It’s often said that addiction is but a symptom of greater issues too difficult to deal with. What comes first, the addiction or the dysfunction? Chicken or egg is of less importance than discovering what’s made life so unappealing that the need to escape from feeling trumped all else. In our grandparent’s day, things weren’t talked about. ‘Sweep it under the rug and stiffen that upper lip’ was the way to deal. So much more is now known about trauma and it’s effects. What isn’t dealt with simmers under the surface but doesn’t necessarily go away. Anger, rage, depression and co-dependency are byproducts of unresolved trauma and emotional pain. What does one do when there’s nothing to lessen the pain? Some perpetrate crimes against others. Some escape into addictions. Some become victimized over and over, leaving loved ones perplexed at what seems to be a lack of clarity. Why does Sally move from one abuser to another? Why does Harry rule his family like a tyrant – controlling and haranguing? Why once the addiction is arrested are these problems still rearing their ugly heads?
If the solutions were easy, there would undoubtedly be less clients in treatment centers. One of the advantages of going to treatment in the first place is to gain insight as to what the addict’s underlying issues are. Abuse leaves victims trapped in maladaptive coping strategies, sometimes so unconscious that they are unaware of them. An ideal treatment center has therapists versed in these issues to help one begin the healing process right from the start. Group therapy is another component in assessing how one processes emotions and deals with the world at large.
Victims of abuse tend to carry guilt and shame even though they may logically know they weren’t at fault. Without a thorough understanding of their motivations and what to do with them, peace of mind may be tenuous at best. For those with severe issues, seeing a therapist and finding extra support after discharge can be crucial. It’s an old holdover to believe those who see a therapist are “crazy.” The field of mental health has made great strides from the dark ages when people were locked up and bled or given lobotomies, yet many vehemently resist acknowledging a need for professional intervention. A therapist can help sort out and bring to consciousness that which you may not recognize. And it’s important for sufferers to know they are not alone. There is relief. Freeing oneself from irrational patterns can do much to help ensure a happier life in recovery.
Sometimes women get confused about the difference between humility and humiliation. Toning down the ego and processing feelings should not be confused with wallowing in self-pity. Self-esteem can get in the way of understanding the concepts of 12-step programs early on. Accepting personal responsibility is an important step in achieving balance, but when one has been repeatedly told they are worthless staring at an early age, she may have such low self-esteem that she wrongly believes everything is her fault. Guilt, shame and depression may reinforce that erroneous thinking. Developing trust in others may also be challenging. Diffusing the kind of defensiveness born out of self preservation from abuse is different than the defensive component of denial. The helpless child is now an adult that may still feel powerless.
So that type of powerlessness is different than the powerlessness over one’s substance of abuse. Specific outside support programs such as Women In Sobriety address this confusion by teaching women to empower themselves in emotional areas. It’s important to note that empowerment is quite different from controlling. 12-step programs get to the same place eventually, but time and care with a personal mentor are needed to avoid misunderstanding and taking things at face value. Since it’s nearly impossible to see our own dysfunction in correct proportion, or to see which behaviors are the result of coping with impossible situations, an objective outsider with an understanding of recovery can be of great value in the long run. Once your mentor has a clear idea of who you are and what your issues may be, she can help you to recognize and assess the need for outside help. To stay objective without clouding perspective, it’s best to seek a mentor who you won’t be tempted to form a romantic attachment with. Survivors are notorious for seeking out co-dependent relationships which often end in disaster. Best to leave that out of the picture.
When one has been the victim of childhood trauma and abuse, it sometimes happens that the response mirrors the abuse and victims grow up to be abusers themselves. It’s sad but true, and men are often victims of the same things women are, but they tend to process them differently. Some men begin to look at these issues while in treatment, but others choose to keep that part of themselves hidden away. When alcohol and drugs deaden inhibitions, physical violence or emotional bullying may enter in the picture (this happens also with women). So in addition to the usual baggage that goes with addiction, this form of guilt and shame can flood the addict with self-loathing.
A mother neglectful of her children while in the throes of her addiction is something that starts to be remedied early on. A mother who physically or emotionally abuses her children may not even be able to comprehend why or what to do about it. The man who beats his wife compounds the low self-esteem he started with by his own loathe actions. Even if he appears to have no remorse, unless he is mentally unstable, he most certainly does. This absolutely needs to be addressed with a professional if sobriety is to be maintained. While it may not be something he/she wants to see about herself, healing the whole family unit is of utmost importance, for the addict’s recovery and the safety of all involved.
Stay or Go?
