“The critical thing is to face our fears—to stay with an emotion we’re having difficulty with, or to stay with the physical pain—and discover: everything’s impermanent; this doesn’t last forever.”
Breaking the Pain-Fear-Avoidance Cycle
Pain has an element of blank;
It cannot recollect
When it began, or if there were
A day when it was not.
—Emily Dickinson
The onset of chronic pain can be, in the words of one Driftwood alumnus, “soul-crushing.”
Pain makes the sufferer’s world smaller. It intrudes on relationships, from the most casual to the most intimate. And when a doctor tells a patient that the pain is unlikely to subside—or can be managed only with drugs that cloud the mind—one natural reaction is despair.
All of these are reasons why people living with chronic pain are at a particular risk of retreating into addiction.
***
“Many pain treatment programs,” according to Dr. Ron Siegel, “take the attitude: ‘let’s first try to resolve your pain—including, historically, with the use of opiates. Once you feel better, we can work on rehabilitation, can make you physically stronger, can help you engage more fully in your life.’ Meanwhile, the research is pretty overwhelming: approaching chronic pain from this angle doesn’t work very well.”
Dr. Siegel—currently Assistant Professor of Psychology at Harvard Medical School, and a board and faculty member at the Institute for Meditation and Psychotherapy—advocates for a different strategy, one that “draws upon cognitive, psychodynamic, and behavioral techniques along with mindfulness-based exercises, combined with everything we know about aggressive rehabilitation.”
“Almost everybody who’s caught in chronic pain syndromes,” he says, “has fallen into some degree of what we call kinesiophobia: the fear of movement. Whether it’s because of medical advice, or because they’ve noticed that certain activities seem to hurt, they start avoiding activity in the hopes of feeling better.”
Sedentariness causes deterioration. As Driftwood Wellness Director Connie Cole put it last month: “If you’re not moving every day, you’re degenerating.”
Inactivity “makes people anxious about using their bodies normally,” Dr. Siegel says. “Pain sensations,” in turn, “are amplified by fear,” creating a kind of feedback loop.
“If you put somebody’s hand in ice water, and you tell them that they’ll have to keep it there for thirty seconds, and you ask them, after fifteen seconds, to rate their pain, they’ll say: ‘It’s not too bad.'” When a person is instead told that their hand must stay in the water for ten minutes, “they’ll tell you after fifteen seconds: ‘it’s freezing! This already hurts.”
To find lasting relief from isolating, debilitating pain, people must refuse to be governed by fear.
***
Dr. Siegel is the author of several acclaimed books—some for lay readers, others for professionals—on mindfulness, psychotherapy, and mind-body treatment. Since late 2019, he has consulted periodically with Driftwood Recovery’s clinicians, helping them create individualized programs of recovery for people with co-occurring pain and substance abuse disorders.
“On a case-by-case basis,” he says, “we consider the factors and forces that are creating the chronic pain for an individual. We pay close attention to the individual’s personal history, family background, psychological dynamics, cultural background and physical condition: any challenges that might relate to the chronic pain, or to possible pathways out.”
Those pathways typically begin with a concept familiar to anyone who has spent time at Driftwood: courageous surrender.
“Pain times resistance equals suffering,” Dr. Siegel says. “This turns out to be the case across the board: not just with pain disorders, but with virtually all psychological difficulties.”
“Say a person is struggling with anxiety. If the person is willing to feel it—to accept anxiety but participate fully in life—their life is not derailed. But if they, for example, refuse to fly on airplanes because they don’t want to feel anxious—well, then, they have an anxiety disorder. Our attempts to avoid discomfort are at the heart of so many of our problems.”
Nowhere is this truer than in the realm of addiction. “Virtually all substance abuse disorders,” Dr. Siegel says, “involve turning to a substance to avoid feeling something unpleasant.”
***
Your pain is the breaking of the shell
That encloses your understanding.
—Khalil Gibran
“The reason mindfulness practices are proving to be so helpful for such a wide variety of psychological difficulties,” Dr. Siegel says, “is that they turn our attention toward whatever we’re experiencing, whether that be physical pain, or sadness, or fear, or joy, or love or appreciation.”
“It’s about opening to experience.”
“The vast majority of chronic pain,” Dr. Siegel says, “has a big psychological component.” In the case of back pain—the subject of Siegel’s bestselling Back Sense—there is surprisingly little correlation between reported pain and the physical problems revealed by MRIs. Many people have bulging or herniated discs, but claim that they have never experienced more than two consecutive days of back pain. “In other words: people who are pain-free often have the spinal abnormalities we point to as the cause of pain.” On the flipside are the “countless patients” who have gone through successful back surgery, but find that their pain persists.
“The therapist’s task,” in such cases, “is to figure out what other process is causing chronic muscle tension, preoccupation with a particular part of the body, and the withdrawal from normal activities that can cause stress and depression, that can tank a life.”
Mindfulness-based therapies, Dr. Siegel says, can break the “pain-fear-avoidance cycle.” With pain management—as with addiction treatment—meaningful recovery begins with acceptance and psychoeducation: “Understand what’s keeping you trapped in your difficulty. Understand how your mind and heart work. Chances are, you’ll end up saying: ‘Oh, I see. The coping strategy that I’ve been using doesn’t work very well.'”
The search for a replacement strategy is, in a sense, a search for new resources.
“That search can start at a place like Driftwood, with the support of a new community that reassures us what we’re going through is okay. It can start with self-soothing strategies like talking to a friend, or getting a massage, or being in nature.”
“The critical thing,” Dr. Siegel says, “is to face our fears: to stay with an emotion we’re having difficulty with, or to stay with the physical pain, and discover: ‘everything’s impermanent; this doesn’t last forever.'”
“It’s your knowledge that you can take on a frightening challenge—that you can enter a wave of pain, pass through, and come out on the other side—that will give you the strength to free yourself.”
***
Watch:
· The Science of Mindfulness, Dr. Ron Siegel’s introductory lecture on mindfulness-based psychotherapy, which has been viewed more than 360,000 times
Listen:
· A collection of recorded meditations recommended by Dr. Siegel
· Jake Knapp’s interview with Dr. Siegel on the popular podcast The Science of Success
Read:
· New research indicates that even a 30-minute introduction to mindfulness can significantly relieve pain: “It’s as if the brain were responding to warm temperature, not very high heat.”
· As doctors become more interested in mindfulness-based solutions to health problems like hypertension, “scientists [may] need to develop new metrics to analyze a potential medical intervention . . . rooted in ancient Buddhist philosophy.“
· A JAMA study finds that “an online version of mindfulness-based cognitive therapy” may aid in the treatment of anxiety depression.
· Mindfulness training for children is gaining traction at home and at school.
“In some ways, a person who comes through a program like ours has an unfair advantage over the general population. Because people don’t ordinarily get that education in coping with life. We’re not born with a manual.
“Every Time I Teach, I Learn”
This is the sixth in a series of posts introducing the people who make up Driftwood Recovery’s community of caregivers.
Through these conversations, you’ll get a chance to meet the people on Driftwood’s team—from its executives to its care coordinators. You’ll learn about the programs they facilitate, and about how their work serves Driftwood’s overall treatment philosophy. You’ll learn about the various paths that brought them here. And you might pick up a book or Austin restaurant recommendation.
In this post, Kuraĝo editor Matt Williamson talks with Driftwood’s Medical Director, Rey Ximenes, MD.
