Home for the Holidays

        As the family member of a loved one who has freshly finished alcohol/drug treatment, you may be wondering what you should or shouldn’t say or do during a holiday gathering.  It’s a new day for the family dynamics if drinking or drug use was part of the scene at past gatherings.

       Letting go of the pain or resentment from the past can be a major hurdle to overcome for family members. Adopting an attitude of forgiveness does not mean that you are co-signing as OK ANY of the addictive behavior. It’s merely to slowly start to turn over a new leaf and begin to regain the trust with a new set of eyes and increased awareness. Adopting this attitude helps you gain a new emotional freedom and not being held in a prison of anger by “faking it.” Writing a letter or talking to the newly recovering member before a family gathering is a good idea. If you want to talk about the problems of the addiction from the past at the time of the gathering, this should be agreed upon fully with other attendees.  Avoiding a family argument that would sour the Christmas cheer might be a challenge if this was a pattern in the past, and getting group agreement to keep it positive and ignore any landmines is a good idea.

     Whether to serve alcohol at a family function should be agreed upon within the group as well. Treatment teaches that the addict can’t expect the rest of the world to change because he/she did, however staying mindful that early recovery is a sensitive window of time should be considered in this decision.

     Remember that the substance user/addict also is invested in letting go of the past as well, and he/she needs family emotional support to help heal those wounds. Not all newly treatment discharged folks are already on Step 8, 9 and 10 but receiving an apology for past ills can help move things forward for you all.    Everyone wants to stop hurting and the power of the group during the holiday can be paramount in changing the course of relationships through shared family recovery.

     Lastly, attending Al-anon and other support groups can help provide insight and strategies for coping with the holiday stress.


The Enabling Matrix

     When a substance user’s behavior becomes a continual negative spiral downward in life, more and more pressure gets put on the family members or friends to fill in the gaps and fix problems. These problems are being creating as a direct consequence of using substances or a by-product of using.  The loved one truly wanting to help the addict and perhaps not knowing what to do except to do gives into the immediate demand or “need”, whether it be paying bills, calling in sick for the substance user, providing bail money or making excuses for them.  Slowly but surely, it seems that the matrix of enabling grows as the substance user racks up more and more fallout from the using lifestyle. The enabler may start to take over major areas of life responsibility for the addict such as the raising of grand children or letting a substance user live back at home. The matrix is fully developed as the enabler 1) accepts the unacceptable, 2) takes on responsibilities not their own and 3) denies the truth of the situation to self and others.

Helping vs Enabling

       The difference between help and enabling is defined by whether or not the addict can work to fix the problem themselves or not. When they can but they want someone else to do it, it is enabling. “Help” is often defined as doing something that another cannot do for themselves like teaching a child to tie shoes. We would never say that we are “enabling” a young child when we are teaching this. But if that child knows how to tie and still wants for parents to tie shoes at age 6 or 7, it becomes enabling if the parents do it. Enablers must think about the consequences of what will occur if they keep doing the enabling behaviors. If we are using the shoe tying example, it would be much easier for one parent to say to the other, “If you keep tying shoelaces for him, then he will never learn to do it for himself and be responsible with that.”  Mental and emotional confusion sets in for the enabler if he/she assumes, despite evidence to the contrary, that the addict wants to be, will be and is being responsible with all aspects of self are, which is what the addict wants the enabler to believe.      Not letting the substance user/addict define the reality is very important.  Enablers must not allow themselves to believe that each demand for enabling is caused by a coincidence or isolated event in the addict’s life. 

     But enablers are caught between hope and fear. They hope that with each small positive word or behavior from the addict, that he/she will start a continual pattern of the such. The flip side of that is fear that upsetting the apple cart by setting boundaries will  be the source of negative consequences. Addicts will, “up the anty” when boundaries are enforced. They will often accuse their enabler of not caring for them or loving them and make threats of what bad things will happen to them if they don’t get what they want.  They may even say that the bad consequences will be all the enabler’s “fault”. They do not see the addictive behavior as the source of the consequences but the withdrawal of enabling as the source of the problem. They may even threaten to disappear or cut off relationship and will use the biggest fear of the enabler in order to manipulate to continue the enabling system.

Are You Enabling a Loved One?