Depending on the severity of the abuse and ages of those involved, the recommendation not to change too much in that initial year of sobriety may not apply. If you are in a situation of domestic violence, returning to the same situation would most likely be dangerous to all concerned and lead to relapse. If you are the abuser, be aware that early sobriety is far from stress-free, so a temporary change of residence while getting help might be best for all around. Focusing on self-loathing won’t do much to break the abuse cycle. Working with a therapist one-on-one is what’s called for.
Finding the right rehab to address these sensitive problems is the best answer. It may take going for a longer term rehab where both the addiction and emotional problems can be sorted out and dealt with, but the results will be worth it. Spending time in a halfway house while undergoing therapy is another option. Finding the right type of help can lead to the hope of normalcy and guilt-free living. The severity of this problem is such that the whole family needs some form of treatment, lest jail or an accidental death be the result.
While it’s normal to be depressed on occasion, being unable to snap out of it and resume life’s duties for months or years is called clinical depression. Clinical depression strikes people from all walks of life and can be particularly troubling for those pursuing sobriety. In many, the depression was what led them to substance abuse to begin with. For others, the depression seemed to appear after a period of abstinence, presenting an extra challenge for those in recovery. The difference between situational (normal) depression and clinical depression has to do with the length of time the depression lasts plus the degree to which it interferes with daily functioning. Major depressive disorder is one of the most common mental health disorders in the United States, and substance abusers seem to have a higher prevalence than those without addiction issues. Some of that has to do with the imbalance of brain chemicals (often involving neurotransmitters Norepinephrine, Serotonin, and Dopamine) which control moods.
Symptoms of clinical depression are:
- Depressed Mood – feelings of sadness or emptiness, apathy
- Lack of Interest or Pleasure in life
- Weight Changes
- Sleep Disturbances
- Being Agitated and Restless or being Sluggish
- Feelings of worthlessness or Guilt
- Feelings of hopelessness
- Brain Fog – Difficulty Concentrating
- Thoughts of Death or Suicide
When a cluster of these symptoms persists for weeks, months or years, it may be that you are suffering from clinical or sub-clinical depression. Clinical depression often responds to treatment by a physician or mental health professional, while situational depression seems to pass after a short time.
In the context of addiction and recovery, depression can seem the norm in early sobriety. It is typical to expect mood swings for the first three months of abstinence, so no treatment is necessary unless it continues on for several more months. It used to be a rule of thumb to wait at least a year to be assessed for depression and other mental health disorders, but that doesn’t seem to apply any more. Those stricken are often treated with antidepressant medication and sometimes co-occurring psychotherapy in difficult cases. In this, an addict or alcoholic would be wise to explore the different antidepressant medications available and avoid those that may trigger a relapse and re-engage the addiction cycle. Tranquilizers and mood stabilizers like Xanax, Valium and other fast-acting medications should be avoided. Antidepressants work differently, directly geared towards adjusting one’s brain chemicals.
Results come on slowly by maintaining a certain level in one’s system achieved after taking for a few weeks. Therefore, there is no “high” involved to trigger the addictive cycle. Because of this mechanism, taking an extra pill when you feel “down” or skipping a pill when you feel “up” will not only have no immediate effect, taking antidepressants improperly can actually create mood swings since the dosage isn’t consistent. For those who were already on antidepressants while active in their addiction, they may find the dosage or type of medication is no longer effective, since brain chemicals are disrupted by the interfering byproducts of one’s addictive substance. These reasons may render the medication ineffective, so abstinence and consistency are important when using these medications if they are to work properly.
Some categories of antidepressants include:
- SSRI’s – Selective Serotonin reuptake Inhibitors
- SARIs Serotonin Antagonist and reuptake Inhibitors
- NRIs – Norepinephrine reuptake inhibitors
- NDRIs – Dopamine reuptake Inhibitors
- TCAs – Tricyclic Antidepressants
- MAOIs – Monoamine Oxidase Inhibitors
- TeCAs – Tetracyclic Antidepressants
- plus a list of other agonists, antagonists and enhancers too numerous to mention
These different types of antidepressants work in different ways, so a professional knowledgeable of substance abuse and mental health issues would be the best place to go in seeking help. It may be important to note that certain drugs like cocaine and amphetamines create a longer period of depression in early sobriety than do other substances like alcohol and opiates. It is also thought that women tend to suffer from depression more than men. Perfectionism and an inability to ask for help may be added factors. There are some non-chemical ways to help alleviate these symptoms in early sobriety and beyond. These include:
- Diet – Avoiding too much sugar and eating balanced and regular meals
- Exercise – A natural way to pump up one’s endorphin system
- Avoid Isolation – getting out of the house exposes one to fresh air and sunshine – natural mood enhancers. And if it’s going to a support meeting to get out, the added benefit is reinforcing abstinence and interacting with others of like mind.
