Guest Article Share by Amy Dresner ~ Writer for The Fix. Getting Through Life Events ~ Taking Care of a Parent and Staying Sober Through It.

Guest Article Share by Amy Dresner ~ Writer for The Fix. Getting Through Life Events ~ Taking Care of a Parent and Staying Sober Through It.

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How to Stay Sober Through a Parent’s Illness – By Amy Dresner 08/05/19


I won’t lie, the urge to fix from the outside is constant. The helplessness is overwhelming, the grief indescribable.

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I think it was about a year a half ago when my mother became wheelchair-bound and was diagnosed with dementia. The two trips to visit her in Santa Fe were so stressful that my bestie, also a recovering addict, started vaping for the first time and she still hasn’t stopped. We had five days to clear out her apartment, find her a board and care, break her lease, put her stuff in storage, forward her mail, and much more. I cried most of that trip but it all got handled.

My life is different now. My mother can’t hear well and she’s confused. She can’t walk or use the computer anymore. People bathe her. She calls me multiple times a day about the same thing. On top of that, I was suddenly given the “power of attorney and appointed Social Security payee.” I was in charge of all her bills, speaking to her nurse, speaking to her chaplain, and speaking to her social worker.

Role Reversal

If there’s one thing addicts don’t seek out, it’s responsibility. As an only child, I alone had to handle all of it. Sure I was sober but mature? Hardly.

I recently had to sign a form to approve the use of Narcan should my mother overdose on her Oxycontin. When the nursing staff assistant tried to explain opiates and Narcan to me, I stopped her.

“I’m …um…well-versed in Narcan. I’m an ex-junkie.”

I heard her mutter an “Oh” followed by an uncomfortable silence.

I’ve never had children for a sundry of reasons: my genes, my fertility, my financial situation, my shitty relationships. Suddenly I had a child and it was my mother. The role reversal was sudden and jarring and I recall rocking and crying and whimpering, “I don’t want this.” But it was all mine, like it or not.

My relationship with my mother was always difficult. I was resentful for her physical absence during my childhood and her emotional absence always. But suddenly all that resentment melted away. Resentment is a luxury, I realized, and as her caretaker, there was no room for it anymore.

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Dispelling Common Myths About Depression (2)

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Almost 50, with Zero Life Skills

Having spent 30 years of my life mentally ill and struggling with addiction, having to “adult” suddenly felt premature and impossible. It was like coming out of a time warp. I was almost 50 but I had zero life skills: No idea how to pay taxes or when to rotate your tires or how to hold down a “real” job, let alone handle all my mother’s shit. Sure I had other life skills: making a crack bong out of a Mountain Dew bottle or how to hit a rolling vein or manipulating people into taking care of me. But these weren’t so helpful now.

I was a grown woman but I still felt and honestly acted like a child most of the time. I still needed my mom but now she wasn’t available. I’d never felt like she “heard” me and now she really couldn’t hear me. I never felt she “understood” me and now she really couldn’t grasp what I was saying. I hate to use the “t” word but yeah it was triggering.

We had grown closer during this sobriety but now, suddenly, she wasn’t somebody I could bring things to. She became somebody who brought things to me and they were all “emergency” needs: Afrin, salted nuts, Nars concealer. My mother had always been particular, snobby, and demanding. That didn’t change. I quickly accepted all of these things and began to lean much more heavily on my father.

Gutted

Then, about a week ago, my father was diagnosed with cancer. I was gutted. He and I are impossibly close; he is my mentor, my hero, my best friend.

“You can’t go. You’re my person,” I wept pathetically into the phone. Everything good about me comes from him: my humor, my intelligence, my writing ability. And now he’s ill. Really ill. My first reaction and I’m not proud of this at 6.5 years sober, was to kill myself or get loaded. My brain screamed, “GET OUT.”

We all have those things: if “this” happens, I’ll get loaded. My dad’s death was always that: my hold out, my exemption. When I told him that a few years ago he said, “Too fucking bad, Ames. It’s in my will if you get loaded, you get nothing.” Fuck.

It’s all so selfish. Fuck his cancer, I’m hurting and I need to attend to that. Suddenly I was making it about me. I try not to cry on every phone call but am rarely successful. I feel weak and small.

I started to spiral, lumping all the bad on top of each other as we do: I’m single, I’m broke, I’m getting old. My parents are dying. But if I know one thing, it’s that a relapse would kill both of them faster than the diseases they were battling. It just isn’t an option.

Still, every day I have the urge to escape my body, numb the pain, check out. Not because I don’t have a strong program or I’m not connected to my higher power or any of that bullshit, but because I’m an addict and we don’t like feelings and we get high to avoid them. Six and a half years of sobriety doesn’t negate a lifetime of drugs and suicide attempts as my top and most successful coping mechanisms.

But if I’ve finally learned anything, it’s that it doesn’t matter what I feel like doing, it matters what I do. I can’t control my feelings or thoughts but I can control my actions.

When I’m Not Crying, I’m Angry

When I’m not crying, I’m angry. I’m so fucking angry. Fuck you, God. God never gives you more than you can handle?! Well, this feels like more than I can handle. And fuck me. Fuck me for having been a complete wreck for most of my adult life.

And then in between the tears and the rage, there’s numbness, where I feel nothing because it’s all just too much. I catch myself just staring into space, zoning out on the multitude of Pyrex dishes at Target. Not lost in thought, lost in nothingness.

I don’t think anything prepares you for the death of your parents. I don’t care how old you are or spiritually fit (insert eye roll). Sure, they’re in their 80’s; it’s bound to happen, it’s part of life, blah, blah, blah.

But you still never think it will happen. And when it does, you are suddenly faced with an aloneness that is inconceivable, an unending void that will never be filled.

I look back now at me mourning a break-up for over two years. What a fucking joke. You can get a new boyfriend. You can’t get a new mother or father.

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I've been through a lot of tough times, more than my fair share and these words are very true.

How I’m Staying Clean

I won’t lie, the urge to fix from the outside is constant. The helplessness is overwhelming, the grief indescribable. So how am I staying clean? Well, I started vaping again (judge away, fuckers). I’m talking to my sponsor every single day, I’m talking to my friends, I’m working with my sponsees.

