouch.  The above image explains it all really well I think.

And then Ruth’s video’s were talking about the Karpman Drama Triangle that Jean over at Unpickled has discussed before here and which I knew about from my time working with families as a school nurse.¬† And as is the way with the magical internet rabbit hole one thing led to another and I found myself looking at this image.

avoiding-the-drama-triangle So much of recovery from addiction is about moving from fear to love and I am very aware that the Karpman Triangle is alive and well in my way of interacting with others close to me!¬† So like recovery from booze and reading sober bloggers ahead of me on the path I wanted to know what a healthy way of relating looked like and in my quest I found the work of Tina Tessina ūüôā

This is what she has to say:

One profound way to intervene in the Drama Triangle is for family members to learn not to rescue each other. The other is to stop allowing others to rescue you.

Recognize a Rescue While You Are Participating In It

Learn to recognize that you are rescuing when you:
– Do something that you do not want to do because you believe you have to, and feel resentful later.
Do not ask for what you want.
Inappropriately parent another adult (giving unsolicited advice, giving orders, nagging, or criticizing)
Don’t tell your partner when there’s a problem, or when you feel resentful, ripped off, rejected, cheated, depressed, disappointed, or otherwise dissatisfied.
– Contribute more than 50% of the effort to any project or activity that is supposed to be mutual, (including housework, earning income, making dates and social plans, initiating sex, carrying the conversations, giving comfort and support) without a clear agreement between you.
Feel your role is to fix, protect, control, feel for, worry about, ignore the expressed wants of, or manipulate your partner.
Habitually feel tired, anxious, fearful, responsible, overworked and/or resentful in your relationship.
Focus more on your partner’s feelings, problems, circumstances, performance, satisfaction or happiness than on your own.

Whenever you realize you are rescuing, tell the other person what you’re tempted to do or not do for them, (how you want to rescue them) and ask them if they would like you to do that or not. Once you’ve offered and the offer has been accepted or rejected, (even if your partner is not honest about what he or she wants, or makes a mistake) it is no longer a rescue, it is an open agreement, and can be renegotiated if necessary.

Learn to recognize that you are being rescued if you:
– Think you are not as capable, grown up, or self-sufficient as your partner.
Find that your partner is doing things ‚Äúfor you‚ÄĚ that you haven’t requested or acknowledged
Feel guilty because your partner frequently seems to work harder, do more, or want more than you do.
Don‚Äôt ask for what you want, because your needs are anticipated by someone, or because your partner will not say “no” if he or she doesn’t want to do it.
Act or feel incapable, childish, irresponsible, paralyzed, nagged, criticized, powerless, smothered, or manipulated in your relationship.
Act or feel demanding, greedy, selfish, out of control, overemotional, lazy, worthless, pampered, spoiled, helpless, or hopeless in your relationship.
Contribute less than 50% of the effort to any project or activity that is supposed to be mutual, (including housework, earning income, making dates and social plans, initiating sex, carrying the conversations, giving comfort and support) without a clear agreement.
Feel your role is to be fixed, protected, controlled, told what you feel, worried about, ignored, or manipulated by another adult.
Habitually feel guilty, numb, turned off, overwhelmed, irresponsible, overlooked, misunderstood and/or hopeless in your relationships.
Focus more on your partner’s approval, criticism, faults, anger, responsibility, and power than on your own opinion of yourself.
Feel controlled, used, manipulated, victimized, abused, oppressed, stifled, limited or otherwise dissatisfied by your partner.

The more familiar these feelings or actions are, the more frequently they occur, the bigger the habit you have of being rescued in your relationship. Rescuing is a habit that you learned early in life that seems ‚Äúnormal‚ÄĚ and is habitual, so it is often difficult to be aware of it. Rescues depend on secrecy or ignorance. The antidote to being rescued is making an open agreement. So, if you suspect you are being rescued, suggest negotiating or talking about it, or just say thank you, if the help is truly OK with you.