- Getting your Feelings Out – talking about your problems always seems to help.
- Light Up – Not on cigarettes, but a special non-chemical treatment for Seasonal Affective Disorder (SAD) that uses light with a special wavelength to enhance the production of Serotonin.
- Practice Gratitude – learning to appreciate and note the good in one’s life is a direct antidote for always noticing the negative. Make a list each day to begin changing your thinking.
- Distract Yourself – when your mind won’t leave you alone, shut if off by reading, working a crossword puzzle, writing or anything you can think of that will engage and interrupt that negative train of thought. TV may help, but most can still think when watching.
- Be of Service – another non-chemical way to feel good. Who doesn’t when helping someone else?
- Get Involved – find something of interest to do, either with others or alone that engages you.
- Wait it Out – A panic attack won’t kill you (it might feel like it, though), tell yourself it will be over soon and quit fighting it.
- Give In – Instead of fighting your depression or anxiety, let it take you for a day; tell yourself tomorrow you will be more productive and stop worrying.
- Start a Project – Remember all those things you were going to do tomorrow? Pick something fun, creative or interesting.
- Write it Down – On a day when you’re feeling good, make a list of things to do when your brain turns to mud. When it happens, pull out the list and pick something!
- Meditate – It’s been proven that little bit of quite time punctuated by deep breathing can do much to still the mind and lull the body into calm.
- Ask for Help – Last, but definitely not least. It takes practice, but it’s worth it. Practice calling those on your support list when you feel good, so that when you don’t, it’s easier to call.
The list is only partial, since most of us can think of things to fill our time that run the gamut from fun to chores. It matters less what you pick, as long as you choose something that is not self-destructive.
The Ultimate Goal: Emotional Maturity and Balance
While it may be argued that the nature of life tends to make inner balance challenging, having something to strive for keeps one sharp and growing. If you can add “teachable” to the list of desired attributes, life will continue to expand in a positive way. Some of the hallmarks of emotional maturity include:
- No longer lying and justifying, but rather, learning to be accountable for your own behavior
- Letting up on the self-centeredness, realizing others, too, are entitled to their own process
- No more blaming – finding the ability to own your mistakes and make restitution when necessary
- Easing up on the urge to control others – the control and manipulation of others only leads to disappointment. It’s a great way of defocusing on self, but dealing with your own issues should be enough to keep you occupied and growing
- Being mindful of indulging in self-pity. Feel your feelings then move on and find what will help
- Moving out of black and white thinking. Most of life lies in the grey areas rather than right or wrong, yes or no, and other all-or-nothing mindsets
- Controlling your temper. Is it really okay to make others suffer for your lack of restraint? Learn to process feelings in a responsible manner
- Practicing patience – with the realization that life doesn’t revolve around your needs, you may find a tolerance you never thought possible. The truth is that life is full of hassles, so learn to roll with them instead of fighting for your way. Peace is the reward.
- Losing envy – jealousy of others’ success only keeps you from pursuing your own! Find the capacity to enjoy and support the successes of others. Replace negativity with kind feelings and a desire to better yourself
- Practicing empathy makes one less self-centered and helps create enduring relationships.
- Avoids co-dependency, learning instead to have healthy relationships based on mutual trust and interests. The best interactions occur between two independent people with stable boundaries who don’t lean on or try to fix each other. Instead use time to enjoy the each other!
- Losing the grandiosity makes you much easier to be with! Boasting is usually a defense mechanism born of feeling inadequate.
- Accepting criticism gracefully without defensiveness makes you the better person.
- Facing disappointment without lashing out or withdrawing is an art! Look at it as an opportunity to learn from your mistakes.
- Taking care of yourself is your job – not your parent’s or your spouse’s!
- Lowering your expectations to the reality level is key to happiness. People can and do disappoint, so learn to roll with it
- Letting go of resentments will do much to free yourself of negativity. Own your part in each situation; learn from it then let it go.
- Creating your own happiness is key to well-being. Expecting someone or something else to make you happy is missing the boat. Happiness is really an inside job.
Whatever path to recovery you choose, our staff has access to hundreds of treatment centers to assure the best personalized treatment for you, then with continued follow up to help you make the transition to sober living as seamless as possible.
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