     If you wonder if you are enabling, you can ask yourself the question, “Am I working harder to help this person find recovery than he/she actually is”? If you answer “yes”, then it is time to work on powering through changing your own enabling behaviors, so as not to create a comfortable environment in which the addict can continue using. The consequences and having to fix those through their own efforts and action is what gets an addict sober. Do not fall into the sympathy trap and the complicated matrix of fixing.  This only makes it worse. Let go of those behaviors. The enabler does not have to cut off relationship with the substance user in order to stop the enabling. Creating distance can be a useful tool for self-reflection and developing a plan of action.  Seek professional expert advice as well to help gain the much needed clarity and accountability to stop the enabling one day at a time.





Managing Seasonal Affective Disorder

        We often hear the phrase “it’s that time of year” when talking about a health issue like the flu season. Well, it’s that time of year for seasonal depression as well. Often lasting from the Fall months all the way through to early Spring, the number of months for seasonal blues is almost 6 full months. One simple explanation for Seasonal Affective Disorder is that the normal circadian rhythms are interrupted because of a lack of sunlight. That light causes melatonin, a hormone, to be emitted in the brain when the light hits the eyes. This melatonin then causes the release of Seratonin, our “feel good factor” hormone in the brain. With less light, there is less melatonin  and Seratonin circulating and thus, a decrease in alertness and the mood.

     Some of the symptoms of SAD (Seasonal Affective Disorder) are the same for other types of depression. Some of these symptoms include, fatigue and low energy, not getting pleasure out of things that were previously enjoyed, poor sleep, appetite changes, weight changes and social isolation. Often times with any type of depression, the longer it goes on untreated, the worse it gets. It can become difficult to tell if it’s Major Depression or merely seasonal blues. The symptoms are the same.

     Treatments for SAD are typically light therapy, medication and psychotherapy. Psychotherapy techniques focusing on the “here and now” are very helpful in supporting the depressed person to move into workable and committed action to reclaim what is being lost from their life as a result of the SAD.  Treatment models like Cognitive Behavioral  Therapy support a person in establishing hare and now goals to step back into life.  If there are any other co-occurring mood problems or coping deficits, treatment methods like Acceptance and Commitment Therapy are more applicable.

     If you think that you or a loved one may be suffering from Seasonal Affective Disorder or other types of depression, please contact Rebecca Bullion, LCSW at 615-414-2995 or cohesioninterventions@gmail.com.    

Does Texting Create Loneliness?

       A new survey by the American Psychological Association (APA) found about 90 per cent of people aged 18-29 were using social media, up from just 12 per cent in 2005.  That means that we have a had a culture shift during that time in the way a majority of the population relates to other humans. This is the culture of the Millennials. But people are designed the same way no matter what era in which they are born. How could we not think that this kind of shift would have a psychological effect?  It’s one thing to send a thumbs up icon and a total other to say, ”Can I take you to lunch to celebrate your raise?”

     Humans are wired for this direct connection. We can try to deny it, but the fact remains. Not having the amount of necessary human contact leaves us feeling anxious, depressed and disconnected. And, indeed, we are putting ourselves into a type of solitary confinement.     Maybe the emptiness that this creates is exactly the reason why people are continually checking. Are we trying to get a legitimate, emotional need met from an empty well? Are we not continuing to do the same thing over and over expecting different results this time? In order to answer that last question accurately, we have to know what connecting is like on the other side, i.e., what does it feel like to primarily connect “the old-fashioned way”? What would it be to have phone time nightly with friends and then have group activities and individual outings as our primary means of relating? This becomes a situation in which you will never know until you try.

     So, how about we decide to go on a fast from letting the electronic world control us. I bet if you start using the phone for talking most of the time, people will think there is something is wrong with you and ask “Are you ok?”  If you decide to take this challenge, set a time limit for it and then go back to the phone as it is being used now for a period of time. Journal your feelings and thoughts and track what changes you go through. Force yourself also to connect with people on a personal, social basis face to face during the fast from the phone time. I would like to know how this experiment foes for you. Feel free to email me with the things you experience, and I will answer you. My email for this challenge is cohesioninterventions@gmail.com

Attachment, Relationship Trauma and Addiction

Early Attachment Issues, Trauma and Addiction

 January 30, 2017

(This blog is not an opinion or a commentary. It is more like a book report from a great webinar I watched today. Please see link reference below.)

