Tag Archives: cognitive therapy

A Case of the What Ifs

In three weeks I will be on my big road trip to New Orleans.  My friend Lynn arrives on Saturday afternoon from Scotland and we’ll head out the next morning.

Here’s the itinerary I’ve mapped out:

Sunday, April 3: 8-hour drive from St. Paul to Chicago with a stop for lunch with cousins and a niece in Madison, Wisconsin.  I am told we must see the protest singers at the state capital.  I have no idea who or what they are.

Monday, April 4: A full day in Chicago—Millennium Park, architectural boat tour, another niece

Tuesday, April 5: 8-hour drive from Chicago to Memphis, check out Beale Street and Sun Studio or the Rock ‘n’ Soul Museum.

Wed, April 6: Visit the National Civil Rights Museum which is in the Memphis motel where Martin Luther King was assassinated, then hit the road for the 7-hour drive to New Orleans

Wed-Sun, April 6-10: In New Orleans for 5 days!  French Quarter Festival will be on, and there are so many other things to do, like an alligator swamp boat ride, plantation tours, and fabulous architecture, gardens, and cemeteries.

Monday, April 11: 6-hour drive from New Orleans to Oxford, Mississippi.  The University of Mississippi at Oxford is where America’s university system was forcefully integrated.  I also wanted to stay in at least one sort-of-small city.  Oxford’s population is 20,000, although I don’t know if that accounts for university students.

Tuesday, April 12: 6-hour drive from Oxford to St. Louis.  Dinner with a friend from grad school, preferably in The Hill neighborhood renowned for its Italian food.  At least eight people have told me we must—must! visit the City Museum.  They say it’s lots of fun, that you can play around on the art like a kid, but it’s really for adults.  I’m not that good at fun, but it is something I’m working on.  I wonder if Lynn, being English, will find it fun.  I’m not at all clear on what it is, but we’re going to find out.

Wednesday, April 13: 8.5-hour drive from St. Louis to St. Paul to get Lynn to the airport in time for her late evening flight.

Whew.  I admit I am anxious about how it will all play out.  What if the route times on Google maps don’t allow time for bathroom breaks or lunches?  That would mean all my times are off.  What if the routes aren’t scenic?  What if Lynn thinks all Americans are racist yahoos?  What if every city is just a mass of Walmarts, Star Bucks, and strip malls?  What if my GPS breaks and we get lost?  What if one of us is mugged?  What if the museums aren’t open on the day we’re there?  What if my back hurts from so much driving?  What if we get into a fight over what to do in New Orleans?  What if we arrive after dark in one of these big cities and the hotel has no record of our registration?  What if a meteorite hits the car?  What if the car breaks down in a bayou and we hear banjo music?

My anxiety is nothing like it used to be, but it’s interesting to notice it.  I’ve learned a lot of tricks for dealing with anxiety over the years.  Some of the ones that work best for me are to:

– bring myself out of my head to focus on my surroundings.  Notice that I am not currently in my car surrounded by alligator-filled swamps or muggers, but in a chair in my dining room writing this post.  This usually helps bring me back to reality.

– remember that nothing lasts.  I may feel anxious right now, but it will pass if I don’t latch on to it.  It’ll probably come back, but then it will pass again.  So it’s not permanent.  If it did get to be constant and lasted for a week, I would call a professional.

– know that, if I do end up surrounded by hillbillies, I will deal with it then.  For now, I only need to do the next indicated thing—finish this post and post it.  And so I will.

The Grey Lady Stumbles

This is the seventh post in a series that started here.

I left Cuernavaca having learned a lot of Spanish and with a new vocation.  Off and on since then, I have worked in international development.  That doesn’t mean I don’t care about causes here at home.  I just think that, as a mission driven person, I do better work if I’m passionate about a cause.  And for many reasons, I am passionate about trying to end poverty and suffering in the developing world.