How to Avoid Rescues
1. Recognize that what’s going on doesn’t feel good. It’s the best indicator of dysfunctional interaction.
2. Stop and Think. Don’t react automatically. If you have a dysfunctional habit pattern, you’ll need to make a different choice than your automatic behavior. Use the following checklist:
a) Does the situation feel fair?
b) Are you reluctant to say what you want?
c) Do you know what the other person wants?
d) Do you feel uncomfortable?
e) Are you resentful, angry, scared or upset?
f) Are you trying to control someone else’s reaction or feelings?
g) Does this feel similar to other interactions that ended badly?
3. After you‚Äôve taken a moment to think about whether you’re rescuing or being rescued, and what clues you are aware of, either ask for what you want, or ask the other person what he or she wants.
4. Offer to work toward a mutual decision.

Taking the rescues out of your relationship removes the drama. Learning to talk about what you want and don’t want, and to offer help instead of just stepping in can make a really big difference in the happiness level of your relationship

Source: Tina B. Tessina, PhD, (aka “Dr. Romance”) psychotherapist and author of The Real 13th Step: Discovering Confidence, Self-Reliance and Independence Beyond the 12-Step Programs

Wow is all I can say.¬† If I feel like I’m about to say something that I might later regret I now find myself uttering Veronica’s words to establish if it is indeed me who is struggling with something, and therefore not feeling okay, and looking to off-load it onto somebody else to make me feel better and in the process make them not feel okay.¬† I have said a great deal less and taken responsibility for an awful lot more as part of that process in the few weeks since I made the realisation.

Maybe this work will help you too? ūüôā

Who needs a drink when you’ve got the Feel Stress Free app?

feel-stress-free-appSo managing all feelings, and particularly difficult feelings like depression and anxiety, was a big part of the early days and months of getting sober for me.¬† Even now I’m always on the look out for new sober treats and self-care tools to make this easier for all of us.¬† The new Feel Stress Free app released this year, is the second mindfulness app I have tried as I have talked on the blog before about Headspace.

For me psychological self-care and fitness is as important as physical fitness and self-care so this was a great addition to my sober tool-box particularly on the go when life gets tricky.¬† As you know I’m a District Nurse and some patient visits can be emotionally difficult so having an app in my pocket that I can tap into, potentially between patient visits if needed, is a much welcomed respite.¬† The apps image and sounds of a desert island, lapping waves and seagulls with background calming music was lovely every time.

This above image is the first screen that greets you once you have downloaded for free the¬†Thrive‚Äôs Feel Stress Free Mobile App which is available for iOS and Android.¬† It works on a subscription basis,which can be purchased for one month, three months or a year. For one month it will set you back ¬£4.99, for 3 months it will cost ¬£3.33 each month and for a year it‚Äôs ¬£1.99 each month.¬† I was lucky enough to get a month’s free trial from the developers ūüôā

This is what their website says:

Be Stress Free has been created over two years of development and research to pro-actively prevent and manage stress and anxiety.

  • Keeps track of your mood over time
  • Enables you to train your thoughts so you can manage how you feel about different situations
  • Trains you in 4 relaxation techniques that give you control over your stress

Stressed or anxious? We can help! Using evidence-based techniques, we help you learn to relax and build your resilience to these common‚ÄĒyet hard to conquer‚ÄĒproblems. Featuring our thought trainer, zen garden, and unique ‘message in bottle’ social feature, there‚Äôs plenty to explore!

I loved the zen garden and ‘message in a bottle’ social feature (that enables you to send a message of encouragement to others using the app) and fed back to the developers:

“Have recently spent a year training part time to be a child and adolescent psychotherapeutic counsellor at the University of Cambridge and one of the therapeutic tools we used was a sand tray!¬† It was lovely to be able to immerse myself in that way again and very valuable.”