Whether or not we are securely attached in childhood is imperative to healthy relationship with self and others throughout life. Insecure attachments frequently develop addiction problems. Early unhealthy attachments are considered trauma in the treatment world.

The four types of attachment are 1)secure, 2) avoidant, 3) ambivalent and

4)disorganized. Attaching is a biological drive. Another way of saying it is that the drive to get our emotional needs met is biological.

There are three early decisions involved in the development of attachment. The first is whether or not the world is a safe place, whether or not people are glad to see me and the third is how to get my needs met. The child learns within the first three years of life the answers to these questions. The answers, good or bad, are stored on an unconscious/preconscious level in the limbic system of the brain which is the emotional center of the brain.

In regard to getting needs met, the questions become, “If I let my needs be known, will they be met, frustrated or I never know whether they will be met.” When children grow up in a chaotic, invalidating environment, the answers to these questions are not positive. Children, early on, will show signs of negative adaptation/reactive attachment issues. These negative experiences become lifescripts and shape how all incoming information is processed throughout the years. For example, a child whose parent is inconsistently available, is often angry and shows little affection and comfort at necessary times, may cause a child to develop anger and anxiety issues because of the frustration and fear for the child in this process.

Children who have chronic trauma become hypervigilent, have poor trust, low self esteem, personality problems and overall, avoid getting hurt through the use of defense mechanisms. Their relationships tend to be insecure/unstable because they do not know how to get needs met appropriately and are avoidant and/or ambivalent about whether to let needs be known.

Addiction serves as a way to comfort the unmet attachment need. The brain chemicals involved in attachment are emulated by and emitted the chemical in the substance. One of the brain chemicals involved is oxytocin. Oxytocin is emitted when a parent shows physical affection and comfort. It causes a child, or an adult, to feel calm and connected. It decreases cravings, increases learning and it heals and restores. It also brings about increased receptivity to the sexual experience and creates an overall positive feeling. A person gets addicted to the substance and to the brain chemical that causes all this. When the substance is removed, the attachment issues can easily get activated because the feeling of attachment is gone.

Often times, in treatment or early recovery, a person may actually develop a romantic relationship which replaces these chemicals. This is, once again, the biological need for attachment showing itself. Addressing how to form healthy attachments is a vital part of recovery work. People that are chronic relapsers are often folks that have compromised attachments because, remember, the attachment problems existed before the substance abuse problem. Process addictions ( ex.gambling, sex, shopping) and getting cross-addicted are also a risk in early recovery because these will bring about the same “feel-good factor” that the substance did.

The goal for people with this type of dual diagnosis is to get in community enough to reduce emotional pain associated with attachment and consistently work all aspects of the program, i.e. meetings, calling sponsor, 12 step and other insight oriented literature, work the steps, most importantly, get rid of a victim mentality. Outside counseling is also recommended.

www.naadac.org/attachment and trauma

Emotional Blackmail

Most addicts and alcoholics have a built-in, well-refined ability to emotionally manipulate others. Since the people that are in close relationships with them are usually caught between hope and fear, the manipulation takes on a dysfunctional lock and key fit.  The "codependent" people are easily manipulated as they desperately hope that things will change when they provide help to the addict.  Yet they are afraid that things will go terribly wrong if they don't offer the help/enabling.  This makes the codependent person an easy target for manipulation as they operate in a delusion of false responsibility.  

Some of the manipulations that addicts offer comes in very subtle ways.  Three of these are described below.

1) The "You're Depriving Me" Game:

An addict/alcoholic will use this over and over if it is one of the tools he/she uses.  This person will create a mess in his/her life and then ask for an unreasonable favor in light of what mess has been created.  For example, if an addict has wrecked a car because of drunk driving, she may ask someone to lend money to help buy a new one and then act like the person in the giving position is selfish if they refuse to help.  Since a lot of lower functioning addicts/alcoholics usually do not provide well for themselves, they are constantly asking for handouts and constantly making excuse as to why the "help" never seems to help them get ahead in life.

