The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 17

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The Last Addictions Memoir (Hopefully): An Evidence-Based Recovery Story Pt. 17

By Anne Giles 08/01/17

Shifting from a "Relapse Prevention Plan" to an "Abstinence Protection Plan" changes the deal.

Image: 
relapse deck
art by Anne Giles

I didn't need no stinking relapse prevention plan.

I've been abstinent from a problematic substance for four and a half years. I'm 58 years old and trained as a counselor. I follow the guidance of the Surgeon General's report, Facing Addiction in America, for evidence-based treatment: medical care first, then individual counseling, then support, in that order.

I'm fortunate enough to consult with two individual counselors, one who specializes in substance use disorders, and one who specializes in cognitive behavioral therapy and dialectical behavior therapy, top evidence-based therapies for helping people with addiction achieve and maintain abstinence.

The individual counselor who specializes in substance use disorders asked me to write a relapse prevention plan.

I almost became apoplectic.

However, having asked myself, "How am I crazy?", and having become aware that I have difficulty differentiating between mountains and molehills, I actually was able to pause for a moment. Then I became apoplectic.

"A 'relapse prevention plan?!' That language is archaic! It's punitive and inconsistent with what science says addiction is and what treats it!"

Given that my counselor knows confrontation contributes to relapse, not to abstinence, and given she knows motivational interviewing assists people with addiction approach ideas that might be helpful but difficult for them, she shifted attention to me and the mountain.

"What term would you use to describe what you have done that has resulted in four and a half years of abstinence?"

From outrage, I plummeted to despair. Spagnolo and Goldman best summarize the state of addiction treatment in their article released this year (2017): "Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective."

If my evidence-based, addiction recovery self-care practices are imagined as a deck of cards from which I deal myself an abstinence-supporting hand, I honestly have no idea which cards, in which combinations, are helping me abstain from the substance that is problematic for me.

And that is the ethical dilemma of my personal and professional life. "Current interventions are only modestly effective," Spagnolo and Goldman write. I can't be sure I'm helping myself or others.

For me, alcoholism is a wild card dealt to my brain. Structures and circuits in my brain have become impaired and, despite all the force, tools, effort and willpower my selfhood, personhood and individuality might bring to the task, I cannot directly repair my punkin head. (This is not true for opioid use disorders. The medications methadone and buprenorphine directly address brain impairments.) The wild card is unpredictable, unknowable, and subtracts value rather than adds it. Further, my wild card seems overlaid with a carnival house mirror. Whenever I approach it, the image distorts and shifts.

But that's the card I've been dealt. As Marsha Linehan, inventor of dialectical behavior therapy, puts it, "People may not have caused all their own problems but they have to solve them anyway." Or, to quote the Transporter's Rule #1, "The deal's the deal."

As a person with addiction to alcohol, what's not my job is to waste time and energy trying to change the wildness of the wild card. Altering my brain right here, right now in order to not take a drink is not within my power or control. Nor is my task to rage against the unfairness of the hand I've been dealt. My job is to, very strategically, play the game. I need to pay attention to the wild card's current state and adjust accordingly, find a bunch of evidence-based treatment cards, and see what, if anything, makes the "interventions" in my hand more "modestly effective." While I'm experimenting during this highly inefficient, trial-and-error process, I have to hope I don't relapse from addiction, a medical condition that can result in premature death.

My counselor listened to my wild-card-of-addiction metaphor. Then she asked me to imagine an additional deck of cards printed with abstinence-endangering activities that I studiously don't do to help stay abstinent.

I became un-apoplectic, sinking with relief into the couch.

How did she know that I envision myself sitting alone and desperate in a back room poker game, with menacing opponents and dangerous stakes, trying to sort the dealer's belief-based and theory-based cards from the evidence-based ones, trying to keep some kind of winning abstinence hand going, terrified of inadvertently holding a losing relapse hand, all the while bullied by the sneering, undulating face on the wild card of addiction?!

How would she have known? As good counselors do, she observed my traits and patterns and listened to what I feel and how I think. She realized that I am feeling exhausted to the point of despair from what I do to try to keep myself from drinking again. She invited me to see what I don't do that also protects me.

And there it is. That's the value of individual counseling for people with addiction. Counselors can't directly treat the brain's wild card of addiction any more than I can. But they can directly, in a profoundly individualized and powerful way, help the person abstain.

Co-rejecting the apoplectic-making, obsolete, negative, fatalistic term "relapse prevention plan," my counselor and I agreed on the term "Abstinence Protection Plan," and I willingly began to think about it.

When I was a child, my mother gave me a replica set of handmade playing cards from Elizabethan times. I envisioned my counselor's idea of a "to-do" deck as a handmade set like the replicas, and the "don't-do" deck as mass-produced, but deceptively printed with kittens.

The top cards in my particular, individual, painstakingly handmade deck of abstinence protection cards are: training my attention; exercise; keeping a strict sleep-wake-nap-wake schedule; no caffeine after 3 PM to foster what can be iffy sleep; a balance of time with people and time alone; feeding myself nutritious, simple, easily digested foods every few hours to keep my digestion calm and my energy steady; work that engages me rather than occupies me; attending support group meetings; going to two counselors, not one.

When I'm dealt these tempting but abstinence-endangering, plastic-coated cards, I try to push them away: going to someone's home or to a community or business event, or going any fucking where that alcohol is served, particularly in a convivial way; staying at home for more than 24 hours; skipping a day without supportive contact; debating on Facebook, in online comments, or in-person.

The idea came to me to make some of the "to-do" abstinence protection cards. I asked Laurel Sindewald to create a template for me. Here's a link to a .pdf of her template. I printed out a couple copies of her template on sheets of printer paper, got out a standard deck of cards to use as models, sketched a few ideas as drafts, then used red and black fine point Sharpies - plus a dab of white out - to create the images accompanying this post.

After thoroughly and seriously creating an Abstinence Protection Plan, I feel less frightened by research that hasn't yet pinpointed what methods, or combination of methods, directly help people achieve their addiction treatment goals, whether abstinence or harm reduction. I accept that what I do may be correlated with abstinence, but I can't confuse what I do with it being causal.

Having thoroughly seen what I'm doing - and avoiding doing - to help myself, I feel the relief that comes from accepting that I, actually, am doing the best I can. I feel such sorrow, but also increasing acceptance, that my human limits may be too limited to prevent the illness of addiction from being more wild than my focused, tame efforts.

The image of myself sitting in a back room at a card table, cold sweat dripping from my face, frantically playing a game of chance without rules, wild card staring cruelly at me, has faded. Instead, I see myself disguised as a dead ringer for a grandma, pearls at my throat, tissue tucked into the sleeve of my sweater.

The wild card is what it is, but the rest of the deck is stacked with my "to-do" cards, selected from evidence-based options. I've had a nap, I've got Lara Bars in my snap-close pocketbook, and it's after 3:00 PM so I've shifted to decaf. My deck of "don't-dos" is a broad-shouldered bouncer at the door, Transporter-like, banishing any and all threats from getting anywhere close to me. I've set myself up to win the best I can. Deal the cards.

The Last Addictions Memoir below:

Part 1 here  Part 2 here  Part 3 here Part 4 here  Part 5 here Part 6 here Part 7 here Part 8 here 

Part 9 here Part 10 here Part 11 here Part 12 here Part 13 here Part 14 here Part 15 here Part 16 here

Anne Giles, M.A., M.S., is a counselor, writer and business owner. She writes about addictions treatment, recovery and policy at annegiles.com. As of this writing, she has been abstinent from alcohol since December 28, 2012, and is in remission from alcohol use disorder.

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