I wasn’t the only reviewer who really liked this as Moonlolly in the City agreed: ‘If you swipe left, you go to a second island called the ‚ÄėZen Garden‚Äô, a virtual Japanese rock garden used to aid meditation. Here you can design your own space and save your best designs.¬† I loved this part, probably because I‚Äôm a big kid ‚Äď it was one of those absorbing exercises akin to adult colouring books. Totally on board with this.’

One of the things I liked about this app is it is designed by clinicians:

Dr Andres Fonseca – CEO, is a psychiatrist with almost 20 years of clinical experience. He believes the way mental health services work at the moment is very broken. Services are focused on intervening when people are in crisis, which is already too late. He believes therapeutic software that is fun to use is the way to help people Thrive.

A bit more detail about some of the key features:

Mood Meter

Start every day tracking your mood to receive the best recommendations to get through it. Based on your results the Mood Meter will recommend different activities. It will record your results on your progress so you can look back and see what works for you. It will learn itself what you find helpful and get better at advising you over time.

Thought Trainer

Our cognitive behavioural therapy based thought trainer is how we help you to re-frame your negative thoughts. We all have negative thoughts at times, but is there a better way we can think about things? That is what the thought trainer is here to do. It tracks how you feel, giving recommendations and helping you to see a positive in the negative. With everything tracked in Progress and the app learning more about you as you use it, the Thought Trainer will soon personalise itself to your experiences.

The evidence

Computerised Cognitive Behavioural (cCBT) therapy has accumulated 10 years of evidence. It has been shown to work as a self-directed treatment without intervention from a therapist. In 2016 Jill Newby and colleagues from St Vincent’s Hospital in Australia undertook a review of all the evidence of cCBT used for depression and anxiety showing it is a very effective technique and comparable to face to face therapy. Here is a link to the study.

Calm Breathing

This is the simplest technique, one that you can learn in the app and practice anywhere you are. It is based on the fact that increasing chest pressure by taking very slow and deep breaths, and then reducing by slowly breathing out, triggers a reflex. This reflex slows down your pulse and gives you a relaxed feeling in your body. As body and mind are connected this then results in relaxation in your mind. Give it a go for 3, 5, 7 or 10 minutes!

The evidence

Deep slow breathing is an essential technique incorporated in many relaxation exercises. It has been extensively examined in the literature in different setting. A good review of the evidence behind it and its uses can be found in General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy, Chapter 14 by Hazlett-Stevens and Craske. You can read a preview of the chapter here.

Progressive Deep Muscle Relaxation

In this technique we also take advantage of the mind-body connection. We will teach you to contract and relax various muscles progressively allowing you to enjoy the difference between the tense sensations in the muscle and the relaxed sensations that come after you have let the tension go

The evidence

Since its description by Jacobson in 1938 this technique has a record of proven efficacy. There is a 2007 review of the literature that summarises all the available evidence up to that date which you can find here.

Self Hypnosis

Not for everyone but those of you who are able to reach a state of hypnosis can benefit greatly from this technique. We will try to teach you to put yourself into a hypnotic trance. If you are able to achieve it, he will help you teach yourself a word of phrase that will quickly bring you back to that state of relaxation whatever your circumstances.

The evidence

It has proven efficacy in anxiety related to many situations. It has been particularly studied in people going through different medical treatments like dialysis, chemotherapy, surgery and dentistry. There is a 2010 review that goes through all that evidence. The main issue with hypnosis is that the person must be suggestible to benefit from it. Here is a recent study on how suggestibility influences outcomes in using hypnosis to manage pain.

Meditation

Simple to learn but hard to master this is quite a powerful technique for relaxation.  It requires dedication and practice but if you persevere it can bring about the most benefits. You will need a quiet space and to achieve a sensation of comfort. You will be able todevelop a passive attitude that allows you to just watch your feelings, sensations and thoughts as they pass through your mind. You will also use word or phrase to help you refocus.

