Works in progress: "Worth the pain"

     My initial temptation was to play today's post as just another reader submitting an update on a writing project. But of course today's author, Caren Jeskey, is an old friend to EGD, having owned the Saturday post for almost three years before she decided to strike out on her own. So it's with pleasure that we welcome her back today. I know that she was missed. Take it away, Caren:

"I really see people in recovery from severe addictions as modern day prophets, because these are folks who have had to figure out pleasure and pain and consumption in a dopamine overloaded world. They really provide this roadmap of deep wisdom for the rest of us.”       —Anna Lempke, M.D.

     Shankar Vendantam’s comforting voice poured through my Bluetooth speaker last Sunday. It was the podcast Hidden Brain’s episode “The Path To Enough” on WBEZ. Guest Anna Lembke — a Stanford psychiatrist and researcher — talked about dopamine fasting. I’ve heard this hot topic mentioned a lot this past year, mostly from young, astute therapy clients.
     According to Dr. Lembke on NPR’s Life Kit last year, “we have to start to intentionally avoid pleasure and seek out pain. And by doing that, we will reset reward pathways and ultimately be a lot happier.” She notes that depression and anxiety are more present in wealthier countries, where access to immediate gratification is easier. She prescribes 30 day fasts from our "drugs" of choice. “I will have patients see me for depression and anxiety, expecting that I will prescribe an antidepressant. But instead what I say is ‘hey, can you eliminate cannabis from your life for a month? Hey, can you stop playing video games for a month? Can you cut out alcohol for a month? Can you not watch any Netflix shows for a month?’”
     One of the keys to reducing dependence on a screen, a habit, a feud, an unhealthy relationship — or any other mood altering substance or destabilizing behavior — is making a decision to do it, (with medical help if necessary). Getting support from others is also invaluable — support groups, therapists, friends who get it, partners. The more the merrier, as long as they offer the right kind of support.
     You can learn how to ride out cravings. When feeling the pain from withdrawal, you can distract by forcing yourself to do things you’ve been avoiding, or by pushing yourself to engage in a healthy, pleasurable activity. Once you see that you can pause and say "no" instead of "yes," you will feel empowered, and emboldened to do it again and again.
     It’s unfortunate that substance use disorders, formerly known as “addictions,” have been historically met with stigma instead of the treatments they require. Disorders are not moral failings. Unhealthy habits often begin before the brain is even developed, or after stressors and traumas, or to people exposed to drugs and alcohol as children, or because of problems with the brain, and other forgivable maladies that lead the seeker into dangerous quick-fixes.
     As we try to stay balanced in an upside-down world, cultivating inner peace as often as possible can be a panacea that keeps us away from harmful choices. To this end, I meditate daily with the app Insight Timer. It's free, or you can give a donation if you so choose. When I'm feeling overwrought — thankfully rare these days — and don't want to hear an angelic voice cooing at me, I will pick something that addresses what's going on inside, such as anxiety or stress. Learning about what's happening and addressing it makes me stronger, and more hopeful. Dr. Ken McGill’s adult feelings wheel and brief exercises to “improve emotional self-awareness” are useful.
     In her talk Healing Addiction on Insight Timer, psychologist, meditation teacher, and author Tara Brach describes why reaching for dopamine highs backfires. She uses the Buddhist concept of a hungry ghost inside of each of us. Trying to fill up the insatiable ghost inside only leads to overconsumption.
     Practicing moderation, cultivating mindfulness, staying connected to others, and cultivating a loving heart are ways that we can experience life’s challenges with more internal grace. Compassion and forgiveness have to be practiced, and sometimes taught, which can be done using Metta meditations, for example. When we send ourselves, everyone we know, and everyone in the world well-wishes using this technique, we can feel a sense of relief. At least we have taken a break from pointing fingers at others.
     Having healthy loving relationships with real humans is ideal. Some say that “the nature of the relationships we build is the biggest factor in our mental and physical health and our well-being. To explore what drives love, both objectively and subjectively, is to develop therapies to help those who may struggle to form healthy, stable relationships, the successes or failures of which will have lifelong consequences" according to The Scientist. Dr. Lembke points out that we need others for basic safety, as well.
     For those previously isolated by living lives mired in unhealthy habits, support groups can be a big piece of finding healthier relationships. For this reason, I’ve provided links to many free groups at the end of this piece.
     I felt disappointed that Dr. Lembke neglected to address secular recovery groups when she mentioned Alcoholics and Narcotics Anonymous on Hidden Brain. Secular groups are not anti-religious, but are science, medicine, and psychology informed. This makes them more accessible to those who do not believe in a god or a higher power.
     Alcoholics Anonymous and affiliated 12-Step groups stemmed from the Oxford Group of Christianity. Their slogans, signage in the meetings and all of their literature is religious. For example, in the Big Book of AA the participant is instructed “on awakening let us think about the twenty-four hours ahead. We consider our plans for the day. Before we begin, we ask God to direct our thinking, especially asking that it be divorced from self-pity, dishonest or self-seeking motives.” In this traditional model of recovery that was formed in the 1930s by men, people are often told to pray. Many have tried and left these programs for just this reason, unnecessarily. No one told them about non-religious A.A. Many who might have lived, have died.
     I am sure you can imagine what it might feel like to be told to go to a mosque or a temple for services if you’re Christian? Or a Christian church if you’re Muslim or Jewish? Or any church if you are an atheist? That’s how many people feel in traditional A.A., which is still often mandated by courts in the U.S. and abroad. Cases have been won against employer and court mandated attendance, but it’s a slow battle. In the meantime, many people do not have the access to this wonderful, donation based support system if they are not told that atheists, freethinkers, Buddhists, agnostics, and everyone else in the world are welcomed there.

     "Loving people live in a loving world. Hostile people live in a hostile world. Same world."

                         —Wayne Dyer

Resources and Links:

Hidden Brain: The Paradox of Pleasure and The Path to Enough

Care And Compassion Over Tough Love: Shatterproof
Secular AA Website
Secular Organization for Sobriety
Beyond Belief Sobriety
Back From Broken Podcast
A Woman's Way Through The Twelve Steps Book
Alcohol & Drug Foundation: Reducing The Risk
Support, Don't Punish: Harm Reduction Campaign
Chicago Harm Reduction Therapy
YouTube Video about AA Agnostica
Emotional Sobriety
Buddhist Recovery Network
The Sinclair Method (I personally know people this has worked for, but like many things it does not work for everyone. Most doctors will Rx Naltrexone, which reduces cravings, but not all understand how to facilitate an effective process).