I’m crying. I’m trying to be kind to myself. I’m trying to be of service to my parents and process my grief elsewhere. I’m calling friends and asking for support. Sure I don’t always answer the phone, but don’t take it personally. Sometimes I’m just too shut down to talk. I sleep and nap …a lot. Depression or escape? Does it really matter? It beats the alternatives.

When I asked other people in recovery how they made it through a parent’s illness and death, almost all of them said the same thing: They didn’t. They drank and used during the whole process to escape the pain and it was the biggest regret of their lives.

Whether the parent had known or not was immaterial. They were haunted by the guilt they felt and if they could do it all over again, they’d stay sober, give their parent the gift of being completely present, and not run from the feelings. I can and will do that, as ungraceful as it might be.

I said to one of my sponsees: “You are about to witness a magic trick. You are about to watch your sponsor go through one of the most painful times ever and not get loaded.” I think I was telling myself as much as her.

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Amy Dresner
is a recovering drug addict and all-around fuck up. She’s been regularly writing for The Fix since 2012.

When she isn’t humorously chronicling her epic ups and downs for us, she’s freelancing for Refinery 29AlternetAfter Party ChatSalonThe FriskyCosmo LatinaUnbound BoxAddiction.com and Psychology Today.

Her first book, My Fair Junkie: A Memoir of Getting Dirty and Staying Clean was published in September 2017 by Hachette Books. Follow her on Twitter @amydresner.

 

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I Am a Childhood Sexual Trauma and Abuse Survivor Maintaining Recovery From Addiction …Helpful Guest Article and by Kristance Harlow 04/22/19.

I Am a Childhood Sexual Trauma and Abuse Survivor Maintaining Recovery From Addiction …Helpful Guest Article and by Kristance Harlow 04/22/19.

Are the 12 Steps Safe for Trauma Survivors?

“When the 4th and 5th steps are done without support for the symptoms of PTSD, they have the potential to retraumatize.

Trauma is a current buzzword in the mental health world, and for good reason. Untreated trauma has measurable lasting physiological and psychological effects, which makes it a public health emergency of pandemic proportions.

Trauma is an event or continuous circumstance that subjectively threatens a person’s life, bodily integrity, or sanity, and overwhelms a person’s ability to cope.

PTSD and Substance Use Disorder

Post-traumatic stress disorder (PTSD) is a condition caused by experiencing or witnessing a traumatic event. Symptoms include nightmares, flashbacks, anxiety, intrusive thoughts about the trauma, hypervigilance, and avoidance of triggers which remind you of the event. Substance use disorders (SUD) are frequently co-morbid (co-occurring) with PTSD.

Many people with PTSD self-medicate with mind-altering substances to alleviate symptoms but getting high or drunk only works for so long. Substance use disorders often evolve from using substances as a maladaptive coping tool.

There are many physiological correlations between psychological trauma and SUD. For example, there are similarities in gray matter reduction for both the person with PTSD and the person with an alcohol use disorder. Although the neural mechanisms of addiction in PTSD patients are not fully understood, research has found that in the prefrontal cortex, dopamine receptors may be involved in both conditions.

Memories related to fear and reward are both processed with the help of these specific receptors. It could be that the processing of traumatic memories affects the dopamine receptors, making them more sensitive to reward-triggering substances.

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Sometimes, people with a dual diagnosis of addiction and PTSD find their way to 12-step programs like Alcoholics Anonymous. These programs are widespread, free, and require no commitment, which makes them more accessible than other types of treatment.

AA’s worldwide membership and lasting existence have caused the program to be of interest to researchers for decades. Previous research has found positive correlations between an AA participation and abstinence. There is less research on how 12-step programs interact with trauma recovery.

Studies on relapse factors have found that common predecessors to relapse in adults include anger, depression, and stress, among others. Recalling traumatic experiences, for someone with PTSD, can cause intense physiological and psychological reactions characterized by these same feelings: anxiety (stress), depression, anger, and frustration. It’s a combination that puts people with both trauma and addiction at a higher risk of relapsing.

Guilt, Shame, and AA

There are two sets of steps in 12-step programs that involve memory recall and direct involvement with others: Steps 4 and 5 and Steps 8 and 9.

Step 4 says: “Made a searching and fearless moral inventory of ourselves.” That step is followed up by sharing that inventory in Step 5: “Admitted to God, to ourselves and to another human being the exact nature of our wrongs.”

Later, Step 8 says: “Made a list of persons we had harmed and became willing to make amends to them all.” To deal with that list, Step 9 directs people: “Made direct amends to such people wherever possible, except when to do so would injure them or others.”

The gist with these steps is that they look at both the resentment/anger the person feels towards others (which always involves taking responsibility for a part or all of the event that caused the resentment and anger), and also the “harms” the person caused others. But there is no direct guidance on how to ensure a realistic and safe assessment of past events is made.

The AA book presents this step as if someone with a substance use disorder has the tendency to blame others. People with PTSD are wracked with self-blame, and it is self-blame and shame which fuels many people’s addictions, but shame is not explicitly addressed in the steps.

Guilt is very commonly experienced by people with PTSD. Survivor guilt can be a bit of a misnomer; PTSD develops from situations that are subjectively experienced as traumatic, but these circumstances don’t have to involve death (although they certainly can and do for many people). Simply surviving can feel like something the person is not worthy of. They may feel guilt when they don’t stay in pain and anxiety.

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“Shame is also common in trauma survivors, especially in people who have been sexually assaulted.”

Trauma survivors must restore a positive sense of self to find healing. Judith Herman, the author of Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terrorexplains that “the survivor needs the assistance of others in her struggle to overcome her shame and to arrive at a fair assessment of her conduct.”

It becomes important, as the trauma reveals itself, to see it clearly for what it was so the person can integrate those experiences into their individual life stories.

AA literature is very focused on decreasing ego and on disrupting the selfishness of the person with the addiction. This is not necessarily a helpful baseline for traumatized folks; it can be harshly critical. The feeling of being judged can deepen the rift between the survivor and others.

Herman writes, “Realistic judgments diminish the feelings of humiliation and guilt. By contrast, either harsh criticism or ignorant, blind acceptance greatly compounds the survivor’s self-blame and isolation.”