The evidence

This is probably the technique that has received the most attention recently. It requires practice to master but everyone can use it if they devote the time to learn it and practice it. There is a complete review and meta-analysis of all the evidence of meditation in the management of anxiety published in the British Journal of Psychology in 2012.

And you can track your progress:

Progress keeps track of everything you do in the app. It is what the app uses to give you better and better tips. If you are working with a therapist you can use Progress as your full-fledged therapy journal.

You can choose how long you want to do each exercise for, from a quick 3 minutes of deep breathing to 25 minutes of meditation, which is great if you want to fit a session into a busy day.  The app also remembers which exercises you’ve done before and how many times, encouraging regular use and making the whole experience feel very personalised.

Echoing the words of Moonlolly: if you‚Äôre going to invest in a mindfulness app, it‚Äôs worth bearing in mind that this is one of the first to have actual¬†CBT therapy incorporated and be officially¬†‚Äėclinically proven.‚Äô

So next time you’re feeling stressed or anxious rather than reaching for a drink, or thinking that a drink would help, why not try this?

Friday Sober Jukebox – Escape Velocity

escape velocitySo here we are again now heading into year 4 ūüôā

There are many things I still haven’t covered on this blog so until I run out of new things to share and say a post will keep appearing,¬† probably on a weekly or two weekly basis, depending on what’s going on.¬† Plus I know myself well enough now to know I won’t be able to keep my big mouth shut about any major news story that breaks in the alcohol and public health worlds!

So today is about psychological escape velocity (the minimum speed needed for an object to escape from the gravitational attraction of a massive body).¬† I had a headf*ck experience recently where I was given the opportunity to see photo’s of a house I lived in when I was a girl.¬† What was really spooky and serendipitous about this was it was via a nursing colleague who had lived in this house about 20 years after me, had taken photo’s and had recently been sorting through them and happened to have them with her in the office then and there that lunchtime!¬† Weird right?

What she didn’t know was that I have really distressing and traumatic memories of this house and time and have spent a good amount of time in therapy talking about it so seeing those images triggered an avalanche of memories.¬† What was so reassuring was that although the memories had only been experienced in the last 5 years (which fuelled a massive amount of drinking back then) my recall of that house was EXACTLY right.¬† Every detail that I had summoned from 40 years ago and discussed was spot on – so if my memory of the place was right so was my recall of the events.¬† This was a major revelation because at the time when I tried to tell someone I hadn’t been believed and I had therefore doubted my own experience and had questioned whether it was all just in my head – that my nightmare’s were just that horrors in my head not real life.¬† Although seeing the photo’s caused intense psychic tremors I was okay and I was able to regulate my emotions and handle the triggered distress.¬† This felt like massive progress to me and as if I had enough emotional and boundary depth to not be pulled back into the psychological pain of that time.¬† These events no longer defined me – I had reached my psychological escape velocity ūüôā

When I told MrHOF he said this was not just the end of a chapter but the end of a volume in my life and he felt it was no co-incidence and a sign from the universe (because I believe in such stuff) that that experience and how I managed it marked closure both emotionally and mentally for me and that I wasn’t doing a geographical by planning our move to Australia.

That same day I was contacted by Regina Walker at The Fix who is a psychotherapist.  I was reading her writing archives when I came across an article about Dialectical Behaviour Therapy (DBT) a technique used in the UK mainly to treat those with borderline personality disorder.  Thanks to my research assistant experience with a Clinical Psychologist who worked with this client group it was something I knew about, knew it was a successful and valuable therapeutic approach and learned from this discovered article that it is being used and applied in addiction!

Here are the key excepts that link my experience recounted above and this technique (the whole article is well worth your time in reading):

The goal of DBT is to acquire skills to deal with the mental anguish the sufferer experiences and create a life worth living. The tools offered in DBT are meant to aid in the achievement of these goals.

DBT, for people struggling with substance abuse problems, is a way to achieve self-acceptance while simultaneously accepting the need for change. There are four basic aspects to DBT: mindfulness, interpersonal relations, emotion regulation, and distress tolerance.

