FROM MALIGNANT SHAME TO RESILIENCE: FROM ADDICTION TO RECOVERY
Betty Ford Institute past president Dr Garrett O’Connor shares discoveries from decades of experience on how to recover from addiction: the role of shame, resilience, spirituality and survival in mending broken people, commonalities with survivors of Auschwitz, training doctors – and protecting the next generation.
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COMPLEXITY CAN BE MADE SIMPLE
Addictive disorders cross all areas of life, affecting all demographics of people, politics and science. Never let that deter you from seeking and applying solutions, some of which have been used successfully for decades. They do exist, with exciting developments in brain scanning and empirical research (Project Match among them) proving their value to the wider world.
Why does treatment of addiction seem dauntingly complex? For a start, it comprises at least 10 cultures:
>> internal medicine and neurology
>> abstinence-based treatment
>> 12-step spiritual recovery
>> pharmacotherapy and harm reduction
>> behavioural and dynamic psychiatry
>> clinical neuroscience
>> corporate, non-profit and public-health sectors.
And the players can include: addiction psychiatrists, general psychiatrists, psychologists, psychoanalysts, neurologists, internists, social workers, interventionists, doctors, nurses, clergy, spiritual guides, addiction counsellors (credentialled or not), family therapists, child therapists, body therapists, recovery coaches, sober companions, peer workers, 12-step volunteers (Alcoholics Anonymous, Narcotics/Gamblers/Cocaine/Overeaters Anonymous, etc), Smart Recovery and Rational Recovery counsellors, experiential workers such as equine therapists, clinical researchers, politicians, policy makers, investors…
There are many paths to good recovery. Simplifying the way is research from Project Match, the most comprehensive and expensive research in the world on the effects of treatment for alcohol dependency. Its five-year followup study confirmed that a combination of 12-step facilitation therapy and regular attendance at AA is the most consistently effective method for the maintenance of long-term sobriety.
SOME OF THE BEST RESEARCHERS…
… in my view are: Keith Humphries, Nora Volkow, Alexandre Laudet, Tom McLellan, Lee Ann Kaskutas, Rudolph Moos, Mark Schuckit, George Vaillant, Robert DuPont, Herb Kleber, Bertha Madras and Amelia Arria. Read their work!
BETTER TREATMENT OUTCOMES
Research by Dupont demonstrates a greater than 85% viability of five-years’ sobriety for licensed safety-sensitive professionals, such as doctors and pilots – under certain conditions. What is the formula? It is longer intensive inpatient treatment typically 90 days (Editor’s note: note that “retention” in UK official figures stemming from NDTMS differs greatly from “treatment”) + 12-step recovery, now proven by many research studies + job and/or licence-to-practice jeopardy + mandatory monitoring for five or more years.
As long ago as April 1980, the American Journal of Psychiatry (Judd Marmor MD) published The Six Elements Critical for Successful Psychotherapy. In 1983, Margaret Yates and I followed up with The Correlation of 12-Step Approach with Six Elements Critical for Successful Psychotherapy These were and are:
1. release of emotional tension in the context of hope, and expectation of receiving help – steps 1,2,3,4,5,7
2. identification with the method – steps 1,2,3
3. suggestion and persuasion – 1-12
4. operant re-conditioning – 4,5,8,9
5. repeated reality testing – 4,5,9,10,12
6. cognitive learning about the basis for one’s difficulties – 1,2,4,5,6,8,10.
Science has caught up with practice to the extent that neuroscientist Professor Carlton Erickson stated at the UK/European Symposium on Addictive Disorders in May 2013 that “AA and NA are now regarded scientifically as evidence-based interventions for the treatment of addiction”.
YIN AND YANG: RESEARCH THROUGH PRACTICE, JOY THROUGH SUFFERING
Getting sober requires that we be willing to endure, sooner or later, a period of authentic suffering as we try to regain our personal integrity. Here, addicts draw on the suffering of the past – and the suffering and survival strategies of prisoners who lived through Auschwitz can offer lessons for alcoholics and drug addicts in recovery. Indeed, my work in this area led to my becoming director of the Elaine Breslow Institute at Beit T’Shuvah, the Los Angeles-based non-profit addiction treatment centre which integrates spirituality, psychotherapy, Jewish wisdom and the 12 steps.
FROM AUSCHWITZ TO LIBERATION;
FROM ADDICTION TO RECOVERY
Auschwitz survivor Elie Wiesel was asked about life in Auschwitz. “It was an endless experience of nostalgia, suffering, shame, fear and humiliation. Some link to humanity – a father a friend – was indispensable; without something to hold onto, people could only throw themselves onto the electrified barbed-wire fences,” he recalled.
Some survival behaviours in the camps:
loss of control
numbed feelings, avoidance
Some survival behaviours in addiction:
All the above, without exception.
Traumatic aftermath for survivors following liberation of the camps:
anger management problems
trust! to talk or not? to whom?
survivor’s silence, guilt and shame
PTSD sequelae such as insomnia, psychosomatic disorders, copelessness, etc
physical and mental disorders
relationship/marital and work problems
psychiatric problems such as depression and suicide.
Traumatic aftermath for survivors of active addiction, beginning recovery:
Some or all of the above.
What was it like to live as an alcoholic? For me, it was 25 years of shame, fear, remorse, despair, humiliation and dehumanisation, deceit, hypocrisy, moral and spiritual bankruptcy, periodic episodes of suicidal intent… Recovery made possible an indispensable link to humanity, without which my sanity and even my life might have been lost.