The primary text of Alcoholics Anonymous (the “Big Book”) suggests alcoholics review their past sexual life when creating a life inventory in Step 4. For the overall inventory, the book suggests that the reader completely disregard “the wrongs others had done” and to look only at “our own mistakes.”

Even in situations where a person caused harm to the reader, the reader should “disregard the other person involved entirely” and find “where were we to blame?” These suggestions can be dangerous for survivors of intimate partner violence or child abuse who have been told that they were to blame for the abuse they suffered.

The book further details what to ask yourself when making an inventory of your sexual conduct:

“Where had we been selfish, dishonest, or inconsiderate? Whom had we hurt? Did we unjustifiably arouse jealousy, suspicion or bitterness? Where were we at fault, what should we have done instead?” It is worrisome that a sex inventory is taken to find out how “we acted selfishly” when one-third of women and one-sixth of men have been sexually assaulted or raped.

An estimated half of women who experience a sexual assault will develop PTSD. One study found that 80 percent of women with SUD who seek inpatient treatment have been physically or sexually assaulted and nearly 70 percent of men have experienced either physical or sexual abuse.

How the 12 Steps Can Harm People with PTSD

Because remembering past traumas makes the brain’s reward center more receptive to the effects of drugs, Steps 4 and 5 need to be approached with extreme caution for people who have experienced trauma.

Ideally, these steps jumpstart healing; but when they are done without support for the symptoms of PTSD, they have the potential to retraumatize. As the person shares their trauma with someone else, hopefully, the listener is compassionate and willing to point out where things were not the addict’s fault—at all.

A child survivor of molestation had no agency in the assault, and it is unconscionable to tell that child, now grown, that they need to determine where they were at fault. It is not possible to “disregard the other person involved entirely” when an event only occurred because of the other person. Sometimes we need to recognize this fact and say to ourselves (or hear from someone else): “You had no part in this, you were a victim at that time.”

In Steps 8 and 9 we are to list and resolve harms done to others. If step 4 and 5 didn’t properly address where our fault doesn’t lie, we may be inclined to list abuses and harm done to us as wrongs we did. It says not to make amends if it will cause harm to others, but we need an additional specification not to make amends if it will cause harm to ourselves.

If you owe an abusive ex-partner money, are you supposed to pay them back if you’ve cut off all contact? These are issues that require careful consideration. Sharing both lists with a compassionate person has the potential to help survivors recover. Sharing both lists with someone who is too harsh in their suggestions and assessments has the potential to push those in recovery back into active addiction.
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Dispelling Common Myths About Depression (1)
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The care of a loving, compassionate, and knowledgeable supporter, like a sponsor, can help sort out these dangerous triggers. Since such a large percentage of people in 12-step programs have experienced trauma, sponsors should be able to provide trauma-informed care; otherwise, going through the steps may end up retraumatizing their sponsees and leaving them vulnerable to relapse.

Yet, there are no qualifications for sponsorship and no way for someone new to the program to be aware of these potential pitfalls. There are so many variabilities to the 12 steps and how they are implemented.

The way in which someone interprets the language of the steps can change how people understand themselves and their history. Trauma-focused recovery can be lost in the mix and deserves more explicit attention.

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Kristance Harlow is a freelance writer and mental illness advocate. She fights stigma and writes about uncomfortable experiences. She lives in a foreign land with her husband and rescue pups.

Find Kristance on TwitterInstagramLinkedIn, or her blog.

 

Important Guest Article Reshare By Amy Dresner, Author of ‘My Fair Junkie,’ A Memoir. This Post Is About Recovery & Depression…

Important Guest Article Reshare By Amy Dresner, Author of ‘My Fair Junkie,’ A Memoir. This Post Is About Recovery & Depression…

Welcome Recovery Friends, Warrior Advocates, and New Visitors,

I am so happy and blessed that Amy agreed to let me reshare her article which comes by way of The Fix Magazine. She is an amazing “in your face –let it hang out” writer and blogger for them. The Fix share news about addiction and recovery from drugs and alcohol and is one of the top resource magazines around!

I happen to have signed up for there newsletter a while back and seen Amy’s article. Being dual-diagnosed myself and still have bouts of depression at times, I felt this article of hers really needed to be shared with all my friends here.

It is very informative and I just love Amy’s views on a variety of issues and her writing style! I hope you enjoy reading it and learn some from it as I did! Don’t forget to grab of copy of her book (link listed in her bio) if you have not read it.

It is truly a great read and her life memoirs are “one of kind!”  ~Cat 

Depression in Recovery: Do You Have Low Dopamine Tone?

By Amy Dresner 09/10/18 ~ Courtesy of The Fix Magazine
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Mature Woman Depression Looking Away
((The Fix does not provide medical advice, diagnosis, or treatment, nor does anything on this website create a physician/patient relationship.  If you require medical advice, diagnosis, or treatment, please consult your physician.)

 

I just felt like shit and slept as much as I could. I showed up to work. I kept my commitments. I spoke when asked to, but I felt more than unhappy. I felt like I just didn’t care.

I just came out of a six-week depression. That might not sound very long, but when you’re in hell it feels like forever. Good news: I didn’t bone any 25-year-old strangers; I didn’t cut myself; I didn’t get loaded; I didn’t smoke or vape although I really, really wanted to. I didn’t even eat pints of Ben and Jerry’s while binge-watching I Am A Killer. I just felt like shit and slept as much as I could. I showed up to work. I kept my commitments.

I spoke when asked to, but I felt more than unhappy. I felt like I just didn’t care. I didn’t return phone calls. I didn’t wash my hair. Suicidal thoughts bounced around my head, but I ignored them like I do those annoying dudes with clipboards outside Whole Foods.

I’ve suffered from symptoms of depression since I was 19, so it’s an old, old friend. What really annoys me was that some (dare I say many?) people think at five and a half years of sobriety, you shouldn’t feel depressed. What I kept hearing from AA fundamentalists was:

“It’s your untreated alcoholism.”

“Listen to these tapes about prayer and meditation.”

“You’re not connected enough to your Higher Power.”

“You’re not going to enough meetings.”

“You need to do more service.”

Thankfully my sponsor, who has a foot in the medical world, did not say something along those lines.  One of my big problems with AA is that it looks at every mental problem through the paradigm of your “alcoholism.” If you’re suffering, you should look to the program for relief.