***
Matt Williamson: You have several board certifications, correct?
Ray Ximenes: Well, I have a board certification in anesthesiology, which is where I started. And then I got board certifications in pain medicine and interventional pain medicine. And then I got board-certified in acupuncture and in naturopathy. My last board certification is in addiction medicine.
MW: Could you explain the difference between pain medicine and interventional pain medicine?
RX: Pain medicine is what we all started out doing. It was basically using what we had—mostly opioids—to treat pain. We’ve since gotten into different drugs and medications: gabapentin and muscle relaxers and antidepressants and things like that.
In interventional pain medicine, we use nerve blocks. That means, for example, using a local anesthetic to dull a nerve’s ability to transmit information. We also use steroids to calm inflammation. And we use spinal cord stimulators and intrathecal pumps, pain pumps. We’ll perform what I guess is called “minor surgery,” although that term—“minor surgery”—I’m never sure quite what it means.
MW: Kind of an oxymoron.
RX: Exactly.
MW: So in interventional pain—correct me if I’m wrong—it sounds like one distinction is that you’re not using drugs as often?
RX: Not as often, no.
MW: And the approach sounds much more localized, or targeted. I can see the connection to acupuncture.
RX: Acupuncture is, for me, just another tool. For years, I saw people doing epidurals and facet blocks and radiofrequency thermocoagulation. And I thought: no one’s doing acupuncture. I realized that if I did that, I’d be ahead of the crowd.
MW: Why do you think that this treatment, which is so mainstream in half of the world, has been so slowly adopted in the West?
RX: It’s hard to really know. Back in the day, the Emperor of China wanted to trade with the West. And at a certain point, he actually said: “No more acupuncture. No more Tai Chi. No more Chi Gong. It’s all this magical stuff that makes people think we’re country bumpkins.” They started adopting a lot of Western medicine at that time, and really put down and shunned traditional Chinese medicine. When Mao took over, I think he kind of went, “This Western stuff’s pretty expensive. We’ve got to figure something else out.” He wanted to go back to some the old ways, including acupuncture and herbs.
In the Western world, we think acupuncture is this thing unto itself. We address it as acupuncture, and we have licensed acupuncturists. In the East, they’re kind of scratching their head about that, because traditional Chinese medicine has always included ten or eleven different disciplines. Diet is very important. Exercise is very important. Herbs are of paramount importance. Acupuncture is important, but it’s part of the fine tuning, not the primary thing. Somehow we got fascinated with the art of needles. An acupuncturist here is kind of like a mechanic who’s licensed to use one specific type of socket wrench.
I use acupuncture as a tool. I also use herbs as a tool. I use a lot of exercise. I use Tai Chi and Qi Gong. And I use a lot of lifestyle advice: telling people what to eat, how to eat. It’s truly a holistic approach.
MW: Do you ever teach Tai Chi to residents here at Driftwood?
RX: Yeah.
MW: I assume that most people who stay here don’t have any experience with it. How do they usually take to it?
RX: Honestly, it’s tricky. Nobody’s here long enough to really learn it very well. So what I finally did was to set up weekly lessons at Bull Creek Park. I said: “Look, everybody’s invited, every Saturday morning.” It’s very much the Eastern way of teaching Tai Chi: “just show up at the park and do it with us.” And eventually you will learn.
MW: It strikes me that Driftwood is a small, intimate place. The resident-to-staff ratio is 1-to-2.8; by design, there are almost three people on staff for a single resident. And at the same time, people are coming in with a wide variety of substance abuse and pain problems, and their recovery programs are highly customized. I would imagine that, for the medical staff here, this would present a challenge. You see a little bit of everything, right?
RX: Sure. People come in here and need something very specialized. For example, if someone is withdrawing from alcohol, we’ve got to be careful. We’ve got to really monitor them, and make sure that we have every medication on hand that we could ever need, because one of the problems people have with alcohol detox is they can get into seizures. At the other extreme, when someone has been dependent on hallucinogens, most of the withdrawal is psychological; there’s no full-blown physiologic detox, although symptoms can recur for a long time. You have to look at each person and know what you’re doing with each one.
Anyway: once you’re in the clear, out of your early withdrawal, the approach to treating addiction is similar for everybody. Obviously, there are nuances that are different for each individual. But in the end, the goal of an addiction specialist is to make sure the person is healthy.
MW: When you’re speaking to somebody who has never had a problem with substance dependency—is there some sort of analogy you typically use to help them understand what an addicted person is experiencing? Why is it so hard to “just quit?”
RX: I do have a favorite analogy, actually.
First off, know that addiction takes over the survival center of the brain. I don’t call it the “pleasure center”; it’s the survival center.
There’s a cup of coffee on the table here. Let’s imagine that I told you to take a sip of that coffee, and you didn’t want to. If you felt strongly about it, you’d refuse.
Now: what if I took a .45 out and pointed it at your head and said: “take a sip of the coffee?” What are you going to do?
MW: Take a drink.
RX: That’s what the addict is experiencing in the brain. “If I don’t drink that, if I don’t snort that, if I don’t shoot that, I’m going to die.” The addict might know that they don’t have to. But they feel that they do. And that’s the trap.
MW: Listening to you, I was just reminded of a documentary I saw recently about a treatment center in Alberta. It’s a public, free, seemingly high-quality residential treatment program. In one scene, this guy comes in who seems, genuinely and desperately, to want help. A staffer is explaining to him what he has to do to get into the program. “It’s free, we’ve got a place for you, we’ll just sign you up. The only thing is, you have to abstain from drugs for five days before you enter treatment here.” And the guy seeking treatment says, basically, “forget it. I’ll never be able to do that.”
RX: That’s pretty rough.
MW: You can see that he isn’t even contemplating it. He’s just listening politely after he hears that “five days” is a hard requirement. In the next scene, a different guy is explaining that he would rather die than go through the agony of fentanyl withdrawal.
RX: That five-day period is going to feel like five days of re-enacting The Deer Hunter. Click. Click. Click. Five days of that? You can’t do it. That’s where residential treatment becomes crucial.
Once you get through early withdrawal, though, you’ve come to the most important part of recovery. When you reach that point, what often matters more than anything else is community. You need a group of like-minded people around you, who know something about what you’ve gone through and are going through. Every time you want to go back and use, there are people who are right there, ready to say: “Nah, man. Don’t do that. I did that. Here’s what happens.”
At Driftwood, we keep people busy, and we educate people. I tell people that this is an educational program. Using cognitive behavioral therapy or motivational interviewing, or various other techniques, we’re teaching you how to cope with life events. Because in the end, addiction is about what you’re hiding from. What is it you fear? If we can get people to cope with that fear in a healthy way, then we’ve made it.
In some ways, a person who comes through a program like ours has an unfair advantage over the general population. Because people don’t ordinarily get that education in coping with life. We’re not born with a manual.
MW: You’re talking about skills that everyone needs. But we don’t develop them, because we’re not in crisis situations that force us to develop them.
RX: Why don’t we have seventh-grade AA? Some kind of cognitive behavioral class: Life 101? We pretend like it’s not necessary until it is, and by that time it’s almost too late.
MW: Most people either have incoherent value systems, or they simply haven’t thought about what their values are. We’re nose-deep in this culture that trains us to laugh at the idea of ever getting reflective, philosophical.