Before I left Cuernavaca, I booked six more weeks of Spanish immersion through Amerispan.  This time I would go to Morelia, a beautiful colonial city that is no longer an Amerispan choice.  I’m guessing this is due to Morelia’s unfortunate #1 ranking as the city most caught in the drug war that has erupted in Mexico since I was there.

And that’s my transition back to one of my favorite subjects, addiction.

The New York Times published an article a few weeks ago about an alternative treatment approach to addiction.   I read it, cut it out, and was saving it to write a post about.  My initial reaction to it was, “Why not?  Why wouldn’t you try both traditional treatment and AA and this thing, if you could afford the time and money.”  But now I’m having second thoughts.

In a nutshell, the article profiles a psychiatrist who has opened a new addiction clinic that approaches addiction as a chronic disease and treats it with drugs, in place of the Twelve Steps and AA.

At least three people have brought the article up to me in conversation, so it’s causing a stir.

When I revisited it for this post, I noticed it was in the Science section, which implies that the content is scientifically valid.  Plus it’s the New York Times, right?  It’s got to be true.

When I searched the NYT website for “addiction,” I found that all the other articles about addiction are either in the Opinion or the News sections.  So you’ve got news about a big drug bust in upstate New York, for example, and then people ringing in with their opinions on what should be done about the drug crisis and the related problem of mass incarceration.

I scrolled to the bottom to read the comments.  There must be hundreds, I thought, and I wondered how many commenters would hail this as a godsend or criticize it as irresponsible.  But there was no comments, and no way to make comments.  That’s strange, I think.

Among other things, Dr. Mark Willenbring states that 60 percent of addiction is attributable to a person’s genetic makeup.  The NYT adds that this is “scientifically unassailable” but offers no evidence.

Dr. Willinbring, a psychiatrist, is no slacker.  For five years he headed the federal agency that studies addiction.  Coincidentally, he’s a Minnesotan and he opened a private clinic called Alltyr in 2012.  It’s within walking distance from my house.

Alltyr treats addiction as a chronic medical condition.  Its treatment plans include drugs used to treat depression, anxiety, ADHD, or chronic pain; family “training,” and cognitive behavioral therapy—which, as I’ve written, was a worked miracles for me.  Alltyr also uses anti-relapse drugs, and I wondered what that meant.

I didn’t have to wait long to find out.

A friend and her husband have been struggling with his drinking.  He was on a wait list for Hazelden Betty Ford, one of the world’s premier rehab centers, also within walking distance of my house.  Then he read the New York Times article.  Alltyr got him in the next day, and after pooh-poohing Hazelden, he cancelled his reservation there.   (Despite Alltyr dismissing traditional treatment, I can’t find any evidence in the article that its method works.)

Alltyr put him on two anti-relapse drugs.  I spoke with my friend the next day.  “He must have still had alcohol in his system,” she said, “because he was so sick he couldn’t get out of bed—much less go to work—for two days.  He said it was like all the worst anxiety he’s ever had in his life rolled into one giant ball and stuffed into his chest.”

Happy New Life, Again

Happy New Year!  I am re-posting this from January 1 of last year.  I hesitated to share such a personal story then, but it has been the most-read post of the 232 Vince and I have written.  Maybe it’s the story, or the encouraging advice.  Or maybe it’s the guns.

If you received this twice, that’s because I accidentally posted it for January 1, 2015.  Off to a good start, I say!

Three years ago, I hit bottom. I had lived with depression for as long as I could remember, but then….  I had to have a tooth pulled—boy, will that make you feel old! Then during a Christmas Day blizzard my car was towed and I spent four hours waiting in line outside at the impound lot to pay $300 to get it back. I then drove to Fountain to visit Vince. The trailer he shared with Seth was full of guns, beer cans, and smoke. I figured what the heck, if you can’t beat ‘em, join ‘em, so after he assured me that none of the guns was loaded, we posed for photos that became my holiday cards to my friends in the UK, where they had a good laugh over us gun-crazy Americans.