Nobody would tell you to “drive around newcomers!” more if you had diabetes or kidney failure, but if you’re feeling down, that’s what you’re told to do. As it turns out, AA is not completely off the mark: “Addiction is a not a spiritually caused malady but a chemically based malady with spiritual symptoms,” addictionologist and psychiatrist Dr. Howard Wetsman told me.

“When some people start working a 12-step program, they perceive a spiritual event but their midbrain is experiencing an anatomical event. When they’re working a program, they’re no longer isolated and they no longer feel ‘less than,’ so their dopamine receptor density goes back up [and they experience contentment],” he explained. But what if your program hasn’t changed or feels sufficient and you still feel depressed?

What if you’re working your ass off in your steps and helping others and you still feel like shit?
“Well, low dopamine tone experienced as low mood can be brought on by fear and low self-esteem (the untreated spiritual malady part of alcoholism/addiction) but it can also be brought on by biochemical issues,” Wetsman added.

Huh?

So was I experiencing the chemical part of my “addiction” or was I having a depressive episode? Perhaps my whole life I’d been confusing the two. Of course, all I wanted, like a typical addict, was a pill to fix it. But as I’ve done the medication merry-go-round (and around and around) with mild to moderate success, I was hesitant to start messing with meds again. I didn’t have a terrific psychiatrist, and SSRI’s can really screw with my epilepsy. And Wetsman was talking about dopamine here, not serotonin. Hmmm…

Dr. Wetsman has some interesting stuff about brain chemistry and addiction on his vlog. He mentions something called “dopamine tone” which is a combination of how much dopamine your VTA (Ventral Tegmental Area) releases, how many dopamine receptors you have on your NA (Nucleus Accumbens), and how long your dopamine is there and available to those receptors.

Stress can cause you to have fewer dopamine receptors and fewer receptors equal lower dopamine tone. He’d explained to me in previous conversations how almost all of the people with addiction he’d treated had what he described as “low dopamine tone.”

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When you have low dopamine tone, you don’t care about anything, have no motivation, can’t feel pleasure, can’t connect to others. In addition, low dopamine tone can affect how much serotonin is being released in the cortex. Low midbrain dopamine tone can lead to low serotonin which means, in addition to not giving a shit about anything, you also have no sense of well-being. Well, that certainly sounded familiar.

Dr. Wetsman has a very convincing but still somewhat controversial theory that addiction is completely a brain disease and that using drugs is the result, not the cause. I really suggest you get his book, Questions and Answers on Addiction.

It’s 90 pages — you could read half of it on the john and half of it while waiting at the carwash. It explains in detail why most of us addicts felt weird and off before we picked up and why we finally felt normal when we used. Again, it’s all about dopamine, and it’s fucking fascinating. No joke.

In his vlog, he explains that dopamine production requires folic acid which you can get from green leafy veggies (which I admittedly don’t eat enough of) but it also requires an enzyme (called methylenetetrahydrofolate reductase or MTHFR for short) to convert folate into l-methyl folate. Certain people have a mutation in the gene that makes MTHFR, so they can’t turn folate into l-methyl folate as effectively, and those people are kind of fucked no matter how many kale smoothies they drink.

But it’s not hopeless. If people with this genetic mutation take a supplement of l-methyl folate, their brain can make enough dopamine naturally. Of course, once you have enough dopamine, you’ve got to make sure you release enough (but there’s medication for that) and that you have enough receptors and that it sits in the receptors long enough (and there are meds for that too).

So this all got me wondering if maybe my MTHFR enzyme was wonky or completely AWOL. Dr. Wetsman urged me to find a good psychiatrist (since I’m on Prozac and two epileptic medications) or a local addictionologist in addition to taking a genetic test for this mutation. In his experience, patients who had a strong reaction to taking the l-methyl folate supplement were frequently also on SSRIs. They either felt much better right away or really really shitty. But if they felt even shittier (because the higher serotonin levels work on a receptor on the VTA which then lowers dopamine), he would just lower their SSRI or sometimes even titrate them off it completely. And voila. Success.

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It’s all very complicated, and this whole brain reward system is a feedback loop and interconnected with all kinds of stuff like Gaba and Enkephalins (the brain’s opioids) and Glutamate. But you guys don’t need me for a neuroscience lesson so I’m trying to keep it simple. The basics: how do you know if you have too little dopamine?

You have urges to use whatever you can to spike your dopamine: sex, food, gambling, drugs, smoking, and so on. What about too much dopamine? OCD, tics, stuttering, mental obsession and eventually psychosis. Too little serotonin? Anxiety and the symptoms of too high dopamine tone. Too much serotonin? The same thing as too little dopamine tone. Everything is intricately connected, not to mention confusing as all hell.

Being broke and lazy and having had decades of shitty psychiatrists, I decided to go rogue on this whole mission (not recommended). I mean I used to shoot stuff into my arm that some stranger would hand me through the window of their 87 Honda Accord so why be uber careful now? This l-methyl folate supplement didn’t require a prescription anymore anyway. What did I have to lose? I did, however, run it by my sponsor whose response was: “I’m no doctor, honey, but it sounds benign. Go ahead.”

I ordered a bottle. A few days later I heard the UPS guy drop the packet into my mail slot. I got out of bed, tore open the envelope and popped one of these bad boys. A few hours later I started to feel that dark cloud lift a little. Gotta be a placebo effect, right? The next day I felt even better. And the next day better still. I didn’t feel high or manic. I just felt “normal.” Whoa. It’s been weeks now and the change has been noticeable to friends and family.

Normal. That’s all I ever really wanted to feel. And the first time I felt normal was when I tried methamphetamine at 24. It did what I wanted all those anti-depressants to do. It made me feel like I knew other people felt: not starting every day already 20 feet underwater. I found out later that my mother and uncle were also addicted to amphetamines which further corroborates my belief that there is some genetic anomaly in my inherited reward system.