RX: Yes, and getting into recovery presents opportunities to inquire, to grow. I’ve learned so much doing addiction medicine. I’ve learned so much about myself. I’ve started paying more attention to the ways I deal with things.
The original meaning of “doctor,” you know, is “teacher.” And so I come out here every week, and I teach. And every time I teach, I learn.
“At Driftwood, the staff and residents always eat meals together, we do a lot of things together, and we don’t ever want the clients to feel like the staff is separate from them. It’s very integrated. We know so much about every client, and work so much on each case. We get creative with every treatment plan, with every discharge plan.”
“No One’s Ever Going to Be Just a Number Here”
This is the fifth in a series of posts introducing the people who make up Driftwood Recovery’s community of caregivers.
Through these conversations, you’ll get a chance to meet the people on Driftwood’s team—from its executives to its care coordinators. You’ll learn about the programs they facilitate, and about how their work serves Driftwood’s overall treatment philosophy. You’ll learn about the various paths that brought them here. And you might pick up a book or Austin restaurant recommendation.
In this post, Kuraĝo editor Matt Williamson talks with Driftwood’s Lead Care Coordinator, Danielle Cobb.
***
Matt Williamson: How many care coordinators do you supervise?
Danielle Cobb: Seventeen at the moment.
MW: Were you a care coordinator when you first started working at Driftwood, or were you hired as a supervisor?
DC: I was a care coordinator. About a year ago, the leadership team here took a chance on me.
MW: And since then, you’ve done all of the hiring, the training, the supervision?
DC: Yes—and also a lot of what I would call “coaching.” Encouraging people to develop professionally, doing what I can to help them achieve their own goals, to get to the place where they want to be in the future.
MW: It seems like the care coordinators do a bit of everything here. I think the impression anyone would get, even walking around the campus as a guest, is that the care coordinators are the people who make this place run.
DC: In some ways, the people I supervise have the most difficult job at Driftwood. They’re here when therapists aren’t—including in the evening, obviously. They offer support in any way that they can: making sure that residents get to meetings on time—and just doing anything and everything that turns out to be necessary on a given day.
MW: How much communication do care coordinators have with the therapists here?
DC: A lot. We do shift reports: the morning shift report, the afternoon, evening, and then the overnight shift report. I also attend Driftwood’s morning meeting, where all of the clinicians are present, so I get a chance every day to bridge the gap of communication between the therapists and care coordinators.
MW: If this question isn’t too open-ended or tedious: could you walk me through all of the different interactions that a resident might have with care coordinators over the course of a day—from the time when they wake up to the time when they go to sleep?
DC: We come on at seven and wake everybody up. We have a communal breakfast with the residents. Then there’s a bit of exercise time and some personal time for the residents. After that, we help people get to their therapeutic programming. There are group sessions running back-to-back through the morning. Through that part of the day, our job mostly involves shepherding people from one group to the next—pulling people in and out of groups for individual therapy, appointments, massages, things like that.
After lunch, there’s more programming, and a couple more groups. And then residents either do group exercise, or an experiential activity off-property. That could be kayaking, yoga, paddleboarding, hiking, bowling, rock climbing—you name it, we do it all.
We have a communal dinner. And then residents have a bit of down-time between dinner and the night’s AA meeting, which is off-property.
MW: What meetings do residents go to? Are they in Austin?
DC: A lot of the time, yes. The location varies. The care coordinators confer and make a decision based on the needs and interests of the residents who are staying here.
A lot of the staffers here are in recovery. We’re familiar with the meetings around town, and we know what meetings are likely to be most beneficial for the clientele that we have currently. Maybe we have a lot of older clients, so we’ll take them to a meeting with people they might relate to. Or maybe we have a lot of young clients and we want to get them involved in a younger community, in which case we’d likely take them to a meeting in the city.
MW: And then finally, you’re back at Driftwood—
DC: And it’s wind-down time. We have tea and group meditation right before bed.
MW: You mentioned that many of the care coordinators are in recovery. Some of the alumni I’ve talked to have mentioned the importance to them of being cared for by people who have gone through many of the same experiences they’re going through.
DC: Sure. But what makes Driftwood special isn’t necessarily that most of us have experience with some sort of recovery path, but the culture here. The love and support and connection and community we have here is unlike anything that I experienced in treatment. It’s unlike anything I’ve seen while touring other residential facilities. We’re a very much a community—a diverse community. That’s where a lot of the power is.
MW: You’ve worked here since this place first opened. It’s grown quite a lot since then?
DC: Oh, yeah.
MW: How is that changing your job?
DC: Driftwood’s growth has felt like a managed, gradual process. We’ve been able to on more staff, or add more programs, at the moments when we’ve needed them. So it doesn’t feel like there’s been a whole lot of abrupt change. We’re a well-oiled machine. But we’ve had to be flexible in our thinking—open to new ideas and systems. In the beginning, we didn’t need a lot of that, because the place was so small.
MW: Can you give an example of a system that you might have been reluctant to put in place initially, but that you’re using now?
DC: I was thinking mainly of the systems we use for communication. In the early days of Driftwood, the care coordinators were able to just talk to one another about anything important. We’ve retained that family feeling, but now, for instance, we do use Slack to make sure that everyone is up to speed on everything.
But what’s more striking to me is how many things are remaining the same. I truly believe the leadership team when they promise that we’re never going to lose our culture. I believe that.
MW: What are some of the features of that culture that you’ve seen that seem especially important to you—things that, if they disappeared, would be a real loss?
DC: At Driftwood, the staff and residents always eat meals together, we do a lot of things together, and we don’t ever want the clients to feel like the staff is separate from them. It’s very integrated. We know so much about every client, and work so much on each case. What we offer is very individualized, in part because we have the time and staffing to do that. No one’s ever going to be just a number here. We get creative with every treatment plan, with every discharge plan.
MW: Is there a time of day, or of the week, when the care coordinators get together to share their experiences with one another, to offer moral support, and so on?
DC: Not exactly, because we’re all so close. We do have care-coordinator meetings. But we also have three people working together on every shift. So that kind of moral support is naturally given every day, every shift.
MW: If someone was considering residential treatment here—for themselves or for a loved one—what’s the thing you’d most want them to know?
DC: When I came into recovery, I only learned one set of strategies, one set of ideas about addiction and sobriety, and they happened to work very well for me. So I came to Driftwood not knowing much about the clinical side of the programs here. This place has taught me that there are multiple pathways to long-term sobriety. Meeting people where they’re at, that’s what guides people into long-term sobriety, right? What worked for me might not work for another person. But something is going to work for them, and the staff at Driftwood is going to be patient and curious and compassionate enough to help them find that thing.
“Some trainers have one way to do something. But every client is different. Each body is weak and strong in different ways. I see that uniqueness in the residents who stay at Driftwood.”
“Everything Was Preparing Me to Be Right Here, Right Now”
This is the fourth in a series of posts introducing the people who make up Driftwood Recovery’s community of caregivers.
Through these conversations, you’ll get a chance to meet the people on Driftwood’s team—from its executives to its care coordinators. You’ll learn about the programs they facilitate, and about how their work serves Driftwood’s overall treatment philosophy. You’ll learn about the various paths that brought them here. And you might pick up a book or Austin restaurant recommendation.
In this post, Kuraĝo editor Matt Williamson talks with Driftwood’s Wellness Director, Connie Cole (CPT, CHC, CYI), and Ryan Potter, a health coach in the Wellness Center.