Vince (11)Vince (7)

Due to the blizzard I spent the night in Seth’s 5-year-old daughter’s bedroom; she was at her mom’s. Here’s a tip for parents who smoke: Keeping your kid’s door closed doesn’t keep smoke out. I couldn’t open the window and after tossing and turning until 5am I slipped out and drove home. On the way I started itching. Great—now I had bedbugs!

I contemplated suicide. I leaned my forehead against the screen of my 20th floor window. I had turned 50 the year before. Thinking about being depressed every day for another 30-40 years wasn’t real appealing.

Here are the things I had tried to manage depression and anxiety:

Meditation

Medication

Prayer (including begging, pleading, and bargaining)

Acting normal

Abstaining from drinking

Cutting down on coffee

Self-help books

Alanon

Exercise

Getting outside every day

Appreciating beauty, be it fine art, nature, music, babies, or kittens

Gratitude lists

Avoiding negative people / avoiding unnaturally happy people

Running away to other countries

Denial

Journaling

Telling myself, “At least I’m not a refugee / amputee / blind / fill-in-the-blank.”

Psychotherapy

Retail therapy

Sleeping, drinking, and movie binges

Reaching out to friends, even when that was the last thing I wanted to do

I thought that jumping out of my window would be exhilarating, until I hit the ground. I had some leftover pain killers from the dentist, and my prescription for Restless Legs. I googled an overdose of the two and learned that they wouldn’t kill me, but that I would likely need a liver transplant. I decided to keep living.

That spring, I visited Vince again and this time, made a reservation at a B&B.  On the free-book-shelf there, I picked up a tattered copy of, “Feeling Good: the New Mood Therapy”, by David Burns, MD. I read it and did what it told me to do, and I stopped being depressed. For good.

The book was about Cognitive Therapy. I had been instructed to use it at least twice in the past, but I’d been too stressed out to do it. Basically, you write down your negative thoughts and then argue with them rationally until you’ve de-fanged them. Writing it down is important; if you try to do it in your head you’ll end up down a rabbit hole.

So was a lifetime of depression cured overnight by one book? No. I think it was all the other things I had tried over the years—the good things, anyway—and then I added this on top of them and together they all added up to a breakthrough.

I still feel sad sometimes–there’s plenty to feel sad about–but I’m not depressed and I’m committed to living.

Sorry for the long post but, if you’re struggling, I want to encourage you to keep an open mind, keep plugging away, and keep trying new things.

PS: I didn’t have bedbugs after all.  I think I was just itchy from the smoke and dry air.  Living with addiction can turn you into a drama addict.

Hedgehogs, Mice, and Echidnas, Oh My

I pride myself on writing realistically about life. You can count on me to tell the truth as I know it, to question everything, and to imagine the worst case scenario. I don’t know why the Pentagon hasn’t called me yet to offer me a disaster-planning job.

But that doesn’t mean I’m depressed, or even “unhappy”—the more generic term. Being a highly-analytical thinker has its rewards. I notice and think about things that other people do not. There’s often absurd fodder for laughs. Sometimes I’m the only one laughing, but that’s okay, right?

There was an article in the Sunday paper about a study that debunked the popular myth that “happy” people are healthier and live longer. Yes! My friend who works in an old folks home—or whatever they’ve been rebranded as now—has always said, “There are plenty of miserable, crabby 90 year olds. And they’ve always been that way, because their kids tell me they have.”

About five years ago, I kicked the depression that had dogged me all my life. Since then I have felt mostly contentment, punctuated with the normal situationally-appropriate emotions. I felt angry when my landlord raised my rent $300 a month, which forced me to move. I was stressed when I moved again three months later so Vince could live with me. I was anxious when Vince was in solitary confinement. I cried for everything my sister and her kids went through when she had cancer. I felt awe hiking in Petra, in the Jordanian desert, and nervous about crossing over into the Palestinian territories. I felt powerless rage when I was banned from visiting Vince. I had a blast with my friends in Berlin. I’ve been bored at work. I was proud when Vince led his squad at his graduation from boot camp. I am excited at the prospect of remodeling my kitchen.

Hey, I guess I just wrote my Christmas letter!  What a year it’s been.