When I emailed Dr. Wetsman to tell him how miraculously better I felt, his first response was “Great. I’m glad. The key thing is to take the energy and put it into recovery. People go two ways when they feel amazingly better. One: ‘Oh, this is all I ever needed. I can stop all this recovery stuff.’ Or two: ‘Wow, I feel better. Who can I help?’ Helping others in recovery will actually increase your dopamine receptors and make this last. Not helping people will lead to shame, lowered dopamine receptors and it stops being so great.”

So no, I’m not going to stop going to meetings or doing my steps or working with my sponsor and sponsees. Being part of a group, feeling included and accepted, even those things can create more dopamine receptors. But sadly I’m still an addict at heart and I want all the dopamine and dopamine receptors I can get. However, I also know that enough dopamine alone isn’t going to keep me from being a selfish asshole…

But maybe, just maybe, having sufficient dopamine tone and working a program will.

 

 

Amy Dresner

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Amy Dresner is a recovering drug addict and all around fuck up.

She’s been regularly writing for The Fix since 2012. When she isn’t humorously chronicling her epic ups and downs for us, she’s freelancing for Refinery 29, Alternet, After Party Chat, Salon, The Frisky, Cosmo Latina, Unbound Box, Addiction.com and Psychology Today.

Her first book, My Fair Junkie: A Memoir of Getting Dirty and Staying Clean was published in September 2017 by Hachette Books.  Follow her on Twitter @amydresner.

 

 

Awareness Month Feature Article by “The Fix” Explores The Topic: ‘AA Is not an Evidence-Based Treatment’

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AUTHORS NOTE:

“I am in no way demeaning or saying that The 12-Step Program and model is not a form of treatment, nor that it doesn’t help people recover from drugs, gambling, or alcoholism.  But more and more articles like the one I am sharing today and hearing many people talk about needing and wanting MORE than 12-steps to reach long-term recovery and have a well-balanced path from ADDICTION.”

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So please don’t leave me nasty comments as to such. What I am exploring is a more in-depth look into having “Wellness in Recovery.” Many are now searching for ways to obtain treatment AND learn the much-needed skills and tools to begin the “inner work” needed to a well-balanced recovery without relapse or slips in the process.

Let’s face it, if we teach new addicts coming into treatment BOTH, we just may cut relapse percentages in half or more and would mean MORE NEW addicts would be getting the help they need as well.

There are many ways to go about it this.

One new exciting way I have been using and venture I am involved with is for those working in the “treatment side and facilities” and those looking for recovery “AT HOME Recovery.”  Learn more about “Wellness in Recovery” and “Oak Valley Productions Educational DVD Series.” It is a fresh approach to having a well-balanced journey, learn to begin and process the underlying issues that may have you turned to addiction, and learn to release and let it GO!

It will help guide you on how to begin your “inner work” as you learn the educational side of recovery from addiction! See all the details of this non-12 step recovery series and have  “Recover in Wellness” of mind, body, soul and Spirit!

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FEATURED ARTICLE: AA, GA, NA, Is not Evidence-Based Treatment by, Laurel Sindewald 03/16/17

“Researchers have not been able to methodologically eliminate self-selection bias or utilize adequate controls in their studies of 12-step groups and Twelve-Step Facilitation.”

When I read Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, I was surprised to see Twelve-Step Facilitation (TSF) included as an evidence-based behavioral treatment for addiction. I had just done a literature review on the efficacy of 12-step-based interventions and found the evidence insufficient to support the prescription of 12-step groups as treatment. TSF is a standardized form of therapy where professional counselors try to engage their patients in participating actively in 12-step groups, in part by emphasizing 12-step philosophy during therapy sessions.

Twelve-step philosophy stipulates that addiction is a spiritual disease born of defects of character and that 12-step groups are the only cure, involving faith in a higher power, prayer, confession, and admission of powerlessness. In contrast, the National Institute on Drug Abuse (NIDA) defines addiction as a disease of the brain – a medical condition requiring medical treatment. A spiritual disease concept is not the same as a medical disease concept. Twelve-Step Facilitation treats addiction as a spiritual and biopsychosocial disease, retaining the spiritual emphasis of 12-step philosophy.

TSF was classified as a professional behavioral treatment in the Surgeon General’s Report. How can a professional, medical treatment be based on a definition of addiction as a spiritual disease? Baffled, I knew I would not be able to understand if I got stuck in bias against Twelve-Step Facilitation. I had studied the research on 12-step groups, but had only dipped my toe into the research on TSF. The Surgeon General’s Report cites hundreds of studies, and over a dozen in support of TSF. So, I did what all good scientists must do: I set aside my bias, knowing that if I want the truth, and I must assume first that I am wrong and dig deeper.

I conducted a preliminary literature review to investigate the effectiveness of TSF as a treatment, and then examined each of the sources the Surgeon General’s Report cited in support of TSF. I looked at the methodology, results, and conclusions for each. In this article, I define “evidence-based” to mean any treatment supported by numerous scientific experiments with rigorous methods that include control groups, randomization of patients to treatments, and bias-free samples. I use “12-step approaches” to refer to all 12-step-based rehab programs, TSF, and 12-step mutual help groups.

The key to understanding research on TSF is to know why the treatment was created in the first place. Researchers had documented a correlation between 12-step group attendance and abstinence, but correlation is not causation and research had been limited in several ways:

  • Studies evaluating the effectiveness of 12-step groups could not eliminate self-selection bias, which happens when group members are not randomly selected and participants opt in or select themselves, creating biased samples. The people participating in the studies had chosen to participate, and researchers could not determine whether successes observed were due to 12-step participation or qualities in the self-selected participants, such as greater motivation to enter recovery, more resources, or greater receptivity to messages of God, faith and/or acceptance. The people who chose not to participate, or who dropped out of the study, were not always accounted for. Researchers could not determine whether the correlation they observed was due to the treatment or to the characteristics of the people participating.
  • Twelve-step groups have no standardized methods or conditions. Leaders of the groups are often laypeople in recovery from addiction themselves. The quality of social support in the group depends on the people who are participating. The literature is interpreted by the members, who create their own cultures around the interpretation. Twelve-step cultures also pass around other information and advice, which may or may not permeate every group. Each sponsor is a different layperson in recovery from addiction, with different character traits. Researchers could not control for all of these variables all of the time.
  • Researchers struggled to maintain rigorous control groups throughout studies. At a minimum, to determine whether 12-step groups have an effect, researchers needed a no-treatment control group for each study. Ethically and logistically, they could not prevent people in the control groups from receiving treatment or from attending 12-step groups.

