BY: T. Franklin Murphy | December 17, 2019
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Recovery is a process of growth. There are four domains of growth that we should concentrate on to catapult us back into the game of life.
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A common obstacle to recovery is confusion on what to do after detox. Expelling the toxins from our blood doesn’t magically heal life. It just prepares us to engage in life. Continued human growth is a noble endeavor for everybody but especially relevant after detox.
But where do we begin? Franklin D. Roosevelt wisely counsels, “There are many ways of going forward, but only one way of standing still.” Years of addiction often leave a life in shambles, putting life back together is a chore. Successful recovery capitalizes on our capacity to grow. We can move forward in many different directions; we just can’t choose to stand still. Detox is a momentous step—getting clean is a priority. A chemical reliance is an ominous foe to recovery. For many, just getting out of the starting blocks seems impossible. Detox rightly deserves full attention. But once the demons of dopesickness are dispatched, we must shift. A gigantic hole needs filling. We must reengage in life-long development—human growth. Recovery is returning to life, growing through emotional and socially developing activities. Medically assisted treatment (MAT) has scientifically proven success, lifting many past dopesickness and pushing them towards sustainable recovery. Uncertainty about the next step after the initial success of detox, often ends with an unwise decision to prematurely eliminate the medical prescriptions. With so many honorable paths available for continued development, eliminating medicinal assistance can be postponed. We start the process best while still benefiting from chemical stabilization. Get life in order first, establishing new habits and then eliminate any medically prescribed assistance. "With so many honorable paths available for continued development, eliminating medicinal assistance can be postponed." The first months of recovery are bleak (see Boredom and Relapse). Our brains are still sensitive to the faulty reward system, heavily influenced by immediate rewards and blind to future costs and benefits. External stimulus frustrates and frightens a delicate recovery. Hang-on; it gets better—much better. Our brain rewires; it just needs time. The initial changes to our motivational programing takes months, but once engaged, the growth can continue for the remainder of our lives.
Growth occurs naturally and intentionally. Spontaneous growth is spurred by new environments. Internal elements and external surroundings stimulate or hinder development. We can intentionally influence this process by creating environments that reawakening our potentials. “One day at a time,” a staple motto of AA and NA groups is applicable. But at the dawning moments, success is more constrained, a day is much too long and full of too many temptations, “one moment at a time” may be more appropriate. This is the necessary beginning. New automobile drivers find the multi-tasking overwhelming. The inexperienced driver must first concentrate on immediate threats; a person in the first stage of recovery must do the same. Both driver and newly sober addict are vulnerable. But with experience, the expert driver lifts their gaze and prepares for future hazards, leaving more time to adjust. And with experience, the recovering person lifts their sights, prepares for obstacles and avoids costly last minute decisions. 
Making it through detox is a courageous accomplishment. The next goal is creating a protective environment that promotes growth. We must lift our gaze. It’s time to develop skills to successfully live in a complex society. There are four key areas: life skills, emotional skills, self-discipline, and social expertness.
These domains overlap. Our mastery in these key areas will guide us through recovery and place us firmly back in the game of life. After years lost to addiction, we must first brush away interfering justifications. Any inkling that we have mastered any of these primary domains is certainly a protective lie that must be dismantled. We must humbly accept that our addictions have rendered us dysfunctional and we need repairing. We are not stronger, smarter, or more capable than others lost in addictions. They need help; we need help. Life Skills:
Life skills are necessary for survival. In addiction we lose critical skills. The addicted life is driven by need. Time loses power. Internal cravings rule the clock. However, modern society is structured. Clocks and calendars are basic tools as necessary as the spear and fire were to our ancestors. Bills, appointments, and services have order, specific hours of operation, and defined rules of engagement. For us to successfully navigate these demands, we need new habits and constraints. Unfortunately, social agencies appointed to assist the needy are not driven by normal market influencers. The red tape is knotted and confusing. My experience is that many government employees distastefully and self-righteously judge the clients as inferior. They prefer to send away an applicant and move to the next in line rather than assist. Navigating these mazes of bureaucracy often requires multiple trips, analyzing conflicting advice, and enduring dehumanizing stares. Life skills are essential. “After stopping, anyone who has been addicted is extremely vulnerable. The addiction itself has taken a toll both physically and psychologically. They have forgotten how to deal with everyday life without the drug and they have to start learning how to cope. A radical turnaround starts with simple steps in mastering life skills, as well as filling the gap left by the absence of drug-determined activities” (Addenbrooke, 2011). Full time employment is necessary. The world of work is wrought with challenges to newly developing capabilities. Each employer has their own set of rules. We must skillfully perceive written and unwritten laws and work within these boundaries. 