The emotion regulation aspect of DBT teaches how to identify, regulate and experience emotions without becoming overwhelmed and acting on impulse. The skills aim to reduce vulnerability and increase positive experiences.

The fourth area of DBT is distress tolerance. This area is focused on the development of skills to cope with crises when emotions become overwhelming and the individual is unable to immediately solve the problem (a death, sickness, loss of job, etc.) but needs to persevere and live through the crisis without making it worse by impulsive actions (for example, getting high or drunk).

Dr. Linehan acknowledged that the self-harming behavior she saw in suffering patients made sense and had a purpose.  But she also recognised that this had to change and that the person had to accept themselves.

She referred to this as ‚ÄúRadical Acceptance‚ÄĚ‚ÄĒacceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it. These seem to be opposites: on the one hand, you have to take life as it is; on the other hand, that change is essential for survival. But for real change to happen, both self-acceptance, and acceptance of the need for change have to come together. This blending of two seemingly opposite views is called a dialectic‚ÄĒand it’s the vision behind the name of Dialectical Behavioral Therapy.

So after 3 years of living life sober, and ‘in the raw’ as Mrs D would say, I have both accepted myself and what happened to me as a child and shown myself self-compassion.¬† I have taken life as it is but recognised that change was essential for my survival. ¬† My psychological escape velocity from my past, and as part of that alcohol, has reached a critical juncture ūüôā

In the past those photo’s would have rocked my world in a very negative way and triggered the most almighty bender.¬† Now I just feel peaceful and content that I can trust myself to take care of myself as I tried to as a young girl.

Surrender

surrenderSo today my family & I fly to Australia for a month.¬† A hard earned & saved for treat for over 1000 days sober (1043 today to be exact!)¬† I can’t quite believe we’ve achieved this many days or this extended holiday.¬† As with my other breaks it will also be a cyber holiday so I’m leaving this post up until I return and linking a copy of my e-book here for you to download while I’m away should you want to:

Free ebook here ūüôā

My online course is self-directed so remains available during this time but can I direct you to Udemy if you have any technical issues.  Equally any comments on the blog or emails sent to me during this time will not be responded to until my return at the end of August.

Plus I’d like to thank a member of the BFB Yahoo for this blog post they called Surrender and if you’d like to read more of their writing you can do so here (she’s on day 145 now!)¬† Over to them and see you in a month ūüôā