 

A woman's torso and hands holding a sign saying "Treatment"

Twelve-Step Facilitation was developed by researchers working on Project MATCH, a well-known and extensive study funded by the National Institutes of Health. Project MATCH compared TSF to Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT), seeking to establish what patient characteristics corresponded with the best results for each treatment. The study found there “was little difference in outcomes by type of treatment” based on the primary outcome measures of percent days abstinent and drinks per drinking day.

By standardizing methodology for TSF, Project MATCH made some headway on strengthening the quality of evidence, but they did not find a way around self-selection bias and they did not have a control group. Many patients, however, did drop out of the assigned treatments early on in the study. Two researchers later examined the outcomes of the zero-treatment dropout group, and found that “two-thirds to three-fourths of the improvement in the full treatment group was duplicated in the zero-treatment group.”

This means that the people in Project MATCH’s treatment groups did not have significantly better abstinence outcomes than the people who dropped out of the study. Importantly, we do not know whether the dropout group sought treatment on their own, and it seems probable that they did. Based on their analysis, none of the interventions in Project MATCH seem to be effective, but without an actual control group, the results are equivocal regardless.

Some researchers have sought to re-analyze other parts of the Project MATCH data, but their findings, while supportive of TSF, are subject to the same methodological limitations of the parent study. Many other studies cited by the Surgeon General’s Report seem to support TSF as effective for improving abstinence outcomes and/or for relatively increasing 12-step participation compared to treatment as usual (TAU), but none of these studies had control groups. The Surgeon General’s Report cited one source in support of TSF that was actually an article reviewing information about 12-step programs to educate social workers, not an experimental study. The Report also cited a study in support of TSF that examined two active referral interventions, 12-step peer intervention (PI) and doctor intervention (DI), compared to no intervention (NI). The study found that while the active referral interventions significantly increased participation in 12-step groups compared to no intervention, “abstinence rates did not differ significantly across intervention groups (44% [PI], 41% [DI] and 36% [NI]).”

This study was the only one cited in the Surgeon General’s Report in support of TSF that approximates a control group, and it does not actually support the efficacy of TSF in increasing abstinence outcomes. The NI pseudo-control group still received a list of 12-step group meeting times and locations, but was not encouraged to attend. The PI group attended meetings twice as much as the NI group, and yet the researchers found no significant difference in abstinence outcomes. The DI group, essentially TSF, was less effective than the PI group at increasing attendance, and again, did not significantly improve abstinence.

My own literature review turned up articles the Surgeon General’s Report did not reference, both in support of TSF and not supporting TSF, but none of the studies I found had control groups either. Results of my literature review, including my assessment of the Surgeon General’s report sources, were therefore as ambivalent as the 2006 Cochrane Review, a systematic meta-study of all 12-step-based programs that found “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.

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In medical science, if a treatment is ineffective or faces prohibitive methodological challenges, the treatment is either revised or abandoned. Twelve-step philosophy prohibits either approach. Twelve-step literature is comparable to the Bible for Christians or the Qur’an for Muslims; if the literature is removed, the identity of the group goes with it. The same basic text has been used for AA since the publication of its “Big Book,” Alcoholics Anonymous, in 1939. Twelve-step literature also explicitly states that “Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.

There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average.” Twelve-step philosophy, by taking this position, is asserting that its methods can never be wrong. If the 12 Steps do not work for people, 12-step philosophy explicitly states it is their fault, and that the fault is inborn and irreversible. The 12 Steps and attendant literature, however, are not modified.

Research does support the concept that changing “people, places, and things” and finding a network of people with a culture of abstinence can improve chances of recovery. However, mutual help groups other than 12-step groups do exist that may provide the social support needed by people in recovery. People who are not religious may be able to make 12-step groups work for them as social support if they have no other choices, but other options will most often be available.

A study in 2001 by Humphreys and Moos found that TSF may reduce health care costs for people in recovery by emphasizing reliance on free 12-step groups, as opposed to cognitive behavioral therapy. Yet their conclusions that the study indicates people should be diverted from CBT to TSF because it is ultimately cheaper amounts to advocating malpractice. TSF itself is not free and is not decisively supported by evidence; twelve-step groups, while free, are not evidence-based treatment, and other available mutual help groups are equally free options for social support. Even if TSF were demonstrably effective at promoting abstinence for some people, 12-step philosophy is heavily spiritual (specifically Christian-based) so it would be unethical to recommend TSF simply because it might save money.

After exhaustive research, I assert with confidence that 12-step approaches are not evidence-based treatments. They may be strong recovery support for people to choose in addition to a medical treatment plan, but 12-step approaches—including TSF—are not established as evidence-based for treating addiction.

Due to the methodological limitations identified in this article, I question continuing to spend thousands of dollars, hundreds of hours, and invaluable expertise on researching a spiritually-based treatment for addiction that cannot be proven to be effective for most people most of the time compared to “spontaneous,” or natural, remission rates. It is time to relegate 12-step approaches to the realm of recovery support services (RSS, as defined in the Surgeon General’s Report), and allocate our research resources to promising treatments that can be studied rigorously and without such crippling methodological limitations.

** Laurel Sindewald is a writer and researcher for Handshake Media, IncorporatedAnne Giles contributed to this report. ** 

 

Recovery and The Holidays. A Guest Article That Helps.

Merry Christmas Recovery Friends,



I have another wonderful guest article I have come across over on The Fix that really is helpful for all of us who live life in recovery. We can never be ready enough for when holiday stress comes our way in recovery. So here are some tips to keep you snug in early or long-term recovery!

Home for the Holidays? Top 10 Strategies for Staying Sane & Sober

By John Lavitt 12/22/15

“These strategies have worked in practice for countless alcoholics and addicts in long-term recovery.”