Emotional Development (Emotional Regulation)
One of the most vicious consequences of addiction is that it retards emotional growth. The powerful chemicals interfere with reality and altered existence sparsely provides opportunities for development—we can’t adapt to realities that we habitual avoid. Addiction is a powerful defense to discomforting emotion—a maladaptive reaction. “When adults use drugs to cope with their problems, they. . . undermine the adaptive responses they might have learned, and they fail to develop the new ones that are needed to survive in our continuously changing world” (Rusche, 2007, p. 107). When new to sobriety, we will experience a rollercoaster of heightened emotion; normal emotional sways are magnified. These emotions don’t have to be frightening. I prefer to think of them as exhilarating, jarring from side to side with slow raises and significant drops. We mature with regular emotional contact, learning to redirect their energy towards healthy action. Emotion becomes the wind blowing against our sails, moving us over the choppy waters from the ebbs and flows of life. We just need to control the rudder. At first, contact with feeling can overwhelm. We must learn to feel and accept; emotions are not the enemy. The first step for emotional development is dismantling of impenetrable barriers—the protective defenses. We must become open to emotion. Compassionate exposure to feeling developments our capacity to adapt to emotion without maladapted reactions. Our emotional development flattens the emotional waves. We can then move forward, feeling the richness of the joys and sorrows of existence. (See Focusing on Feeling). We must learn to feel and accept; emotions are not the enemy. Self-Directed
Putting our lives in order is work. We must accomplish tasks that avoid immediate harm but also lighten burdens on our futures. Future focused action must be forced at first; only to become habits later. We rewire our brains through forced attention. Overtime, deadlines and opportunities become emotionally salient, creating their own motivation. Our bodies adapt to the habitual presence of the future, spurring action to invite non-immediate rewards and to avoid the risks of future set-backs. We must lift our gaze. When lost in addiction, action waits for emergency to call. This programming doesn’t work for recovery. We can’t succeed through thoughtless reactions. The reactionary style creates the problem of addiction and leads to dreaded relapses. The anxiety of reoccurring (self-made) emergencies whittles at resolve. When we wait for the emergency to act, life obliges, providing constant emergencies that demand action. We must grab this angry bull by the horns and change it. When unprepared, the onslaught of offensive charges never stops. We can’t wait for breathing space to adjust—the space will never arrive. The unplanned expense, illness, or traffic jam wait to pounce and consume. Our lives already burdened from neglect can’t absorb too many more set-backs. Life set-backs can’t be eliminated; but can be minimized. Goals, planning, and preparation greatly enhance our ability to combat the unexpected. Many emergencies never materialize when we are prepared. Preparation is action when an immediate response isn’t necessary. So, get out of bed, turn off the video game, and do some preparatory work. 
A recent study on ambiguous risks published in JAMA Psychiatry expands on this topic. The world of everyday choices is full of ambiguous risks. Most problems that haunt our futures are not predictable. We know things will happen, and we know there will be obstacles; we just don’t know what they will be or when they will happen. A dark cloud surrounds our futures that greatly diminishes visibility. This study tested 70 opioid use patients in treatment to measure their known and ambiguity risk tolerance. They compared these findings with later successful completion of treatment. They discovered that relapse was significantly associated with higher levels of tolerance for ambiguous risk (Konova, et al. 2020). This is significant. The common risks of normal daily life were typically ignored by those who failed in recovery. The unknown probability of something bad happening did not motivate preparation or avoidance.