Good morning BFBers

Today is day 30 for me. It’s been a ride and a half and I am so grateful for the support of this group. The¬†longest I have ever gone without¬†alcohol with the exception of three pregnancies and a few military deployments was 11 days out of the last 20 some years. Ridiculously,¬†I used to congratulate myself on going more than 24 hours without a drink and never could have fathomed a whole month. Yet, here I am.¬† And I feel deep down that I will never drink again.¬†I made myself a promise that if I could make it this first month that I would come clean and share my story here.¬† There are obviously years leading up to all of this, but this is how I came to SURRENDER.
Thirty days ago I drank an entire bottle of whiskey in an attempt to “feel better” after I had a series of¬†unsettling events.¬†I see it all now as what it was: a painful wake up call from God. The day before my last drink, I had worked a twelve hour shift in the ER, 10 of which were spent taking care of a patient who was an alcohol overdose who was found unresponsive by her family. She had aspirated (inhaled her vomit into her lungs), then had an anoxic (lack of oxygen) brain injury and a stroke¬†as a result. She was 4 years older than me and will probably never wake up again. She left three kids.
Instead of coming home and recognizing that¬†situation as a cautionary¬†tale and using it to examine my¬†own drinking,¬†I did what I¬†always did after a rough shift:¬†I drank. I drank about 5 shots of whiskey and then restlessly went to bed at 0300.¬†My sweet son who has a lot of sensory issues and learning disability had a giant meltdown about his socks the following morning which, in my¬†probably still intoxicated¬†state I did not handle well. I yelled at him which made it all worse and he went to school feeling misunderstood and sniffly.¬† I sat down after taking the kids to the bus feeling like an utter failure, trying to shake the images of my patient the night before. Her kids crying at the bedside, her slack jaw, the medications I was using to keep her alive, the rhythmic hiss and whoosh of the ventilator that was breathing for her.¬† So… I drank some more. A lot more.
I fell asleep,¬†and was¬†awakened by my¬†phone ringing; the school calling to tell me that I had forgotten to get my 5 year old off the bus. I stumbled to¬†my car, looking like God knows what and¬†went into the office.¬† I could hear my words slurring, burst into tears when she¬†came out of the nurses’¬†office and made some probably unintelligible statement to all of the office ladies that I wasn’t feeling well and had laid down and not heard my alarm. I have no¬†idea why they didn’t call the police or why¬†they let me take my daughter.¬† Unless the¬†idea that I, a mom with three kids at that school who is active and “together”¬†could have possible been severely intoxicated at NOON was just too difficult to imagine.¬† Maybe they¬†truly believed that I did have the flu or something..¬†I drove home the 0.8 miles to our house (yes, I’ve measured just how far I drove drunk with my precious daughter in the car), remember trying to make her a PB and J. I took another shot to¬† manage the guilt I felt when I realized that instead of jelly, I had dumped out a jar of olives onto the sandwich and had to start over.¬† That was the last shot in the bottle, so of course I opened the second. I made her a sandwich and then I don’t remember anything after that.¬† Apparently, my subconscious knew that I was in trouble because I called my husband (I don’t remember) and told him he needed to come home right away because I was messed up.
The next thing I remember was lying in the tub vomiting up my guts, with my husband trying to get me up and out of the shower. Me crying that I just wanted to die and finally saying out loud to him over and over¬†“I’m an alcoholic.” Then passing out again.
I finally woke up at 11 pm that night in my bed, feeling like I’d been hit by a truck. I had bruises on my entire body; my face was throbbing.¬† I looked down and realized that my left knee was completely dislocated. It was like looking at someone else’s knee. I literally felt nothing; just thought, “huh, pretty sure my knee cap shouldn’t be sticking out the¬†side of my leg.”¬†I stood up shakily and it popped back in. I hobbled to the bathroom to see my face. My lip was swollen, my right front tooth was broken and the whole side of my face was purple.. I have no idea how I sustained those injuries.¬† My first thought was of my kids. I asked my husband where they were and he told me “you made R lunch, called me and set her up with a movie. She was watching Strawberry Shortcake when I got home an hour after your call. The other two are fine. I was here when they got home.”
I see all of those things now as Divine providence. The school staff should have called the police. I was in a grey-out when I drove my daughter home and didn’t crash or hurt anyone. I could have killed both of us driving like that. I gave myself a concussion smashing my face into something because I was too intoxicated to stand. I knocked out my front tooth and tore a ligament in my knee.¬† I could have been more severely injured, passed out, aspirated and been just like my patient the day before.¬† It had been building for a while and my husband had never seen me like that. And though the signs were probably there if he had been looking, he never noticed. What a spectacular reveal!¬† Like whipping that curtain away from Oz, everything was out in the open, warts and all and now this is the new reality.
