Category Archives: Relapse

Getting through the tough times

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As a recovery coach, I often see my clients need some help getting through the tough times, without using drugs, picking up a drink or acting out. Recently, I personally encountered some rough patches in my own life, so I went to my library of recovery books. Reading books on recovery is an import tool I use regularly in my practice. Several years ago, I was curious about Buddhist recovery, so I became an avid reader of the books by Pema Chodron.

Pema Chodron Celebrates 80 Years

Pema Chodron, is a Buddhist nun, she was born in 1936, in New York City, and is celebrating her 80th year. After a divorce, in her mid-thirties, Pema traveled to the French Alps and encountered Buddhist teacher Lama Chime Rinpoche, and she studied with him for several years. She became a novice Buddhist nun in 1974. Pema moved to rural Cape Breton, Nova Scotia in 1984, ­­­to be the director of Gampo Abbey and worked to establish a place to teach the Buddhist monastic traditions (waking before sunrise, chanting scriptures, daily chores, communal meals and providing blessings for the laity). In Nova Scotia and through the Chodron Foundation, she works with others, sharing her ideas and teachings. She has written several books, and in my time of deep spiritual need, I went to her book “When Things Fall Apart”.

Drawn from traditional Buddhist wisdom, Pema’s radical and compassionate advice for what to do when things fall apart in our lives helped me. There is not only one approach to suffering that is of lasting benefit, Pema teaches several approaches that involve moving toward the painful situation and relaxing us to realize the essential groundlessness of our situation. It is in this book, I discovered a simple breathing exercise I can use during these chaotic times so I can move into a better space. Pema advocates this tool as a breathing exercise, although this exercise could also be considered a mindful meditation.

I use Chodron’s tool whenever and wherever life hits me below the belt. I share this tool with my clients. It is all about breathing and consciously repeating words to yourself to accompany the breathing. Since we breathe every day, it is indiscernible whether you are using this tool as you travel on the bus commuting home from work, in a conference room with your boss, or when you are feeling low and want to curl up in a ball and die.

Breathe

Pema explains in her book, when things get way too complicated; step back and breathe. When the force of the world, the politics of the U.S., Great Britain or Italy start weighing heavily on your mind, breathe. When you look at all the pain around you and feel powerless to do anything, breathe.

Pema explains, inhale and say silently to yourself breathe in the pain, then exhale and say breathe out relief. Then, inhale, and say silently to yourself breathe in the relief, and exhale and say breathe out the pain. I find I need about 15 minutes of conscious breathing in this way. After doing this, I find I have new energy or something else crosses my path to move me into a different space.

If I continue to be in that negative space of worry or feeling powerless, then absolutely nothing will be accomplished that day. I know we all have something to accomplish every day, whether it is just getting out of bed, taking a shower and brushing our teeth or running a Fortune 500 company, this exercise gets us from zero to ten in fifteen minutes. Chodron’s exercise moves me to the space I need to be in, so I can function. It is what I need.

So, I invite you to try this simple exercise…and remember…keep breathing.

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A Call for Clinical Humility in Addiction Treatment

by William White and Chris Budnick,  video featuring Chris Budnick

The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help.  The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see endnotes 1, 2 and 3, below) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.

The challenges for each of us who work in this special service ministry and forwilliam_l_white_portrait_1 the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See endnote 4 and 5 for two vivid examples.)

There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (endnote 6). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (endnote 7 and 8).

The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”

Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is: https://www.youtube.com/watch?v=A5MYhZbnhfU

Chris-Budnick LCSW,LCAS,CC,MSWMy name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993. 

There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.

Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.”  “We can’t help her tonight.”  She was killed within hours of this decision leaving behind a 2-year-old daughter.  I told the officer that we pledge to do better.

This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.

While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:

  • I’m sorry for all the barriers you confront when trying to access help.
  • I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.
  • I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.
  • I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.
  • I am sorry for creating unrealistic expectations of you.
  • I’m sorry for provider success statistics that have misled you and your family.
  • I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.
  • I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.
  • I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.
  • I am sorry for my arrogance when I’ve assumed that I am the expert of your life.
  • I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.
  • I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.
  • I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.
  • I’m sorry for turning you away from treatment because you’ve “been here too many times.”
  • I’m sorry for not referring you to different services when you have not responded to the services I offer.
  • I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.
  • I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.
  • I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.
  • I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.
  • I’m sorry for letting society maintain the belief that you used again because you chose to.
  • I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.
  • I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.
  • I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.
  • I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.
  • I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.
  • I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.
  • I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.
  • I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.