“Have you ever noticed how Hollywood has made a cottage industry out of Christmas disaster comedies where going home for the holidays becomes something of a living nightmare? From I’ll Be Home for Christmas(1998) and The Family Stone (2005) to This Christmas (2007) and Home for the Holidays(1995), this subgenre has come to symbolize the challenges that going home for the holidays represents for all of us. Such a challenge, however, becomes even more difficult when you are in recovery from alcoholism and addiction, particularly for the newly sober.”
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“By creating a heightened awareness of your old triggers in advance, you will not be surprised by them when they pop up over the holidays.”
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After all, how are you supposed to deal with all of those antiquated family triggers that bring out the very worst in you? What are you supposed to do when that annoying uncle keeps offering you his special eggnog with that extra special kick? How do you navigate when you feel cornered and overwhelmed?

The goal of this impromptu Home for the Holidays How-To Guide is to provide you with strategies that will help keep you both sober and sane over the Christmas break. These strategies have worked in practice for countless alcoholics and addicts in long-term recovery. In fact, many of them have worked for me, saving my ass when the going got tough because the inside of my head was getting ugly.


1) Set up an out-of-town meeting schedule in advance.

We are so lucky to live in the 21st century where so much can be accomplished over the Internet in advance! If you are traveling, use the websites of the 12-step programs to find meetings in advance. After figuring out your basic holiday obligations and commitments with your family, set-up a meeting schedule that works for both you and your family. At the very least, know the daily meetings you can attend in your area and try to figure out what meeting you are going to go to first.

If you haven’t done this in the past, you are going to be impressed. Across the world, 12-step members are so open and giving to out-of-towners, particularly over the holidays. You will very likely find the temporary emotional support, positive feedback and empathetic commiseration that you will need to help you stay sober and sane over the holiday season.

2) A heightened awareness of your old triggers is essential.

Before you go home for the holidays, think about the past and go over your old triggers with your sponsor or a friend. As Peter Griffin is fond of saying on Family Guy, talk about what really grinds your gears when you are with your family. By creating a heightened awareness of your old triggers in advance, you will not be surprised by them when they pop up over the holidays.

When they do pop up, take advantage of your heightened awareness to mollify them and take away their power. Please remember that triggers have no power on their own; they only have what you choose to endow them with. I have found that talking to them works well, although it’s best not to do in front of other people. Rather, when I’m by myself, or in the bathroom, or out for a quick walk, I recognize their presence and say something like this: “Oh, it’s you again. Welcome back. Considering that I’m home, I’m not surprised to see you. After all, my family has always gotten under my skin in that particular manner. This time around, however, I am choosing not to be bothered by you. Maybe next time, maybe even tomorrow, but just for today I am going to let it go.”

I know it sounds silly to talk to your triggers in such a manner, but it also can prove to be highly effective. Such a conversation frees you from the burden of having those triggers fester like an open wound in your psyche. At the same time, by talking to the triggers, you place them outside of yourself. Feelings are not facts, and triggers are not necessarily part of who you are at the very core of your being. Rather, they are a situation you are experiencing, and a heightened awareness of that situation, of those triggers, can free you from their control.

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3) Be an amazing guest by being of service to your family. 

I remember going home for the holidays several years back and calling up my sponsor because I was feeling very resentful. My whole family lives in Park City, Utah, and I live in Los Angeles. When I got there, we went out to dinner as a family and all of the conversations at the table were about Park City and the ski team and the local mayor and so on and so forth. Nobody asked me anything about my life in the City of Angels. It really pissed me off. I was triggered so I reached out and called my sponsor.

As I was grumbling about the lousy dinner, my sponsor speculated, “I’m sure they planned this in advance because everything really is all about you. Right now, you’re doing a great job thinking all about yourself all the time. How’s that working for you?” Feeling picked on again, I answered, “Not that well.” My sponsor chuckled, “Then how about trying something different? How about trying to be of service to your family and be an amazing guest in your parents’ home?”

Although resistant at first, I was amazed by how well this approach worked in practice. When help was needed, I went shopping for last-minute groceries for my mom. Every day, I offered to do the dishes and walk the dogs; I took advantage of any opportunity to be of service. My parents were somewhat amazed by this change of stripes. They started asking me about my life back in Los Angeles, wondering what had happened to affect their son in such a positive fashion. In other words, by being of service, I actually got what I initially wanted and so much more. I got out of my head and into action. Most importantly, I felt good about myself. Such a strategy seems to work.

4) The negative reaction happening in your head is not reality.

As alcoholics and addicts, please remember at all times when home for the holidays that we have a disease of perception. Personally, I tend not to see situations correctly at first glance, and I tend to take things personally, letting my emotions jump in and take control of a situation. My old sponsor used to tell me that this is the difference between a reaction and a response. My initial reaction is based on what’s happening in my head, and it’s not reality. Rather than giving in to this knee-jerk reaction, I can use the tool of the pause.

The pause allows you to take a step back from your emotions. My old sponsor always recommended that I take three breaths. In any situation, unless a maniac is chasing you with a knife, you should have time to take three breaths. If you don’t feel you have time to take three breaths, then something is most likely off with you and not with the situation. By taking three breaths, the pause comes into effect.

Suddenly, it becomes apparent that my father wasn’t trying to put me down, but he actually was making joke. Maybe a bad joke, but definitely a joke. My sister wasn’t insulting my career choice, but just reflecting on her own frustrations with her work. The pause helps me to realize that my first reaction is not reality. Instead of a knee-jerk reaction, I am given the grace of making a balanced response that comes from a place of positivity. Such a shift can be the difference between a lousy and a wonderful evening while home for the holidays.

5) Use the phone, FaceTime, Skype and the Internet to keep in touch.

When you are away from your support network, it’s very important to stay in touch. Please use the phone, FaceTime, Skype, the Internet, or whatever works for you to keep in touch. If the pause described above isn’t working, take a step outside or go to the bathroom in order to call a trusted friend or your sponsor. Let them know what is happening and externalize your fears, resentments, worries and discomfort. The very act of externalization often is enough to shed light on a dark corner, giving you the ability to move on from a perceived difficulty. By keeping in touch with your support network, you keep yourself safe. You use the tools in your recovery tool belt to make most bad situations better.

6) Choose what non-alcoholic drinks you’ll have ahead of time. 