None of it lasts. Some people figure this out somehow, much earlier in life than I did. Emotions come and go. The pleasant and the unpleasant, they’re all fleeting. So enjoy the nice ones while they last and know that the bad ones will dissipate. Don’t panic if you feel blue once in a while. Don’t latch on to the negative feelings or thoughts. If the blues don’t go away for weeks, of course, seek professional help.

In the last week I’ve had some really good times with people I love.

Yesterday I took my mother to tour the Purcell Cutts House, a prairie-style home build in 1913 and owned by the Minneapolis Institute of Arts. This is the living room:

Purcell Cutts

The guide explained that the simple, serene style was in part a reaction to the chaos of the age. The architect was from Chicago, which was the industrial center of the U.S. Meat packing and other industries attracted droves of immigrants and African Americans from the south. There wasn’t enough housing, and the water and sewer systems weren’t up to par. There were no child labor laws, workers’ compensation, welfare, or social security.

So architects brought nature and art inside. Obviously this was not a house that could be produced on a mass scale. The immigrants and African Americans still lived in poorly-heated hovels. But at least this one architect could escape all that and find sanctuary at home!

Last weekend, I hosted a cookie-baking party for Vince and his cousins.

Hannukah HedgehogsTaisei n me

They’re not pretty, but we had fun. Strangely, Vince and I had prepared enough dough to yield 16 dozen cookies but only nine dozen made it to the final stage. Hmmm…or should I say, Mmmmm….cookie dough?

So enjoy the moments that contain things you love. In my case: design, craftsmanship, nature, history. Kids, creativity, and cookie dough.

A Break from Breaking Free

ANNE

Vince says he’s hit a wall with the blogging, and I need more than 10 minutes notice to come up with new material.  After over a year of blogging and nearly 200 posts, I’d say we’ve earned a break.

We’ll be back.  If you haven’t yet binge read the thing from the beginning, start here and click on the right-pointing arrow at the bottom of each post to proceed.  Feel free to share with others, and thanks for reading.

 

Dear Vince

VINCE

This is another one of my treatment assignments. My dear mother has been waiting for me to publish this for a while since it’s actually written by her.  Well, sort of.

It was written by me during a phase of treatment in which we were learning about the ripple effect. Not quite like the butterfly in China causing a hurricane in Iowa.  Or whatever.  This is more like how my actions, however insignificant they may have seemed at the time, affected my friends, family, and society.  The assignment was to write a one page letter from a victim in our ripple.  I chose my mom pretty quickly because I believe my actions have had the greatest effect on her over time.  It wasn’t supposed to be hurtful or degrading, but simply state, from her point of view,  my actions and how they made her feel. It was well received by counselor and peers, but I still don’t know if I really hit the mark. I guess I’ll find out soon. I wrote it from the time just after my arrest for my current charge.  Here goes:

Vince, I haven’t seen or heard from you in so long.  But for now at least I know where you are and that you are safe.  When I heard you were arrested I can’t say I was surprised but I was still sad and hurt.  On the other hand I was grateful that you might have another chance at recovery.

In your nearly five years of sobriety, you shined.  You were always a favorite with the kids in both our, and our extended families.  They looked up to you. They admired you, and loved you. We all loved you since the day you were born.  Then, without any warning, you disappeared.  For the second time in a decade, you fell off the face of the earth.  Because of your history, we knew more or less what was going on.  And from our experience we knew that any attempt to communicate with you would have been shot down.

After a couple years, the second time around, you showed up and said flat out you were using again and if I wanted to be part of your life I needed to accept that.  Well, I did.  It was tough.  You drank so much and so openly with your friends but you seemed happy.  But every time I would bring up the future, or school, or family, you shut down and didn’t want to talk about it. So I stopped bringing it up.

Then after eight years you were gone again.  The closest friends you have ever had couldn’t tell me where you were.  They were just as confused and upset as I was.  For a while I was so afraid that you would show up dead in an alley or on the side of the road, but then you showed up on the news, and you were finally somewhere again.