***
Matt Williamson: Connie, you’ve been at Driftwood from the beginning, right?
Connie Cole: I was here before the beginning! This place was a bed and breakfast. And I helped design the Wellness Center.
I was working as a personal trainer, and one of my clients was the woman who was building this place. I mentioned to her that I was in the process of selling my studio. And she was like: “Oh, I’m building a gym. You should train your clients out there, and you can train me, too. We’ll work out some deal.” I had no idea that she was building this beautiful facility. She was in the process of turning a raccoon-infested house into a state-of-the-art gym, building it up. I ended up working out here as a trainer for four years. And then she decided to sell the place.
When she sold, I was like, “oh, no—what am I going to do?” But then Driftwood Recovery’s founders came out, and I happened to meet them. They had several months of preparatory work left to do, and they said: “you don’t have to leave. Just keep meeting your clients out here until we open. It’s no problem.” They didn’t know me from the man in the moon.
Then I started training them. They discovered that my specialty was working with people with disease and disability: chronic pain, bad shoulders, a bad back, bad knees. So they hired me. For the first year and a half, I helped them develop Driftwood’s wellness program. And then we hired Ryan because we were growing so fast. I’m here full time, and Ryan comes in from one to five. That’s when a lot of the activity happens—in the afternoon.
MW: Ryan, what were you doing before you came out here?
Ryan Potter: I was at UT, studying kinesiology. While I was a student, I worked for the men’s basketball program. I was a strength intern. I facilitated and administered training regimens. That could mean something as simple as changing weights, or it could mean workshopping an entire strength program with a student athlete. During the summer and offseason, we did a lot of stretching. I found out that stretching the leg of a seven-foot-tall athlete is a three-man job.
The guys that were our strength coaches there have gone on to bigger things. One of them is coaching for the Philadelphia 76ers. Another one is an associate professor at a university. So even outside of class, I was learning from highly accomplished, deeply knowledgeable people.
A lot of that work at UT involved rehabbing injuries, teaching people how to work around injuries. That all became directly relevant to the work I’m doing now at Driftwood.
MW: Connie, what got you interested in working with people in chronic pain?
CC: I started out as a martial artist thirty years ago. And my master was hurting people. We were using our body weight to train, and he was popping Achilles tendons, breaking shoulders. I kept thinking: there’s got to be a way to do this without injury. That’s how I initially became interested in training: I wanted to become a better athlete without hurting myself.
But when I started working as a trainer, every client seemed to have a bad back, or some other ailment. Because I wanted to help them, I started studying ways of training people for function, training them to feel better. The transition to my current chronic pain specialization was very natural.
MW: I had this personal trainer a few years back who was a former Big Ten football player. And this guy did not understand my limits at all. He wanted me to do all of this stuff that I wasn’t comfortable with. Even if everything was safe—I’m sure it was—it didn’t feel safe. I kept trying to make him understand that I wasn’t hoping to compete on American Ninja Warrior; I just wanted to be in slightly better shape! I wish I’d worked with you two instead.
CC: Some trainers have one way to do something. But every client is different. Each body is weak and strong in different ways. I see that uniqueness in the residents who stay at Driftwood. We get people who are extraordinarily conditioned—over-conditioned, even. We get people who are in wheelchairs, or who have been run over by cars, who are in pain in ten different places in their body.
My background has helped me deal with that variety. In a way, I feel that for my whole life, I was training to do this job—like everything I did was preparing me to be right here, right now. I’m doing my dharma. This is what I love.
MW: What do you mean by “over-conditioned?”
CC: You’ve heard of cross addiction. We have people out here, sometimes, who are addicted to exercise. They’re not necessarily bodybuilders, and they don’t necessarily have body-image problems; they just have to exercise every day, to an unhealthy degree. You should exercise every day! But that doesn’t mean you should do CrossFit every day.
MW: Why not?
CC: If someone took a bat right now, and lightly beat you all over your body, your body would produce free radicals. A lot of inflammation happens. Your body would be in disrepair.
Something similar happens with your entire body is overworked through exercise. Did you get that soreness from being beaten up, or from overexertion? Your body doesn’t know the difference. Many of the same physiological results happen.
MW: How do you customize a fitness program for a new resident?
CC: Every resident that comes here—whether they’re on the pain track, or on the chemical dependency track—gets an assessment by me. People in the pain program get a more thorough evaluation, because they need it. They also get evaluated by our medical director. They get evaluated by our nurse practitioner. They get evaluated by Dr. Melanie Somerville. Then we all collaborate on how best to get them out of their pain or get them functional without whatever substances they were using.
MW: What are you literally doing during that initial assessment?
CC: I jokingly refer to it as a Vulcan mind-meld. I try to find out as much as I can about their pain. Is it localized, or is it a systemic inflammatory pain, like Crohn’s disease? A person might come in with pain from a traumatic brain injury. I ask where they’re feeling the pain, and they show me.
At that early stage, we won’t use weights or anything like that. We’re just talking. Sometimes we will move. My goal, sometimes, is to see how I can shift someone from lying down or sitting to moving.
But it’s very low key. It’s copacetic. It’s not scary. It’s not hard. It’s not threatening. It’s kind of fun. “What do you like? What do you dislike?”
Later, when residents come here and start exercising, it’s never intimidating. People can work out with Ryan and do some of the harder things, or they can walk, or they can ride their bike, or they can swim.
RP: Connie and I know that we have a limited window of time with all the clients here. Part of my job is planning an individualized program that will get a client to the goals that they want to achieve in X amount of time. In athletics, that’s super important, because you have a start date on the season: here’s where this athlete is, we need to get them ready by this point.
In certain ways, the situation is similar when it comes to new residents at Driftwood who will be transitioning out of here in one or two months. We want to get them ready for the next phase of their lives.
MW: How much time generally passes between the end of someone’s detox and the beginning of their sessions with the two of you?
CC: Most people who come here have about a week of detox, although that period varies, depending on how you feel, and how you are detoxing. During your detox, you may or may not want to participate in our fitness programs. If you don’t want to move or exercise during that first week, you don’t have to. But we might encourage you to move.
The phrase we use at Driftwood is “challenge by choice.” I’m not going to tell you that you have to do high intensity interval training with Ryan. You get to pick your challenge. If you can drag yourself down to the gym and put one foot in the door and do a little something, I promise that when you leave, you’ll feel better. You’ll feel better every time.
RP: Just to give an example of challenge by choice: lately I’ve been taking control of the afternoon group exercise. And over the course of the last two or three cohorts, it’s evolved into a full-fledged workout. But it changes from class to class. It’s scalable. And you can always join a group exercise but work at your own pace.
We put a menu of exercises up on the wall every single day. If you can complete every single one of these, that’s amazing. We’re proud of you. But if you come in and just try a couple of them, we’re happy with that too.
MW: Why is it important to have not just “a gym” but “a wellness center?” I’ve heard clinicians describe the work that you and Ryan are doing as fundamental to the broader recovery project here.
CC: Everyone at Driftwood believes that fitness, and being functional, is vital to being sober. If you’re not moving every day, you’re degenerating. On the other hand, when you move every day, your body starts to function better, your mind functions better, and you start to feel better. And when you feel better, you don’t feel like you’re seen in the same way. Having a spring in your step, feeling strong and empowered, helps you stay sober and helps you in your life outside of recovery.