But recovery has brought more: a higher power, real friends, a loving wife and children, a sponsor, a therapist, service to suffering alcoholics. It has even brought employment and income, and respect.
In contrast, drug/alcohol-induced suffering includes: severe withdrawal syndrome, comprehensive losses, despair, copelessness, psychache leading to suicidal ideation, extensive collateral social damage, family destruction with ruined children, serious legal consequences, demotion or unemployment, financial collapse, physical/mental/spiritual sickness, soul-rotting malignant shame, becoming dehumanised. It is no wonder that shame is omnipresent.
SHAME, RESILIENCE, ADDICTION, SURVIVAL – AND RECOVERY
Neurobiologically, substance and “process” addictions are considered to be disorders of the brain. Clinically, however, it is the broken hearts and shame-drowned souls of ourselves, our families and our children that suffer most from the consequences of our addictive behaviour.
Malignant shame can belong to an individual or a whole family. It can come from adverse childhood experiences: the trauma from adverse childhood experiences is encoded in our hearts and souls, as well as in our developing brains.
Malignant shame is a universal and critical clinical feature of addiction. It leads to isolation, guilt, denial, secrets, silence, hiding and coverups, by everybody in the family.
Malignant shame is the sworn enemy of love, empathy, intimacy, humility, compassion and spirituality. It is catastrophising, destructive pessimism, despair, self-loathing, suicide, rage, fear, envy, hatred, substance or codependence… relapse. Broken promises are, in turn, a major source of cumulative malignant shame.
So integrating negative emotions with positive emotions must be a core element of recovery.
NEUROSCIENCE CAN DETECT “SPIRITUALITY”
Traditional psychological concepts of spirituality are now validated at the tissue level by neurophysiological brain research, especially sophisticated imaging techniques. Hitherto unsuspected addiction-specific neurochemical connections between the limbic system, the prefrontal cortex and the temporal lobes make addiction something more than “just the drugs”.
Addiction distorts communication between the survival and reward centres of the primitive midbrain and the humanising components of the frontal cortex, thus blocking meaningfulness, love, purpose, compassion, judgment and empathy. Spiritual activity in recovery can re-establish vital pathways of connection between these brain structures, opening the door to rehumanisation.
PERPETUATING THE SHAME
Adverse childhood events in my family of origin included:
alcohol other-drug abuse
physical and emotional abuse
witnessing domestic violence
mental illness in the family?
parental separation or divorce.
Adverse childhood events passed on by me to my family included:
90% of the above. One lesson to be learned from the above lists is to do our best to safeguard the next generation.
HIDDEN HARMS: THE CHILDREN
Families suffering because of addiction are riddled with feelings of rage, sorrow, bewilderment and shame. Sadly, those hurt the most by the ravages of alcohol and other drug addiction don’t even drink or use drugs – they are the silent, invisible, children.
In the US, at least 9million children aged 7-12 live with a parent who suffers from addiction. In the UK, at least 1million children are known to suffer from growing up with an alcohol-dependent parent What are the consequences of doing nothing?
For a start, children from addicted families are at higher risk to develop a variety of behavioural problems.
Children from addicted families are 2-4 times more likely to become alcoholics.
Many of these children learn and practice silence, secrecy and denial.
Many of these children suffer from guilt, shame and a lack of resilience.
The family laws of addiction, according to pioneering author on children from addicted families Claudia Black Phd, are “Don’t trust! Don’t talk! Don’t feel!”. Where does that sound familiar from?
What is the cost of doing nothing for these children? Some of the too-high price is:
attenuated social development
decreased human capital,
and lost opportunities.
INTO THE LIGHT: PROGRAMMES FOR CHILDREN
Focused, meaningful and sustainable solutions can be achieved through appropriately designed and delivered children’s programmes, for those aged 7-12 growing up in families struggling with addiction. They focus on resilience, perseverance and success. They are usually four days of intensive prevention and education, with long-term followup. A children’s programme gives them visibility and resilience. It gives them a future. It gives them their authentic voice.
Research on the Betty Ford Center children’s programme, for example, showed that, 90 days after completing it, 85% of the children felt more trust in others. 87% realised that they were not alone in their struggle. 81% feel more comfortable sharing about themselves and their families. 93% no longer felt responsible for their parents’ addiction.
Some of these children will thrive. Sadly, others will not. But all should be given a chance.
LAST WORD: ON DOCTORS…
“9 out of 10 primary-care physicians in the US miss the diagnosis of addiction in their patients”
CASA, Columbia University Study
April 2000; repeated 2012
“4 out of 5 of these physicians do not believe that addiction is a treatable disease.”
“The untutored physicians who write the prescriptions, and the pharmaceutical companies who make the drugs, are the true vectors of the current prescription epidemic.”
“Given the current inadequacy of physician education in the addictions, a doctor’s office could possibly be
the most dangerous place for an addict or alcoholic to seek help.”
GARRETT O’CONNOR MD is one of addiction medicine’s most highly-respected authorities. He headed the Betty Ford Institute, which when it created the definition of recovery now used in the US government’s drug policy. He is associate clinical professor of psychiatry at UCLA and director of the Elaine Breslow Institute for Integrative WellBeing at Beit T’Shuvah. Details at www.ukesad.org/ 2013/01/dr-garrett-oconnor.html.