2) "It's too Hard" Game

When help is given to the addict, the codependent person often expects certain conditions to be met if the help is given.  An example of this would be, in reference to the above listed car example,  that the addict would use the car to go search for a job and as a means to get to and from work.  When it comes down to looking for the job, the addicted person has rarely FULLY completed the promise he/she made.  This leaves the helper feeling angry as there was a deal made and a promise made by the addict that they would follow through in trying to get ahead in life.  Truly this person wants to get ahead in life, in part.  However, the stronger part which is in control of the addict, just wants to get high and drunk and escape the pressure.  It IS IN ACTUALITY too hard to get and keep a job when one is high or drunk on a very regular basis.  This leads into yet another game.

3)  "It Wasn't That Bad" Game

If  the codependent person actually gets assertive enough to point out the pattern of using and drinking that thwarts any effort to get ahead on the addict's part, the addict minimizes the use of alcohol/drugs and explains it away as not being connected in any way to the lack of progress in achieving life goals. Inside of this game, the person minimizes, not only the substance use or effects of other addictive behavior, but minimizes the viewpoint of the codependent person.  The irony of this is that the codependent person is often more in touch with the healthy reality of life.  The addict has delusional thinking in not connecting the dots i.e.,  the cause and effect of using.  This delusion becomes a shared reality with the codependent as this enabler gets sucked into a sort of black hole of mental denial that reality is not actually what it is.

Clearing away the fog of the delusion is like coming out of a trance.  It can take time to correct the thinking process and get on a healthy track. 

Shame Blamers

    A good friend in the "Bongo Girls" coffee group coined a fabulous term in a group coffee session..."Shame Blamers". (Thank you Kari Estrin at www.kariestrin.com).

    I am not totally sure what she meant, but I am going to write a blog on what I think it is.

    In today's world there are many people who employ a complicated myriad of dysfunctional coping...all at once.  What is happening here is a combination of Projective Identification, which I will discuss next, the offending party not owning their own part in a problem and also, that person using shame tactics to manipulate the offended party into taking all the responsibility for problems in a relationship. 

    First, let me describe what Projective Identification is.  It is a "tag you are it" kind of game.  It goes like this.  Person #1 commits an offense toward Person #2.  When confronted, Person #1 attempts to "save face" by admitting no wrong and "turning the tables" to deflect onto something Person #2 can be blamed for in an altercation.  Person #2 can opt IN to accepting the deflection and thus, gets led down this toxic road, or he/she can stick with the point which is to hold Person #1 to  accountability for the action. 

     People who initiate this game usually have weaker ego strength and a lot of inward shame and low self-esteem. Ego strength is an inward, emotional strength that enables a person to accept responsibility without going into a total shame spiral and sinking into almost a suicidal despair and depression. It is the ability to say to oneself "I know I did wrong but I am still loveable".  It is the ability to see a grey area instead of just seeing self and others as "all good" or "all bad".  When one holds this type of coping, self and others fall on one side or the other as opposed to being a mix of good and bad qualities and all people being "a work in progress". It also involves maturity to work through problems by forgiving self and others and letting resentments go. 

     In the way the game goes, Person #2 is usually someone who is easily manipulated emotionally and is willing to accept the deflection and focus on themselves primarily in an attempt to heal the relationship or to avoid the emotional withdrawal pains of discontinuing this kind of toxic interaction. In the way the conversation goes, Person #1 owns nothing and thus, gives person #2 "nothing to work with" in terms of an equal resolution.  If person #2 wants to stay in the relationship, he/she has to settle for this uneven kind of resolution and ignore a need for validation of his/her own feelings.

     This is not the way true and full problem resolution is supposed to go.  Please see future blogs addressing proper problem resolution.


Healthy Codependency?

     When the word codependency comes u in the therapy room, people often say "Everyone's codependent".  And I usually agree. Really. It's true, it seems most people have this feature to some degree.  So what does this term really mean?  Well, for the prefix "co", we can use the word "together".  "Together dependency"...doesn't sound so unhealthy.  