When going home for the holidays, I always know that I’ll have to accompany my family to a few holiday parties where a lot of people will be drinking. I prepare for these parties by knowing what non-alcoholic drinks I am going to order ahead of time. If you don’t feel like having a Coke, I have found that soda water with a lime or mixed with cranberry juice can be an effective drink to avoid any unwanted questions. Such a drink looks like a mixed cocktail, but isn’t. If such a drink is not a trigger for you, it can do the job. At the same time, just a bottle of water or a glass of orange juice works great. As long as you know what you will be ordering before you arrive and you give yourself a few options to deal with availability, you will not stumble into an uncomfortable situation.

7) Free yourself from any pressure to justify or explain your sobriety.

Please do not be afraid of that relative who will pressure you to have just one glass of champagne or a shot of their favorite whiskey. You don’t have to explain to them why you don’t drink. And you definitely don’t have to do this with a stranger at a party or out on the town with friends. Instead, you need to free yourself from any pressure to justify or explain your sobriety.

Rather than telling my story or sharing like I was at a 12-step meeting, my sponsor recommends that I tell people that alcohol simply doesn’t agree with me. If you tell someone that drinking any alcohol at all makes you feel sick, very few people will ever push the subject beyond that point. After all, if you have an allergy to alcohol, as it says in the Big Book, then you aren’t making anything up. You are simply letting them know that drinking does not work for you, but you are happy that they are enjoying themselves. In such encounters, keep to the positive side of the road, and they will pass quickly.

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8) Don’t get trapped; try to have a way out waiting in the wings.

Despite using all of the above tools, you still might find yourself in a sticky situation where you feel the necessity to leave. My sponsor reminds me not to get trapped anywhere while on vacation, even in my family’s home. He believes it’s essential to have a way out like a rental car or the phone number of the local taxi company. When connected to the local meeting schedules that you looked up before leaving, such transportation can help you out of a sticky situation and into a comfortable seat in a meeting.

Even when we apply all the tools that we have learned in our recovery, things can often get overwhelming when it comes to family. In most cases, this hopefully won’t happen to you, but it can. I promise it will pass if you are able to take a breather. If you can’t get to a meeting, go for a walk. When I am on vacation, I love taking my parents’ dogs for a walk because it allows me some time on my own. Although a rental car tends to be the best answer, public transportation works well in most big cities. If you can’t afford a rental car and don’t have access to public transportation, try to develop other strategies. Saving up a small sum in advance for emergency taxi rides can be useful.

9) Embrace physical activity, sweating and the adrenaline rush.

If you are going home to a white Christmas, embrace the fun of winter sports. Go skiing, sledding, skating or snowshoeing. If you have kids and relatives or even if you don’t have them, build a snowman. The cold air of winter is so refreshing and does wonders for the soul.

If you have any lingering old resentments against certain family members (don’t we all?), a playful snowball fight can be a cathartic release as long as it remains playful. No slush and no ice needed: Always embrace the Golden Rule when it comes to snowball fights and any casual roughhousing. Never do to another family member what you wouldn’t want done to yourself or your child.

If you are going home to Palm Springs, or the like, for the holidays, the above is a bit beside the point. Instead of celebrating a winter wonderland, go for a swim or a jog. Ask your family if you can go to their local gym, even setting up a temporary membership in advance. My father is always thrilled when I go to the gym with him as opposed to staying home and watching football. Finally, a hike in the hills with your favorite family pooch or your partner allows you to both get away and work up an appetite.

Physical activity is essential. Sweating and the old adrenaline rush are great releases for addicts and alcoholics. Now I am probably dating myself here, but remember that Olivia Newton John hit song “Physical”  from 1981? The lyrics of that song really apply in this case: “Let’s get physical, physical/ I wanna get physical/ Let’s get into physical/ Let me hear your body talk, your body talk/ Let me hear your body talk.” Yes, innocent Olivia Newton John—famous for playing Sandy in Grease—was singing about sex, but letting your body talk by working out and sweating over the holidays makes a lot of sense.

10) Revel in the corny and wonderful spirit of the season.

When it comes to the Christmas season, I love watching holiday specials to get in the mood. Frank Capra’s It’s A Wonderful Life or the Charlie Brown Christmas Special are staples that make me smile. In the past, I often identified with George Bailey and his hardships or Charlie Brown’s droopy little tree that nobody seems to like at first. It always was a relief to know that a happy ending was right around the corner. Modern Christmas movies like National Lampoon’s Christmas Vacation, The Santa Clause, and Elf can help take the edge off of a family gathering by making you laugh at the inherent goofiness of it all.

Christmas cartoons and specials make me smile. Dr. SeussHow the Grinch Stole Christmas remains a perennial favorite. I really do love the Grinch and identify a bit with him as well. When every year his heart grows three sizes on that Christmas day, I feel like my heart grows as well. Finally, Rudolph the Red-Nosed Reindeer, Frosty the Snowman and Santa Claus Is Comin’ To Town are classics that shuttle me straight back to the magic of childhood. Any one of these shows can help you revel in the corny and wonderful spirit of the holiday season.

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If your family celebrates the Christmas season, decorating the tree and hanging stockings can bring out the hidden kid in you when you head home for the holidays. Although I am Jewish by heritage, my sisters and I would often stay up late and go to Midnight Mass on Christmas Eve, enjoying the ritual and being with a bunch of happy people in a group setting. We also enjoyed and still enjoy driving around our town and checking out the best Christmas decorations and lights. As kids growing up in New York City, we particularly loved going to Rockefeller Center and checking out the famous Christmas tree lights. Such simple excursions can create intimacy and bring out the best in everyone.

If you celebrate another tradition like Chanukah or Kwanza, lighting the candles on a Menorah or taking part in the ancestral role call can connect you to your past and the meaning of the holiday season. If you and your family are big Seinfeld fans, you can celebrate feats of strength and dance around the Festivus pole as an alternative to the commercialism of the season. Whatever works for you is what is important.
Find the corny and wonderful spirit of this magical season that lights up the eyes of children around the country. By accessing this spirit of the season, you can make a trip home for the holidays into a joyous adventure as opposed to sinking into a negative morass. Yes, it can be a challenge at times, but I hope this list of top 10 strategies not only helps to keep you sober and sane, but also helps to make this holiday season a lovely experience for you and your family. . . .

Wishing you and yours a very Merry  Christmas and Holiday Season! XO
Author & Recovery Advocate, Catherine Townsend-Lyon 🙂