MW: Could you discuss the concept of aftercare? How can people sustain and deepen their wellness when you and Ryan aren’t around?
CC: Good question. While you’re here, of course, you get to exercise every day. You have wonderful food every day, and meaningful clinical therapy every day. It’s a healthy bubble, and you’re scheduled in that bubble. But you’re also becoming equipped to stay healthy when you integrate back into the world.
Many of our residents transition to our Riverside extended care facility. Everyone who goes to Riverside gets a membership at the Y downtown, and our house manager Cassie encourages them, finds a way for them to exercise regularly. Ryan, on his own time, trains a lot of people who are in that community integration program. If he’s developed a strong relationship with someone, he’ll try to continue working with them after they leave.
MW: I’d like to finish with an open-ended question for both of you. Could you share something that you think people should know about the Wellness Center? Something, maybe, that I should have asked you about, but didn’t?
RP: One thing that’s great about this place is the fact that Connie and I have complementary skill sets. In addition to the background she’s already described—all of those certifications she has—she’s also a yoga instructor. I’m certified in a technique called foundation training, which is for lower back health and core strength. I’m one of the few people in Austin that has that certification. Between the two of us, we’re ready for almost anything.
CC: I said earlier that I feel I’m “doing my dharma” here at Driftwood. Dharma is about whether you’re doing what you were put on this planet to do. Are you living your dream? Are you doing what you’re good at? One of our goals is to find that thing for the residents. Maybe they’ve lost it, or maybe they’ve never found it.
We’ve had people who have left here who have gone on to be personal trainers. They had such a positive experience with us that our work became part of their dream. Some people leave here and find their dharma by becoming therapists in the recovery community. A lot of the people who work at Driftwood are in recovery. They’re here because they want to help people who have been in the same shoes that they’ve been in.
We work with people on this crucial question: what meaningful role are you going to have in the world when you leave here? And sometimes, people find that through fitness.
“When you take people who have been eating badly, and you feed them [well] for thirty, sixty, ninety days, the transformations are astonishing. You see people’s lights come on again.”
“The Transformations Are Astonishing”
This is the third in a series of posts introducing the people who make up Driftwood Recovery’s community of caregivers.
Through these conversations, you’ll get a chance to meet the people on Driftwood’s team—from its executives to its care coordinators. You’ll learn about the programs they facilitate, and about how their work serves Driftwood’s overall treatment philosophy. You’ll learn about the various paths that brought them here. And you might pick up a book or Austin restaurant recommendation.
In this post, Kuraĝo editor Matt Williamson talks to Culinary Director Jason Donoho.
***
Matt Williamson: When I knew that I was going to be talking to you for the blog, I asked someone in Driftwood’s Admissions office if he’d be willing to take pictures of his next few staff meals for me. Within minutes, he started texting me photos. He’d apparently been Instagramming his lunches since he’d first started working here.
I’m guessing that most people who work in residential treatment aren’t taking pictures of their staff lunches. So, that’s unusual! But then, your biography is kind of unusual for the head chef at a treatment center.
Jason Donoho: I do come from a fine dining background. I’ve actually been working in restaurants since I was twelve years old and growing up in Puerto Rico. I always knew I wanted to be a chef. After school, I’d go to local restaurants and, like, beg for work. As a teenager, in the summer, I’d work thirty, forty hours a week in kitchens. It’s possible that some labor laws were being violated.
And this was fine dining—really nice hotels. By the time I was in my early twenties, I was working at the Four Seasons resort. It was, you know, the pinnacle of luxury—but I was starting to decide that I wanted to do something less pretentious. Don’t get me wrong: I love the Four Seasons, and I still go there on a regular basis. I have friends that work there. But I wanted to explore more casual dining. And so I started working in different styles of restaurants, and kind of finding my own voice. I worked, for a while, for the Alamo Drafthouse. I did some consulting work. I worked for two “fast casual” restaurants in Austin. I helped local chains do national expansions: learning how to take a menu created in a test kitchen and roll it out with training materials and packets for people in other states.
It didn’t take me long to reach the point of burnout on that kind of fast-paced, high-pressure corporate work. But it was great experience.
I found Driftwood serendipitously. For some time, I hadn’t been cooking in a professional kitchen. I think that’s what I was probably yearning to get back to. While I was doing consulting work, a friend mentioned this beautiful place opening that had all the pieces in place, but hadn’t found a chef. When I first met with the founders of Driftwood, I was under the impression that it was going to be a consulting job, or that they needed someone to come in and help them with the hiring. Instead, I became Driftwood’s Culinary Director.
MW: You were telling me earlier that you knew, as soon as you saw this place, that you wanted to work here.
JD: The feeling you get when you drive through the gate—it’s pretty instantaneous. There’s a vibe here that’s very healing and very relaxing. Obviously, we have this beautiful setting, which helps. There’s something about the landscaping, the architecture, the interiors of the buildings, the materials that were used . . . and then, when you zoom in a little closer, you find all of these amazing people. A lot of my co-workers have been here with me since the very beginning. As soon as you pass through the gate, it kind of starts to float away: you leave the outside world behind.
MW: I know that diet is part of what Peter Fluor was referring to when he talked to me about Driftwood’s emphasis on a “recovery lifestyle.” And you were recently at a conference on “culinary medicine.” What does it mean for food to be “medicinal?”
JD: For a lot of people in early recovery, nutrition has not been a priority. Getting whole foods, meals made with love and energy, is so important. Not processed, not high-sodium, not high-fat. Real foods: lean proteins, leafy greens, yogurt, olive oil, avocados.
When you take people who have been eating badly, and you feed them like that for thirty, sixty, ninety days, the transformations are astonishing. It’s not just food that’s changing people, obviously; it’s the treatment here. But when you have that high standard of treatment in combination with proper nutrition . . . it’s phenomenal. You see people’s lights come on again.
MW: What process did you use in designing Driftwood’s menus?
JD: When I started here—not having worked in a clinical or treatment setting before—I had no idea what kind of food other residential treatment centers served. But other people, who had years of experience working in world-renowned facilities, told me. And the food they described was pretty much what I imagined: high-school cafeteria food. A salad bar, you know, with, like, bottle dressing.
I was given very little concrete direction early on. Just: “we want really good food made from scratch.” So I took that and ran with it. We treat the kitchen here at Driftwood almost like— I wouldn’t say a restaurant— but like a high-end home.
Or maybe it is like a restaurant, in a particular sense. You may have heard the term “family meal.” At high-end restaurants, the entire staff will eat one meal together every day. It’s usually simply prepared—but prepared by some of the best chefs or cooks in the world. It’ll be tacos or sandwiches, but elevated. At Driftwood, every meal is a family meal: we shoot from the hip. We don’t have rigid recipes; we’re always trying different amounts, different ingredients—we’re always changing things. And it’s all made from scratch. So, you know, we may have a salad at lunch with a Greek yogurt ranch-style dressing, but with fresh herbs from our garden, and fresh onions and spices. And then at dinner, people are like: “Oh, can I have some that ranch from lunch?” thinking that we’re just going to hand them a bottle. And it’s like: “No, we made that for lunch, and it’s gone. We dressed all of the salads. And that’s it.” We don’t have boxes of powdered mixes of anything sitting around. The only thing we don’t do 100% in-house is bread; we’re not a commercial bakery. Everything else, we make by hand from scratch.
MW: That sounds like a ton of work.