Risk ambiguity is the chance of being caught in a crime, having a lie detected, or falling back into tempting environments. We must fortify our lives, avoiding actions that invite harsh consequences. We can’t just avoid the obvious stupid things; we must avoid the actions that randomly punish. I most likely can drive home drunk and get away with it. I can’t drive home drunk several nights a week and get away with it. I’ll either crash or be arrested. I’ll eventually suffer the consequence, maybe tonight, or may be next year. I just don’t know. Drug overdose is the current leading cause of unintentional death in the United States. Opioids (including fentanyl) accounts for the largest cause of these lethal doses (47,600 deaths in the United States in 2017). However, the growing literature and general knowledge of these dangers have little impact on the continued use. An intravenous drug user will typically explain that their specific habits of injection eliminates the risk. It doesn’t; and many unfortunately will die. Their tolerance for personal risk is gently wrapped in swaddling lies of self-justification. Leon Festinger’s theory of cognitive dissonance explains this paradox of self-deception. Festinger’s theory tells us that becoming aware of conflicts between our beliefs and our actions violates the natural human striving for mental harmony, or consonance (Banaji & Greenwald, 2016, p. 59). Basically, the mental gyrations of justification alleviate the appearance of risk. And since ambiguous risk is far from certain, bypassing of appropriate caution routinely goes unpunished. And as in the cited JAMA article is also predictive of failure. Habitual ignorance of risk is different than calculated exposure. Repeated disregard of potential dangers surely will backfire. Every now and then, we lose and get bitten—and consequences bite hard. The habitual risk taker loses another job, destroys another relationship, stumbles into another arrest, and finds themselves back in the throes of addiction. "The road to recovery will not always be easy, but I will take it one day at a time, focusing on the moments I've dreamed about for so long."
Amanda Lindhout Successful recovery requires avoiding places and circumstances where the possibility of relapse is present—very ambiguous. Recovery is achieved through a chain of non-emergency choices. Success in most ventures is achieved with proactive action before the emergency. We read the assigned chapter in biology tonight because we don’t know what next Tuesday (the night before the exam) will be like. We don’t shoot heroin because we don’t know how we will react in dopesickness. Ignorance of ambiguous risks are magnified by poor predictive abilities. This awful mixture is a destructive cocktail of dysfunctional adjustment. We ignore the risks and mis-predict our response, relying on strength we don’t have and ignoring susceptibility that is present.
A Self-disciplined response is proactive preparation for possible complications that can beset the recovery progress; actions not motivated by known emergencies. Carter lived under the cement structures of a busy overpass near the San Francisco Bay. He was one of many intravenous drug users calling this small dirt lot their home. Although Carter spoke often of change, the heavy ball of heroin and unbreakable chain of addiction scarcely prevented any delays to his next fix. Carter’s moment of freedom, paradoxically, came from incarceration. After a short stay in jail, he was transferred to an inpatient recovery program. Upon graduation, Carter joyously swung his fists in the air signifying is momentous conquest. He escaped the horrors of homelessness and addiction. Assisted by the program, Carter found a union job with a nice paycheck and plenty of benefits. But his recovery was not complete. Carter’s freedom wasn’t an expression of strength; but a change in circumstances. He needed continued development. We’re all weaklings, given enough adversity we collapse. If we believe differently, then hard lessons will soon follow. Carter, believing he was now free, ignored the ambiguous risks of relapse. Carter ignored the repeated warnings of occasional use and old social scenes. Carter felt stronger than other people in recovery. He would never exchange his new life for the old existence under the bridge. He returned to his old social circles, bragging of his employment and housing. Carter’s story of recovery ended as quick as it started. His life ended, lying in the cold dirt under a familiar overpass. Carter subordinated everything in his life (shelter, sustenance, and family) to injecting heroin—twice (Bourgois & Schonberg, 2009). Social Skills