    This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.

                                      – Chris Budnick,  Licensed Clinical Addiction Specialist

This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling.  WW

I honor and applaud Bill and Chris for bringing this message to clinical professionals across the nation. It is time to shed and change these old models that have not been working and embrace these new tenants that Bill, Chris and many others espouse.  Truly such client-centered treatment can change the course of recovery for many. MK


Endnotes:

This post was previously published on William White’s web site- www.williamwhitepapers.com on April 29, 2016. William White and Chris Budnick have authorized this reposting.

 

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Recovery Coaching Texas Prison Style

Kyle Gage PhotoKyle Gage lives in Longview, Texas, and he is a recovery coach. Longview is a little oil and manufacturing town a couple of hours east of Dallas-Ft Worth and about an hour west of Shreveport, Louisiana. The small town has had some illustrious citizens: Forest Whitaker was born in Longview, and Matthew McConaughey went to Longview High School in the ‘80s. Kyle had less of an illustrious impact on Longview.

A Hard-Earned Recovery 

Kyle entered his first rehab at 17. He enrolled in a boarding school for troubled teens. He continued in and out of rehab many times, trying to do it his way. At twenty, he knew he had to change, so he attended some NA meetings, through which he stayed clean for about 6 months. Then he used. He tried to keep things under control, and managed to avoid any serious consequences for about a year, but then one day he was pulled over by the police, who found methamphetamine.

In lieu of jail time, he agreed to treatment. After his treatment episode he remained clean on probation, in part because he was receiving regular tox screens. Staying clean was motivated by his desire to stay out of jail. For 7 months he was sober, but then he started to drink. Eventually, drinking turned to using drugs. Because of his fear of failing a tox screen, he stopped reporting to probation and went on the run. Kyle was picked up a few months later for the probation violation and was sent to the James Bradshaw State Prison in Henderson, Texas.

He got no help for his recovery in the state prison, drugs being as easily available there as they were on the streets. Upon his release he began using again and was eventually arrested for burglary. He went to treatment but left against medical advice. He went to live at an Oxford House, and remained clean for 2-3 months. The stinking thinking eventually returned, so he drank and drinking led to using. In a very short time, he was arrested. At 26-years-old, he was facing two consecutive ten-year convictions for burglary and grand theft auto. Kyle knew this was serious.

He asked the judge for help, and the judge gave Kyle ten years of deferred adjudication. Deferred adjudication is a form of a plea deal, where a defendant pleads “guilty” or “no contest” to criminal charges in exchange for meeting certain requirements laid out by the court. In Kyle’s case, these terms were that he go into an inmate drug-treatment program, attend Drug Court upon his release, make a commitment to outpatient treatment, perform community service and complete probation within the allotted period of time ordered by the court.

Kyle was sentenced to six months at the Clyde M. Johnston Unit, the Texas correctional institution’s Substance Abuse Felony Punishment Facility in Winnsboro, Texas. This facility is Texas’s drug treatment program for offenders. He received a lot of treatment and therapy at the Johnston Unit, where Kyle realized that he needed to embrace recovery.

Embracing Recovery

For Kyle, embracing recovery in prison began by helping others: helping others gave him hope. He was the person that led the NA meetings in his dorm. The counselors at Johnston announced that a recovery coaching certification course for the inmates would start at Johnston. They said they only had room for ten men. Kyle applied. He was hoping they would pick him, but he was nervous because he knew that it was very competitive and they were only picking one person per dorm.

Kyle’s mother found the book Recovery Coaching—A Guide to Coaching People in Recovery from Addictions on Amazon.com and sent it to Kyle. Kyle read it before he even got accepted into the class, which he eventually was. He excelled in helping others in the Unit embrace recovery. He graduated the recovery coaching class and was even invited to talk to the Unit’s next class of recovery coaches.