JD: It is, but I have an awesome staff. I have three staff members who work only in the kitchen, and then various other people on the staff who help—especially the care coordinators, as we call them: the people who make sure all of our clients get to appointments and get to see the nurse, and make sure that everybody knows where they’re going, and are comfortable, and have what they need. The care coordinators help in the kitchen a ton. We have two people that are essentially my Sous-chefs: an a.m. sous chef and a p.m. sous chef. And then we have a woman named Adrian, who was actually working at this facility part-time when it was still a bed-and-breakfast, who monitors inventory and helps keep everything running.
MW: Could you talk a bit about the communal dining aspect here? The first time I visited Driftwood, I showed up just after noon, so my first image of this place is of a mostly empty campus, and then seeing all of these people having lunch together in this bright, open space.
JD: The entire staff—from the clinicians and nurses to the president and owner—always eat together in one communal dining room. And I think that fosters more collaboration and attachment. That’s crucial, given Driftwood’s attachment-based model. Every day, every staffer knows that our clinical director, for instance, will be across the table or a few seats down, eating the same lunch. It can be reassuring, knowing that you can strike up a conversation with your colleagues, not in a clinical or formal setting—just like: “hey, how’s your day going?” It’s cool.
I don’t ever want the staff to get bored with the food. So we serve a different meal every day: no matter what, there’s always some variation. Even if we always serve tacos on Tuesday, they’ll be slightly different tacos. But we’re mindful of the fact that we have to appeal to a variety of tastes. So, for instance, we don’t do a ton of seafood because some people aren’t too keen on it. I love seafood, and we might serve shrimp once in a week, but never more often than that.
But there’s another dimension to consider. Boredom may be bad, but there’s a comfort in familiarity. When you’re in residential treatment, it can be nice to know that you’ll have eggs in the morning with some toast and some bacon. Sometimes, we’ll go super high-end and fancy. And then we’ll have turkey meatloaf and mashed potatoes. And it’s all really good.
Loneliness shortens and impoverishes our lives—and we’re increasingly enveloped in systems that, by design or accident, isolate us.
Revisit Robert Putnam’s classic essay “Bowling Alone” in the first days of the 2020s, and this fact may startle you: it was published in 1995.
It was published, in other words, before the advent of smartphones—at a time when “the world wide web” was a tech hobby enjoyed by about 14% of Americans and 0.4% of people globally.
Putnam’s essay—which he expanded, five years later, into a well-received book—used a variety of statistics to make the case that the US was fast losing “social capital,” i.e., ”features of social organization such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit.” In the mid-90s, Putnam noticed, people weren’t going to city-council and PTA meetings, weren’t joining lodges, scout troops, labor unions and bowling leagues, weren’t going to church.
As more and more Americans were “bowling alone,” research indicated steep declines in “connectedness, “civic engagement,” “good neighborliness” and “social trust.”
Surveying these trends, Putnam was most concerned about their possible effects on the health of our “liberal democracy.” At what point might civic disengagement be significant enough to threaten stable government?
A psychologist or biologist reading Putnam’s essay might have different concerns.
Social isolation can be twice as dangerous as obesity—more harmful, by some measures, than smoking 15 cigarettes a day. It increases the risk of stroke. Extreme isolation “transforms the brain,” in part by causing overproduction of a neuropeptide known as tachykinin, which increases fear and aggression. The destructive effects of isolation are so well established, in fact, that the prolonged solitary confinement of prisoners is considered torture under international law.
Since Robert Putnam started fretting about the slow death of bowling night, the social atomization of people around the world has increased geometrically, in ways that nobody can deny.
More and more of us spend our working days in tiny, lonely gig-economy compartments. People who might prefer the stability and intrinsic community of a physical workplace are being forced into the pseudo-entrepreneurship of contract labor. The effects, per one study: “Gig workers were almost twice as likely to report frequently experiencing a sign of loneliness . . . scored higher on a mental health measure capturing experiences of anxiety and depression. . . . [were] 50 per cent more likely to report feelings of helplessness, and [were] almost 40 per cent more likely to report feelings of little control.”
When we clock ourselves out for the day, we turn our full attention to social media and online games. Researchers at Penn found evidence that “an excessive intake of social media may be bad for [college students’] health.” According to a recent article in the Guardian: “nearly a quarter of all millennials cannot name a single friend . . . [and] close to a third . . . ‘always’ or ‘often’ feel lonely.” We no longer look for romantic partners in person, relying instead on potentially addictive dating apps that turn relationship-building into a cold, continuous massively multiplayer online game. Given that online dating services are for-profit businesses—an app stops generating revenue when its user forms a long-term romantic attachment—it’s unsurprising that the rise of Tinder and Bumble has coincided with an increase in the number of single people.
Noam Chomsky once said that we live in “a very atomized society . . . [with] all sorts of efforts to separate people from one another, as if the ideal social unit is, you know, you and your TV set.” The new ideal relationship, perhaps, is between you and your phone, which has gradually become employer, grocery store, friend, lover, and—of course—TV.
***
The first part of this discussion explored the feedback loop between loneliness and opioid dependence. The fact that we are all increasingly enveloped in systems that—by design or accident—isolate us from our neighbors, is relevant to any conversation about addiction. In the next post, we’ll start talking about strategies for breaking the feedback loop.
-MATT WILLIAMSON
Loneliness “predisposes people to entire spectrums of physical and mental illnesses. [It] creates a hunger in the brain [that] hypersensitizes our reward system.” Lonely people easily become “restless, irritable—and impulsive.”
This is the first in a series of posts on the ways in which social detachment and addiction interrelate.
A few days ago, neuroethicist Rachel Wurzman gave a TED Talk exploring “voluntariness” as it relates to her own Tourette’s Syndrome and to people struggling with chemical dependencies.
“[As a] researcher who studies differences in how individuals’ brains wire and rewire themselves,” Wurzman says, “I’ve long been fascinated by failures of self-regulation on the impulsive and compulsive behavioral spectrums. So much of my own behavior has existed all over that map.”
Her own tourettic tics are “involuntary” in the sense that she cannot prevent them—yet they feel voluntary: “I still feel like it’s me moving my shoulder, not some external force.” The shoulder-twitch feels voluntary in part because it always follows a “premonitory urge.”
Those experiences—feeling an intense urge, and watching as the urge is answered and relieved by a behavior that feels, at once, voluntary and compelled—may be familiar to some readers of this blog who don’t have Tourette’s.
“It’s a fact,” Wurzman says, “that people suffering from addiction have lost free will when it comes to their behavior around drugs, alcohol, food, or other reward-system-stimulating behaviors.”
“That addiction is a brain-based disease-state,” she says, “is a medical, neurobiological reality.” It remains conventional, however, to treat the disease of addiction as categorically different from other diseases. A heroin injection just seems, to many outside observers, too different from a sneeze.
“The brain’s default state,” Wurzman says, “is more like a car idling in drive than a car in park. [Some of the things] we think we choose to do [are] things we’re programmed to do when the brakes are released.”
The striatum—the part of the brain that governs motor and action planning—“detects emotional and sensory motor conditions, and triggers [whatever] behavior you have done most often in the past under those conditions.” Wurzman’s early research focused on “how miswiring in the striatum relates to compulsive behaviors.”
She found that when she stimulated the striata of mice in particular ways, the mice began to rub their faces habitually—i.e., to develop tics. “They couldn’t stop even when they were wounding themselves.”