A lethal consequence of addiction is the loss of the protective shield provided by a family or a group (Jung 1976, p. 624). The stigmatized conception of addiction fills victims with shame and guilt. In the face of unconquerable cravings and misguided judgments, drug users sever relationships. The drug of preference becomes the primary relationship and only others willing to accept the addiction are allowed into the circle. Oddly, those that allow the dysfunction to continue are praised. “They are the only one’s that understand me.” Anyone that sparks discomfort is avoided. This ugly part of addiction prevents growth, ensuring the drug remains the most powerful influence in the addict’s life. In Mary Addenbrooke’s intriguing book, Survivors of Addiction: Narratives of Recovery, she explains, “The addicted lifestyle has to be protected, because of the shame. This is often hidden under a cover of bravado and it may involve secrecy and complicated deception – so that the addiction can continue unhindered” (2011). Addiction is isolating. The drug user willingly violates rules of social decency. These patterns of engagement become intricately woven into the brain. Social sense is exchanged for the next fix. Changing dysfunctional relationship adaptations is essential for recovery. Others matter; trust matters. Reconnecting with healthy people (employed and stable) is necessary. They hold us accountable. Social ethics of honesty, respect, and compassion must be reestablished. People matter more than substances. Addenbrooke in remarks following the self-report of a client that habitually failed in treatment wrote the following, “the addiction has taken over Lee’s life so that in place of growth, there is deterioration. It has led him into an enfeebled infantile position, dependent on others. It has a life of its own which is sucking his life-blood dry. . . The drugs have ‘got him’” (p. 144). Lee couldn’t escape his justifications. He continued to avoid healthy relationships and truncate emotions. He was left to contend with life ill-prepared and alone. His recovery never gained traction. We need people to succeed. Recovery is an exercise in humility. The twelve-step programs emphasize the powerlessness of addiction. The years of false bravado, expressed intelligence, and followed by incomprehensible action must be reversed. We must embrace the fear, accept our ignorance and begin to act with wise preparation. This requires humility and courage.
Others aren’t perfect. Most are inexperienced with the temptations and obstacles that a person addicted must face. We quickly discover that helping hands give way. Friends, family and professionals occasionally disappoint in their humanness, falling short of our expectations. Our social development comes from tolerating the complex and mixed feelings that accompany imperfect relationships. We can’t demonize the people that give imperfect support. We must capitalize on these valuable resources. We need these people. Life flourishes with relationships that are simply ‘good enough’ to promote development. Recovery that journeys through these four essential domains repairs our brokenness. Our successes (and even failures) can lift us from helplessness back to a healthy life. Our mental health, physical wellness, and emotional stability will improve, creating the atmosphere where healthier relationships can be established. In this state of being, we can declare freedom from the demons, and glory in a promising future of love and comfort. Please support FLS with a share:
Resources:
Addenbooke, M. (2011) Survivors of Addiction: Narratives of Recovery. Routledge; 1 edition. Banaji, M.R. & Greenwald, A. G. (2016) Blindspot: Hidden Biases of Good People. Bantam; Reprint edition Bourgois, P. & Schonberg, J. (2009) Righteous Dopefiend (Volume 21) (California Series in Public Anthropology). University of California Press; First edition Konova, A., Lopez-Guzman, S., Urmanche, A., Ross, S., Louie, K., Rotrosen, J., & Glimcher, P. (2020). Computational Markers of Risky Decision-making for Identification of Temporal Windows of Vulnerability to Opioid Use in a Real-world Clinical Setting. JAMA Psychiatry, 77(4), Rusche, S. (2007) False Messengers: How Addictive Drugs Change the Brain. Kindle Edition |
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