The following is an excerpt from a person in recovery checking in with their therapist:
“Just wanted to give you a little update on my week. Ended up with almost 55 hours last week at work! …
The following is an excerpt from a person in recovery checking in with their therapist:
“Just wanted to give you a little update on my week. Ended up with almost 55 hours last week at work! Boss was actually supportive, and normally I would be waiting for the other foot to drop, just like I do at home, but I set that thought aside and leaned into being grateful for some overtime dollars to pay down some bills. I am finding myself not dwelling on my anxious, worrying, negative thoughts as much anymore, and being able to move on faster. I mean the thoughts are there, but it’s okay, and I am okay moving forward without taking them with me. Home was tense, my marriage may not make it, but I also know I don’t have to “light things on fire” like I have in the past. I have to remember that I love him and me, but being together might not be the best thing for either one of us. This will be hard, so I have to remember to be taking care of myself so I can bring my best to this difficult situation. The world still finds ways to “test me,” but I took a deep breath and just took them in stride today. Feels extremely weird to let things go, but it does free up a lot of time, and I find myself being more positive! Funny right? I really am working on trying not to take everything so personally. I am leaning on the right people for support and trusting they can help me. Trust is really hard, as I know I haven’t been trustworthy in the past. I have had multiple FaceTime conversations this week with my family, [which] has been really nice. I’m eating healthier—okay, it’s not perfect, but I have a few carrot sticks with my chips at lunch—progress not perfection! But I’m moving, drinking water, meditating and doing stuff that is slowly bringing me joy. Sleep is so much easier now, and if I have a rough night, I just think of things I’m grateful for. I’m trusting the process.”
This is an actual excerpt from a woman 622 days into sobriety. This is a reflection of “recovery.” I’m her therapist in a treatment program for people with substance use disorders, work that often elicits “that must be so hard” responses from people when they find out what I do. Sure, it is hard work, but any work we put our mind, hearts and bodies into could be called “hard.” The shared excerpt is also meant to demonstrate that the work is an honor, incredibly rewarding and a great source of hope and possibility.
As someone who has now been working in the recovery field for more than 20 years, I am deeply motivated by the fact that I spend an increasing amount of time talking to people, communities and organizations that are outside and beyond the recovery field because I take it to mean that what is truly needed to confront the challenge of addiction is being increasingly understood. I have a private psychotherapy practice based in Liberty, NY (currently exclusively telehealth). I do not actively provide recovery support through that practice. What’s with the excerpt from my client at the top of this article, then? Well, I am also a clinical supervisor for an online, intensive outpatient addiction treatment program (IOP), which means people with substance use disorders spend 10 hours a week in Zoom meetings with others, laying the groundwork for recovery. This program is called “intensive” because it demands significant life changes on the part of the client. (It is important to note that if this program isn’t enough to support their ceasing of substance use and engagement in learning and healthy living, clients will need what is referred to as a “higher level of care,” which would be residential treatment.)
The IOP program uses the 10 hours of provided treatment to provide education about the physiology of addiction and why they can’t “just stop or stay stopped” on their own; a space to try out new tools for communicating, understanding and managing feelings; and the support to explore meaning and opportunities from both their past life as well as their future. While this happens in the time spent “in” the program—comprising three-hour groups with the same small group of people three times a week and another hour-long session with a therapist—they also have to do a lot of work outside of the program. This includes assessing their existing relationships and determining which ones will help them maintain sobriety and build a life in recovery and which might not. It also requires learning how to build new relationships with people to build an essential sober support network. “Outside” work involves actively trying out new skills and tools learned “in” the program and building confidence with them. This often means changing how one does almost anything, from driving a different path to work so as not to pass the triggering liquor store each day, to picking the dusty guitar back up or trying out a new hobby, and often needing to “act as if” it is fun before it even really feels fun.
Addiction involves a broken reward system in relation to neurotransmitters in our brain. Things that cause pleasure in a person who is not addicted can’t stimulate pleasure in the brain of an addicted person, even if that thing used to bring the addicted person pleasure. And finding pleasure in things that are supposed to naturally cause pleasure—like time spent laughing with loved ones, music, exercise, or a delicious meal—does not immediately return when substance use ceases. The re-regulation of pleasure-causing neurotransmitters is a fundamental aspect of the recovery process and can take up to two years. This is why another vital aspect of early recovery is engaging in fun. Having fun is an essential element of self-care for every human, and those in early recovery are often even more resistant to that idea than others. Sometimes those in early recovery question whether they deserve to have fun as they begin to process the impact their addiction has had on themselves and those around them, and they often feel as if they can’t have fun if drugs or alcohol aren’t involved (because that’s what hijacked their pleasure system to begin with). This belief is actually true early on, but all of this work is meant to repair the reward system as quickly as possible—but it is work, and it takes a lot of it.
Beyond the efforts being put forth by the person recovering from the disease of addiction, there is a comprehensive family and friends’ program for loved ones of those in treatment; the program lays out the physiology of addiction and offers support on ways to more effectively support their recovering loved one as well as make their own life more manageable and enjoyable. I lay this all out to explain why I believe one weekly 45-minute session with a therapist alone does not offer a viable approach to all that recovery from addiction demands (though I do believe it to be an important part of a more comprehensive approach), and why communities need multifaceted networks of resources which include and support the recovery community. Our community is doing tremendous work in developing such a network but will need comprehensive support from all to succeed.
This brings us back to those conversations—like this one happening in the form of a newspaper article—with the world of people beyond those suffering from addiction or treatment providers. Recovery is a process of engagement with an entire community. It certainly begins with a person with addiction’s body, and perhaps, most precisely, the neurochemistry in their brain, but that process of healing occurs in the context of interpersonal relationships, personal and professional opportunities, experiences that allow for the training of new habits and strategies of decision making. Reflect back to the excerpt from my client at the beginning. She did not mention alcohol or drugs once. She talked about work, family, thoughts, feelings, stress, anticipated loss of a relationship, choices, finances, trust, carrots and so much more. But no mention of alcohol or drugs. This is because recovery is about learning to regulate emotions, accepting human imperfection in oneself and others and building the ability to be vulnerable and supportive and to be supported in return. It’s about savoring the joy and contentment life has to offer without getting lost in the pain and disappointment it will also involve along the way. Addressing the presence of addiction in our community is not only about getting rid of drugs but also building opportunities for all to engage in lives worth living. That is recovery.