In her later research, Wurzman proved that changes in the striatum had a similar effect on humans’ “social neural chemistry.”
“There are naturally occurring opioids in your brain,” Wurzman says, “that are deeply linked to social processes.” Some such opioids are essential for people “to feel the rewards of social interaction.” Accordingly: impaired opioid reception in the striatum “has been deeply linked with loneliness.”
“When we don’t have enough signaling at opioid receptors, we can feel alone in a room full of people [we] love, who love us.” That feeling of isolation isn’t just unpleasant, Wurzman says: it’s “very dangerous.”
Loneliness “predisposes people to entire spectrums of physical and mental illnesses. [It] creates a hunger in the brain [that] hypersensitizes our reward system.” Lonely people easily become “restless, irritable—and impulsive.”
“If we don’t have the ability to connect socially, we are so ravenous,” says Wurzman, “we’re likely to seek relief from anywhere.”
What may look, from the outside, like an irrational, impulsive choice, prompted only by an individual’s free will, may actually be a response—rational in its way—to a state of internal emergency.
When we’re starved of social connection and/or its related opioid signals, a drug like heroin “is going to be a heat-seeking missile for our social reward system,” Wurzman says.
There’s a kind of feedback loop, then, between drug dependency and isolation. Drugs that take over the striatum prevent us from receiving the benefits of social connection. Social disconnection, meanwhile, makes us especially hungry for the alternative rewards that drugs like heroin provide.
If loneliness primes us to become attached to drugs like heroin, oxycontin, and fentanyl, Wurzman asks: “is it any wonder people in today’s world are becoming addicted so easily?”
—MATT WILLIAMSON
“Everyone has experienced trauma to some degree, and everyone out there numbs. Whether the numbing strategy is binge-watching Netflix, or gorging on cookie dough, or injecting heroin, there’s some way that we try to numb the pain from the experiences that we’ve been through. When numbing comes from alcohol or drugs, it’s easy to get addicted. And it’s even reasonable to become addicted, because the drugs work—they numb the pain of those emotional wounds—until they stop working.”
This is the second in a series of posts introducing the people who make up Driftwood Recovery’s community of caregivers.
Through these conversations, you’ll get a chance to meet the people on Driftwood’s team—from its executives to its care coordinators. You’ll learn about the programs they facilitate, and about how their work serves Driftwood’s overall treatment philosophy. You’ll learn about the various paths that brought them here. And you might pick up a book or Austin restaurant recommendation.
In this post, Kuraĝo editor Matt Williamson talks with Consulting Psychologist Stevie Stanford.
***
Matt Williamson: I’ve been told by a few people who have been your clients here that you have some amazing insights about trauma and attachment disorders. But since you’re the clinician at Driftwood who specializes in sex addiction and love addiction, maybe we should talk about that first.
Stevie Stanford: Ah, but the interesting thing is, is you can’t really talk about sex addiction, love addiction, toxic relationships, without addressing attachment trauma.
MW: How do you define “attachment trauma,” then? It’s at the core of Driftwood’s treatment philosophy, but a lot of lay readers probably won’t know what it means, or what an “attachment disorder” is.
SS: “Trauma” is not just shorthand for the pain from events like car accidents, sexual assaults or combat. It can refer to any negative experience that alters your trajectory, changing the way that you see the world.
Maybe your third grade teacher stood you up in front of the classroom to do a math problem, and you messed it up, and he shamed you. And from then on, you thought that you were terrible at math, you didn’t like going to school, you tried to avoid seeing that teacher. You might have a problem with bald guys, because the guy who publicly shamed you was bald.
Oftentimes those smaller things have a big effect. And when you tell people about what you’re feeling, and you aren’t validated, it becomes worse, because no one’s there to nurture you and help you heal.
I once heard someone say that “attachment trauma” results whenever a primary caregiver is non-nurturing. That’s a pretty drastic definition, and I don’t know exactly how I feel about it. But I like to look at things on a continuum, and I would say that the continuum of attachment trauma begins with any non-nurturing behavior from a primary caregiver.
MW: But every parent on earth does things that are not nurturing. Are some of those traumas things that we just cope with, or deal with, during childhood, while others linger and become disruptive?
SS: Right, right. And surviving traumatic experiences can make us more resilient. But there are other traumas that we never quite wrap our minds around; we don’t understand why they happened. To explain them, we tell ourselves: “I’m not worthy of love.” “I’m not deserving of compassion.” “I’m not good enough.” And as we move through the world, when bad things happen, we’re like: “Oh, there’s more evidence to put in the file.”
MW: Can you get more specific about the kinds of non-nurturing experiences that can change a person’s self-conception?
SS: A rupture during childhood can be perceived as abandonment, which is highly traumatic. If a parent has an affair and leaves abruptly—“see you later”—that’s a significant rupture of attachment, obviously.
But sometimes a rupture can happen because mom gets cancer and dies. A little kid may lack the cognitive ability to understand: it wasn’t that mom wanted to leave. That child may develop some negative cognition that they carry into the world.
MW: So every child has one primary caregiver? Is abandonment by a parent less traumatic when that parent is not the primary caregiver?
SS: It would depend. Studies have shown that there needs to be some sort of attachment, attunement, with a primary caregiver. It doesn’t have to be mom, it doesn’t have to be dad; it might be grandma, grandpa.
I had a client whose parents were both drug addicts. He didn’t have a close attachment with either one of them. But he had grandparents in his life who were phenomenal role models, who showed him how to love and how to connect. And so he was able to develop those skills himself.
MW: A person might say, “Well, such-and-such happened to me, and it was no big deal. Don’t be so fragile.” And maybe it wasn’t a big deal for that person. For someone else, though, it was a life-shattering event.
What are some of the features that turn what is ostensibly the same experience into something that’s deeply traumatic for one person, but forgettable, even meaningless, for another person?
SS: There are a number of identified factors that impact the effect that trauma has on people.
One of the first factors is age: the younger you are, the more impact it will have.
Another is preparation. If parents are going through a divorce, and are able to tiptoe into it and talk to the children about it, it may feel less like an earthquake.
And another factor is the degree of responsibility that the person feels for the trauma. If you think, for example, “the reason that I got raped at the college party was because I was wearing that short skirt,” the harmful effect of that even may be more significant.
Of course there are many other factors, but those are three that come to mind.
MW: Most people who go through severe trauma don’t have access to any sort of therapy. What do those people end up doing?
SS: I would say, first, that everyone has experienced trauma to some degree, and everyone out there numbs. Whether the numbing strategy is binge-watching Netflix, or gorging on cookie dough, or injecting heroin, there’s some way that we try to numb the pain from the experiences that we’ve been through.
When numbing comes from substances, alcohol or drugs, it’s easy to get addicted. And it’s even reasonable to become addicted, because the drugs work—they numb the pain of those emotional wounds—until they stop working.
But there are also “process addictions”—when you’re addicted to food, when you’re addicted to sex, when you’re addicted to love, when you’re addicted to exercise.
Notice that all of those are things that we generally want in our life. We want sex, we have to eat food, we like to be able to exercise.
When a person has an unhealthy relationship with alcohol and drugs, a therapist might recommend abstinence. But when the problem is a process addiction, it can be more complicated. A therapist can’t say “don’t do that again.”
MW: “Don’t ever eat.”