My thoughts during that first night were so full of shame that I just wanted to die.¬†I was in severe physical and emotional pain.¬†I didn’t want to see my kids in the morning, knowing that I had failed them so utterly.¬† Whatever any one tells you or what you want to believe, this disease is PROGRESSIVE…¬† over the last two months that I drank¬†I had reached¬†the point that I had become the clich√©d slurring, falling down mother who endangered her child, and endangered other¬†people on the road with¬†me.¬†I never would have imagined that¬†a few ” You deserve it/¬†Mommy’s time out” glasses of wine (which became¬†bottles which¬†became day time drinking which became binge drinking vodka or whiskey because I had so much tolerance)¬†after my children were in bed would swallow me whole;¬†destroy my self-respect, make me a caricature, a failure and shatter every illusion of perfection or control I had ever clung to. And all of that happened in the span of two years. To anyone on the outside, I looked like a “together” mom of three adorable kids who is a damn good nurse, a tough lady with a great sense of humor who has survived a lot of tough times in life, the tall redhead with the¬†quick wit who has a reputation for being able to handle anything.¬† Except I couldn’t handle alcohol anymore. And I¬†felt like a fraud. If anyone knew….
If you are struggling with moderation, thinking you can control it, I am here to tell you that if you are truly an alcoholic, this disease will not allow you to do that indefinitely.¬† At some point, down the road, and I can’t tell you when it will be for you…Something will happen. That feeling of dread you have, that worry about being a news story, or being the next Diane Shuler… That is the voice of God telling you to STOP NOW.
That first morning, hurting and hungover, it was clear that I could either choose death or choose to accept¬† the idea that I could never, ever drink again.¬† I was living on grace and borrowed time.¬†Because I should have been in jail or dead.¬† So I chose SURRENDER.¬† If you are reading this and haven’t gotten to that place yet, I beg you to accept that you may not be given the choice later.¬† So pick life.
Ironically, the last two days have been the hardest of these 30. I’m struggling with sleep again, feeling down and lacking energy. My anxiety is flaring and I had two panic attacks in the last few days where I honestly thought I was having a heart attack…¬†But fortunately I’m able to recognize all of this as symptoms of PAWS.¬†So, I’m pushing through, trying to rest when I need it, giving myself slack and working on doing a LOT of breathing and pausing.¬† The biggest thing I’ve learned in this last month is that just because I’m feeling something uncomfortable, I don’t have to fix it immediately.¬† I’m a person who hates unresolved things… always had to fix everything¬†the very second that it cropped up. And if I couldn’t fix it, then I would just drink to feel better about it. Now, I’m finding that I don’t have to have knee-jerk reactions, don’t have to sacrifice my own well-being to make others feel better, or manage their emotions to the detriment of myself. I don’t have to “fix” it all right away. It can just BE for¬†a while.
This of course makes me very uncomfortable and uneasy. But I have that little voice in the back of my head that says ” This sucks, but did you DIE?” Nope. Still alive and ticking.¬†This month has been rough. Lots of firsts, some easy, some very difficult. But I’m still here, taking it a day at a time. Knowing that drinking just isn’t an option has freed me to get to the real work of unraveling myself.¬† Which is scary and some days like today I just don’t want to go there. The same stresses exist. I’m still suffering career burn out.¬†I still have three kids and no local family support. My son still has very very bad days that throw everything into disequilibrium. ¬†My husband still has PTSD and is too¬†proud to get help. My marriage is still very rocky and probably even more so now that my husband who is a normie can’t understand what the big deal is and why I’m not just magically all better now¬†I’m not drinking.¬†If anything, all of this hurts a thousand times more because I’m not anesthetizing myself anymore. But I’m not drinking.
I know I can’t control and fix all of¬†that so for THIS DAY, in this moment I will pause and¬† just be grateful that I’m sober.¬† I’m finding¬†that though painful, this coming back to life is indescribably worth it.¬†¬†I¬†know¬†that all of this hard work, these tough (often invisible) moments will be worth it. Because I am also open to the good things: laughter, joy; the million small details you can’t see when your edges are blurred.¬† I’m not sure I will ever come to a place where I can be “grateful” for being an alcoholic.¬† I still struggle with a lot of shame and regrets. But perhaps as this journey progresses I will eventually see it as a gift.
In the mean time, thanks for listening. Thanks for “getting” what it means to have the courage to unflinchingly take stock and face this disease.¬† And I hope you can be encouraged by reading my story.¬† Because if anyone as stubborn as me can finally learn to let go, there is hope for you.
Surrendering On