     "Together dependency"  in itself is not a bad thing.  It is when the duo or group is "together dependent" around an addiction and/or unhealthy relational dynamics that the problem begins.  Often I use the word "interdependence" to help clarify what healthy relational dependence is. With interdependence, two or more people are working to meet many needs and are basically emotionally developed and healthy and then enlist others where needed to meet needs.  That sounds like a state of emotional maturity when the word interdependence is used.  So i guess that would make the word "codependency" a word used to describe relational immaturity.  And truly it is.      

     Our societal, cultural and clinical use of the word "codependency"  has gotten really worn out in the eyes of many.  It seems trite now.  People take it as an offensive label often.  Maybe there is a way we can rework it and make it a fresh new  term we can breathe new life into so that others won't run from it.  After all, people need to be "together dependent"...just not around something like addiction that drains the lifeblood out of all involved.

Emotional Balance vs. Chemical Vacations

     We hear the term a lot, but what does it really mean?  A definition from Webster's says: 

     "control of emotional bias and maintenance of the power of sober judgment, esp. under stress"    as well as

     "to adjust or apportion to achieve proportion, harmony or symmetry" or

     "the relation between input and  output".

It is so easy to get overwhelmed in today's world.  Inside of the trappings of overachieving and "busy-ness"  is just that... a trap.  when it feels like that and that there is no way out, addiction cn grow and increase as a "stress reliever" or what I often call a "chemical vacation".  Whether the chemicals a person is addicted to are their own, via process addictions, or the chemicals in a substance, we establish chemical imbalance in the body when too many stress hormones are in the blood stream. Getting emotional, logistical and spiritual needs met starts to establish and re-establish the balance and decrease the stress.  Sometimes it requires just letting go. One of the slogans in 12 Step programs is "Let go and let God."   To me, this means not trying to control everything and allowing God to actually be able to do some work. one thing about God, he lets us have free will.  In light of that, it is when we decide to move that things can start to fall in place.



Gasoline and Fire

Two addicts or alcoholics in a romantic relationship are like gasoline and fire.   The passion runs high on the positive end and on the negative end.  Often times these relationships are filled with psychodrama and vicious arguing.  Two people involved in such may be experiencing a certain "emotional hemophilia" in which the fighting continues, things cannot be talked about logically and brought to a resolution.  this is often a direct result of the swirling vortex of addictive insanity in each person as well as a plethora of character defects in which each person wishes to have the last word.

Senseless fighting can lead  to an increased level of emotional discomfort which will most likely be medicated by the addict/alcoholic.  The potential for ultimate destruction exists inside these fights.

One way to have the last word is to say "I'm sorry."  Holding onto that and not starting the fight again is the work done inside the 12 steps.

Addiction - Nature or Nurture

In the rooms of AA, one often hears, "Do you drink because you have problems or do you have problems because you drink?"  Truth be told, it's both. 

I once read that SHAME is the greatest determining factor as to whether or not a person developed his/her propensity to become an addict.  I whole-heartedly agree with this point.  As a therapist in private practice for 24 years, I just have rarely seen alcoholics/addicts come out of emotionally healthy and loving homes that practice all the rules of The Functional Family.  However, it often looks like The Functional Family from the outside, from the view of those outside the family system. 

The Nature of Alcoholism/substance abuse is that it takes over the normal chemical processes of the body and that once them chemical is introduced into the body on a regular basis, the body acclimates and tolerance builds.  The Nurture of alcoholism is the emotional world that has grown inside of the person which drives them to drink and use.

Sometimes it is hard for those outside to see inside of a family,  and sometimes it is hard for those inside a family see inside a family.  So how do we discern what relational factors are present in a family?  When beginning to look at that, it is important to take an attitude of No Judgment.  Discerning is defined perceiving and "figuring it out". Judgment is defined by condemning.  There is no room for non-constructive criticism and judgment when taking the inventory of family dynamics.  Everything should be done in the presence of as much love as can be mustered.

To simplify family dynamics and the Nurture of Shame, we can use Virginia Satir's Five Freedoms as a guideline.  These, synopsized,  include the ability to perceive(see and hear), feel and think what one perceives feels and thinks as opposed to what one should feel and the ability to take risks on one's own behalf instead of always "playing it safe".  How much these five freedoms are present in a family determine how relationally healthy the system is.  In 12 Step terms, how much can each member "Live and Let Live"?  

Let's learn to practice unconditional love and know that each person is in process on his or her growth path.