Since then we have become closer than ever, as a result in large part, by you being open and honest about everything with me and more importantly yourself.  I’m glad you are excited about being where you are. I hear in your voice and in your letters the same enthusiasm about recovery you had when you left Hazelden and Florida.  Me and the rest of the family will be here for you when you get out.  You will always have our full support in every way as long as you remain active in your recovery.

And that’s it.  When I was writing it I recall feeling sad for the first time in treatment.  I don’t often feel emotions, and rarely do they make me feel bad but this assignment did just that.  Even though that wasn’t the point of it, I thought of a lot of bad times I’ve had with her and because of being high or drunk nearly all of my adult life.  I hope you get out of it what you can mother, and I’m sure I’ll hear your thoughts on it in the morning!

For the rest of you. Well my day to day life is a struggle.  I don’t have a job yet.  I am not worried. My agents are not worried.  But I can tell my mom is.  I communicate with the world three times a week for an hour at A.A. meetings, through this blog and on Facebook.  I do not like talking to people outside of my family or very few friends, all of which I was incarcerated with.  Shit.  I’m over 700 words.  Until next time.

Addiction: Disease or Habit?

ANNE

I chanced upon this article, Addiction is Not a Disease, by Laura Miller in Salon.  It describes how addiction used to be considered a moral failing, then was reconsidered as a disease with the rise of 12 step programs, and now neuroscientists are thinking it’s more of an extreme habit.

Miller bases her article on the book Biology of Desire by Marc Lewis, a neuroscientist who is a former addict himself.  He posits that addicts have a “particular ‘emotional wound’ the substance helped them handle, but once they started using it, the habit itself eventually became self-perpetuating and in most cases ultimately served to deepen the wound.”

The disease model has been supported by the fact that addicts’ brains are different.

“The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed ….

“More and more experiences and activities get looped into the addiction experience and trigger cravings and expectations like the bells that made Pavlov’s dogs salivate, from the walk home past a favorite bar to the rituals of shooting up. The world becomes a host of signs all pointing you in the same direction and activating powerful unconscious urges to follow them. At a certain point, the addictive behavior becomes compulsive, seemingly as irresistibly automatic as a reflex. You may not even want the drug anymore, but you’ve forgotten how to do anything else besides seek it out and take it.”

The good news is that habits can be unlearned.  AA and NA and other 12 step groups do work for a lot of people.  Others may need cognitive behavioral therapy, or meditation, or something else, or all of these things.  It’s kind of like how I fought long-term depression by trying everything, until something broke through.

I’m all for understanding the causes of things, in case that knowledge points to new solutions.  I’m also big on measuring success to discover what works.  This article in Scientific American basically concludes “we don’t know” whether AA works because (in my lay language) it’s too loosey goosey to study with the gold standard of the randomized clinical trial.  It works for some people and not for others, and there are probably as many reasons for both outcomes as there are members.

On a long drive a few evenings after reading the article about how addiction is not a disease, I caught this one-hour podcast about the history of Alcoholics Anonymous.  I knew most of the story already, how two chronic inebriates, Dr. Bob and Bill W., found each other and developed the AA program based on something called the Oxford Group, which had gotten started in England and which was overtly religious.

The story is poignant.  Both Bill and Bob were headed for early graves.  Instead, they met each other.  Talking about their problem with someone who also had it worked some magic that no amount of nagging by their wives or warnings from doctors could.  Bill’s wife Lois and another recovering alcoholic’s wife, Anne, founded Alanon, to help them recover from their own insanity caused by living with alcoholics.

There are lots of “gurus” out there who will tell you that you have to go to AA or Alanon every week for the rest of your life, or that you have to give up every mood-altering substance—from heroin to caffeine to sugar—or that “real” meditation is only done in the early morning, for a minimum of 45 minutes, sitting in the lotus position.

I say, be open to trying a variety of solutions, and equally willing to stop using things that aren’t working.  Why would you want to limit your options when you’re up against something that could make your life miserable, kill you, or land you in prison?