SS: “Don’t ever love again.” That’s not going to make for a very fulfilling or enriching life. Something that we say here at Driftwood often is that we don’t want people to survive in sobriety; we want them to thrive.
MW: How do you help someone figure out whether they’ve got a process addiction involving sex?
SS: It’s tricky. There’s an ongoing fight between people who believe that sex addiction is a thing, and sex therapists who believe that the idea of “sex addiction” is inherently stigmatizing.
I’m unusual in that I’m both a sex therapist and a sex addiction therapist. I’m interested in helping my clients find shame resiliency. On the other hand, when I meet a client who comes in and says, “I keep cheating on my wife. I’m seeing prostitutes. Because of this, I’m losing my money, losing my job”— this starts to track closely with the diagnostic criteria for addiction.
MW: What’s the difference between “sex addiction” and “love addiction?”
SS: My favorite way to differentiate the two is to talk about the end goals. So let’s say we have—and this is going to be gender stereotyping, but I’m going to go there—let’s say we have a 25-year-old male over here and a 25-year-old female over there. And they each have had ten one-night-stands in the last two weeks. What are their end goals? Oftentimes, the male is using love to get the sex. The female, meanwhile, may be having sex in order to get the love.
Looking at what the person’s attachment style is, and looking at some of the trauma they’ve experienced, helps give me an idea of what the person’s end goal is. When it comes to sex: when you’re having orgasms, you’re getting dopamine pings. It’s hitting the same parts of your brain that drugs and alcohol hit. And so you can get addicted to that feeling.
MW: What is a love addict, then?
SS: A love addict is somebody who loses himself or herself in seeking relationships with others. So as soon as they meet someone, they feel an intense connection. I see love addiction happen a lot when people don’t have a strong sense of self. And so they get into relationships and the relationships make them feel worthy, feel like they belong. Maybe you’re just a regular person moving through life, and then you fall in love with a punk rocker, and all of a sudden you’re a punk rocker, too.
MW: If you’re vulnerable to this sort of influence, and you happen to fall in love with the right punk rocker—less Darby Crash than Joe Strummer, say—could everything turn out fine?
SS: As long as there’s still some sort of differentiation, as long as you are each able to remain separate. Otherwise, we fall into a thing called codependency.
Driftwood is an attachment-based program. The goal, however, isn’t just for people to form “attachments and relationships.” We want them to form meaningful attachments, healthy relationships.
People struggling with addiction, economic insecurity, or mental illness are not separate from us; they’re our family members, our neighbors, and, in many cases, they’re the people we honor on Veterans Day.
It’s Veterans Day, which means that people all over the US are posting and tweeting messages of gratitude to military service members.
If you support veterans, however, keep these facts in mind during the 364 days of the year that are not Veterans Day:
Fewer than half of returning veterans in need of mental health treatment receive any care. Around 40,000 veterans sleep on the streets on any given winter night. Veterans are at heightened risk of developing substance abuse disorders, which often co-occur with depression and post-traumatic stress disorder.
A new study reports that veterans “are at ground zero of the [opioid] epidemic, facing an overdose rate twice that of civilians.” 44% of veterans return from combat service with chronic pain, which can contribute to heroin and fentanyl addiction.
Inadequate access to long-term mental health treatment for veterans is part of why the suicide rate for veterans is 50% higher than the civilian suicide rate.
Earlier today, Karie Fugett published a moving piece in Vox about her husband’s suicide. “Shame and isolation,” she writes, “killed Cleve as much as the fentanyl. If [you] want to help veterans . . . address the stigma surrounding addiction and invest in more policies and programs that not only help them with pain but secure their futures even if they do have addictions or are in recovery.”
***
Nobody, whether they’ve served in the military or not, deserves to be homeless, to be deprived of access to counseling, or to be excluded from society because of a substance abuse disorder. This stigmatization just seems more galling when it’s directed at people who are in crisis specifically because they did the things we claim to honor.
Encourage those close to you to treat people struggling with addiction, economic insecurity, or mental illness with compassion and respect. They’re not separate from us; they’re our family members, our neighbors, and, in many cases, the people we honor on Veterans Day.
— MATT WILLIAMSON
Drug courts and jail-like “treatment centers” may seem like a humane alternative to conventional drug criminalization — but they carry their own serious risks, especially to youths and people with co-occurring mental illnesses.
PBS Newshour ran a piece last week on a topic that isn’t given enough attention: the inappropriate, but increasingly common, use of jails and prisons as “treatment centers.”
Sam Weber tells the story of Robin Wallace, a Massachusetts woman who petitioned a court to “involuntarily commit” her opioid-dependent adult son, Sean. The judge did “commit” Sean, but not in the conventional sense; the state essentially incarcerated him, depriving him of access to methadone and keeping him in solitary confinement in an environment “supervised by corrections officers,” leaving him “sicker than [he’d] ever been.” A year later, faced with the prospect of returning to jail, Sean took his own life.
In 2016, Surgeon General Vivek Murthy released a report affirming the expert consensus that addiction is a “public health crisis,” not a moral crisis. This article in The Atlantic, which discusses Murthy’s report, describes many of the monetary and human costs of policymakers’ stubborn insistence on treating sick people like criminals.
Once substance-dependent individuals are in the criminal justice system, they may never get out. (See, e.g., the much-publicized case of Meek Mill, whose teenage misdemeanor drug arrest kept him in and out of court for fifteen years. At one point, when Mill was in his early thirties, he was given a years-long prison sentence for “violations” like riding a dirt bike.)
In recent decades, policy solutions like dedicated drug courts have gained remarkably broad support as a humane way to treat substance dependency. In this 2017 Pacific Standard piece, however, Maia Szalavitz reports on the dangers this “half-crime” approach poses, particularly to young people and people with co-occurring mental disorders. A disturbing episode of This American Life explored the risks of giving judges near-total control over the lives of drug-dependent people.
Former drug-court judge Morris Hoffman, writing in The North Carolina Law Review, describes not only the danger and inefficiency of punitive approaches to addiction, but their Heller-esque absurdity:
“[Drug courts’] unstated central assumption is that modern treatment modalities are so effective that if a defendant fails them three or four times, it must be the defendant’s ‘fault,’ and that particular defendant therefore must be one of those ‘volunteer’ addicts against whom the sword of the criminal law may morally swathe and not a truly ‘diseased’ addict. We compassionate judges can then sentence that defendant to prison, smug with the knowledge that our experts, by the simple device of offering treatment a certain arbitrary number of times, can separate the diseased from the criminal . . . But of course this whole approach is a charade . . . [If] addiction is really a disease, then the most diseased defendants are precisely the defendants most likely to fail many, and perhaps even all, treatment attempts. Drug courts thus may be performing a kind of reverse moral screening—those defendants who do not respond to treatment, and therefore may be the most diseased, go to prison, while those defendants who respond well and whose use of drugs truly may have been voluntary, escape prison.”
Nevertheless, drug courts now exist in all fifty US states, and Canada is preparing to double down on its use of the criminal courts to deal with problems like fentanyl addiction.
As Sean Wallace’s case illustrates, the use of police officers as drug interventionists, and corrections officers as drug counselors, is not merely unhelpful but dangerous, at once preventing individuals in crisis from getting the help they need and exacerbating their crises. Asking a prison to function as a licensed drug treatment center is, as Robin Wallace memorably puts it, “like trying to teach a snake to knit.”
— MATT WILLIAMSON
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