Coaching Other Offenders

The primary counselor notified Kyle that he wanted him to talk to an offender that was a disciplinary problem. Jason was 19-years-old, (his named has been changed for this post) and faced 10-15 years for aggravated assault. Jason was a first-phase client, which meant he had only been at the Johnston Unit for 30 days. He was a meth addict, and he was having trouble adjusting to the Unit: He had issues with people in his dorm. He didn’t attend AA or NA meetings. He didn’t want to be in recovery. He wanted to give up, and fantasized about “rendering his sentence.” The inmates call it “getting sent back to county.” Rendering a sentence means to go back to the original courthouse and say to the judge “Thanks, but I would rather serve 10 years for aggravated assault than spend any more time in therapy and treatment for my drug addiction.” Sound crazy? According to Kyle, that is what goes through the heads of many offenders. The grip of the addiction is so strong that living life sober is frightening. Many choose to self-sabotage by creating problems, by assaulting or threatening another inmate and receiving an extension of their sentence.

Jason was referred to Kyle specifically as Jason reminded the counselors of Kyle, with his sleeves of tattoos just like Kyle. Kyle met with him and talked to him about meth, since they shared the same drug of choice. Kyle asked for Jason’s story, and listened. It was different from Kyle’s, but there were many similarities. Kyle shared many of Jason’s traits: Being an outlaw, an outcast, and a gang member. Jason didn’t think the meetings would be beneficial to him. Kyle shared that it was in the 12-step rooms where he truly felt alive.

Kyle asked Jason about his plan when he gets out of Johnston and allowed Jason to self-actualize as to where he wanted to be in 5 years. Jason broke down and cried during this meeting. He was frightened at what he was facing, he had a lot of anger issues, and he didn’t know what to do. So, Kyle told him what worked for him.

During the six months that offenders were at the Johnston Unit, there was no chance of them using drugs. The coaches assisted the offenders with embracing recovery, working the 12 steps and learning to use the steps in their daily prison life. Kyle coached men that were violent, had assaulted another men, were disciplinary problems, and where coaching was the last step before they were “sent back to county.” Kyle was there to stop them from rendering their sentence and losing everything. Sometimes an inmate had a family member pass away and the inmate was not granted permission to attend the funeral.  Although this coaching had nothing to do with recovery from drugs or alcohol, the recovery coaches are assigned to console these inmates through the grieving process.

When inmates were close to being released, having  no experience with 12-step meetings or recovery on the outside, and  having no intentions of asking for help, Kyle gave them some “recovery capital.” He would give them lists of AA and NA meetings near the half-way house to which they were being released.  Kyle would give them information on Community HealthCore, which is a large, social services agency in Texas with outpatient drug and alcohol treatment programs. He would tell them about drug court classes and behavioral health counseling. Kyle and a few of the other recovery coaches in the Johnston Unit were from the Dallas area. When a prisoner would be going to back to the Dallas area, the coaches would refer the offenders to people on the outside who could take them to a meeting.

Another prisoner, Caleb (his real named also changed) was in the reentry process—in a few weeks he was being released to a half-way house in Beaumont, Texas. Caleb had been in this position before.  As he got  closer to the “door” he became scared, and he was afraid of going back into the real world. He was so sure that he could to do things his way, but in the back of his head, he knew that doing things his way was what had gotten him into prison several times before. Kyle ran the 12-step meetings, and Caleb would attend as a “woodworker” (working wood means doing the absolute minimum, not participating, not getting involved and not believing this program would work for them).

Kyle was assigned to speak to Caleb.  Kyle asked him what happened after he drank a beer, and Caleb admitted that after he drank one beer, it would soon be a dozen and very shortly, he was thinking about using crack (his drug of choice). Kyle knew this story very well, because it was Kyle’s story. So he shared his story with Caleb. It didn’t seem to work. Caleb kept wood working and didn’t really engage in the program. Caleb was antagonistic, he would challenge the tenets of the program, ask questions about will power, saying recovery was a choice, and that he was “not an addict forever.” He didn’t think that any program would help him, but he knew that if he went out into the real world, he would use again.

Many offenders self-sabotage their release process by getting into fights and end up staying in prison a few months longer. This happened to Caleb. He remained at the Johnston Unit a few months longer, which was just enough time to let Kyle’s work with him penetrate. Upon his release, Kyle gave Caleb the information on 12-step meetings in Beaumont and he agreed to attend the meetings. Kyle continues to communicate to Caleb, who is sober and has not re-offended.

At this point, Kyle Gage has been out of the Johnston Unit for about a year. He is wrapping up his Drug Court commitment. He is enrolled in a community college to get his Associates Degree and also works as a new car salesman. Kyle will continue recovery coaching to help himself and others maintain the recovery that he loves.

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