Monthly Archives: January 2015

What are Boundaries ?

Boundaries is a word that is often thought of as being used purely in therapy or in various types of psychobabble that many people in rehab and recovery work in 12 step fellowships will ignore or not go near.

This is a real shame, as the idea of boundaries and an understanding and implementation of them in an individual’s recovery work is a key and crucial element of their staying sober and moving forward with their life.

Anyone entering rehab is likely to be struck by the number and type of rules and regulations that often exist by way of structuring the individual’s life whilst they are in rehab. To many people these rules and regulations seem excessively rigid, and often put people off going into rehab as well as giving them an excuse to leave once they are there.

There is no doubt that some rehabs take these rules and regulations to an extreme, but it is likely that they would argue that the purpose of these rules and regulations is to provide some type of structure for the individual to begin their recovery process in.

The structure is of itself a set of boundaries, providing what should in theory be a safe place for the individual to begin the process to effectively switch off from their active alcoholism, and begin the process of their emotional recovery.

The nature of boundaries is in fact an integral part of any healthy child development in any relatively normal or safe and well functioning family.

The intent is to provide a safe and secure environment, where the child can essentially bounce off a permanent structure in such a way that allows them to develop their own sense of identity whilst exploring what is and what is not acceptable.

Many people who are alcoholics have grown up in homes where there were either no boundaries or very lax boundaries. This meant that they never really developed a healthy sense of self or a healthy identity, and in many ways always felt out of control at some level.

This internal and often external chaos has often been a key element of fuelling their active alcoholism, and is one of the first things that recovery, either in rehab or in meetings of Alcoholics Anonymous, seeks to address.

The boundaries that are set in a rehab are obviously external, although the intent is to provide a sense of safety that ultimately an alcoholic will be able to operate into their own life, and create a sense of safety that is within.

The sense of an inner stability and safety will take some time to develop for most people, and is to a large extent dependent on the individual recognising a lack of boundaries in their life, and where this has taken them.

Setting boundaries about one’s own life is not about setting rules, although this may be the initial sense of what is happening. It is about recreating at an adult level a healthy sense of self in the individual that does not let other people manipulate them, and gives them the freedom to explore and rebuild their life in a loving and healthy context.

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The Nature of Blame

The tendency to blame other people and institutions for whatt has happened to us tends to get a bad press, often being thought of as a bad way to think or a way of thinking that is a process where there is no escape.

It is one area of emotional insight work that falls into the trap of judging emotions rather than accepting them as part of how we think.

The other main areas that are akin to this are things like gratitude, which is sort of an seen as a good emotion, or anger or self-pity which are seen as not very pleasant character traits and thought of as bad emotions.

Anyone entering a rehab will be, or is likely to be surprised that the main focus of the time spent in rehab will not be on alcohol particularly, but on the therapeutic approaches that the rehab offers as a way of helping the alcoholic understand the underlying emotional drives that have fuelled a drinking.

Rehab will most likely invoke the 12 step programme of Alcoholics Anonymous, and is likely to use a watered-down version of the 12-step process as part of their own addiction treatment program.

Whatever the approach used by the rehab, it is likely to include a process that is known in AA language as taking an inventory. This is in fact much simpler than it sounds in theory, it is simply the individual taking stock of their lives and looking at where their sense of anger and fear and other emotional highs and lows have taken them.

It is probably simpler to look at the process as outlined in the book Alcoholics Anonymous which focuses on resentment as being the main priority in taking an inventory. It asks the individual to outline and detail their resentments in a particular way, in such a way as to give them an insight into who they are angry with and why they are angry.

The real freedom comes from understanding what it is within the individual themselves that triggers their anger, irrespective of the cause or how strong or big the trigger is.

The important thing about dealing with one’s anger or resentment however one does it, is to realise that one is not judging the emotional response, one is simply acknowledging it as being a reality of how the individual may think.

Often the individual does not want to acknowledge that they do think this way, but all that does is actually suppress the anger and the blame even further. Self-censorship of one’s emotions is a highly damaging process.

Telling yourself you are not angry or that you do not blame people when you actually do, merely buries the anger and rage even further and is likely to create an even deeper neurosis which will do much more long-term damage that people may realise.

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A Sense of Belonging

Anyone who has ever sat in a meeting of Alcoholics Anonymous is likely to have heard at least one or more individuals say that whilst growing up and as adults they never felt as if they belonged, with a fitted in.

They may not enlarge upon this feeling they had, they may not explain what they did not feel they belong to or what they feel they did not fit into, but most people who are alcoholics will understand and identify with the sentiment.

It is one of the perhaps unique features of meetings of Alcoholics Anonymous, whether held in a rehab or outside the world of rehab, that individuals share certain character traits and beliefs which other people who are alcoholics readily identify with.

This sense of identification is often a key part of giving new, and often people around sometime, a sense of identity, and a sense of feeling they are in the right place in order to deal with their alcoholism.

This sense of not belonging, or not fitting in, is a felt sense that is often very common amongst children who grow up in homes where one or both of the parents are active alcoholics.

Often this growing up in what is known as an alcoholic home has many different side-effects, but one of the main ones is that the children will feel a lack of safety, a lack of permanence and a lack of any sense of adult control over their lives.

This sense of no one being in control often leads the children themselves to believe that they have to take a sense of control over their lives, and this leads to a completely disjointed sense of responsibility at an age where it is completely inappropriate.

One of the major side-effects of growing up in an alcoholic home, is that there is not this natural sense of belonging, a sense of which is more likely to be commonplace in a loving and secure home environment.

There is not a natural and unconditional acceptance of the children, instead the children will feel that they have to earn a sense of being loved and wanted and belonging to the family.

The legacy of this type of needing to earn a sense of being wanted and loved can have devastating consequences for the child, both at the time and in later life. It is probably fair to say, based on anecdotal evidence, that a large percentage of members of Alcoholics Anonymous grew up in homes that could be described as alcoholic as outlined above.

Acknowledging what the problem is, and where it has come from is a crucial part of recovery, and one of the first major emotional insights that a rehab should be working towards helping the individual understand and integrate into their adult life.

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What is Balance?

The idea of achieving balance in life can possibly seem quite a natural process for many people, depending on what sort of things they want to be in balance.

Many people assume that this means managing a work/life/family balance so that the person has time for each of those, and can integrate them into a healthy and holistic life that is fulfilling and worthwhile.

For someone who is an alcoholic, especially if they are about to enter or even when they leave a rehab, the idea of balance can have a completely different meaning.

It is always a bit dangerous to generalise about alcoholics, but it is probably fair to say that most alcoholics feel their life is completely out of balance when they get sober, both internally and externally.

Many people who are alcoholics live a life that emotionally is based on huge swings of great highs and great lows. Their life as an alcoholic can often result in huge traumas and great joys.

The idea of balance can be equated with a life that is quite boring, and the one thing that most alcoholics crave above all else is excitement.

It is important to re-examine what people who are alcoholics really mean or want, or might want by the idea of balance.

Upon entering rehab, it is probably fair to say that the individual will be in a pretty desperate state, and will need much reassurance that there is a lot of value to the idea of rebuilding their life without the need to drink or use drugs.

Up till this point, the life of the individual is likely to be premised on the basis that they need to drink in order to stay alive and in order to function.

The notion of staying sober and rebuilding a life may seem not only boring, but also pretty mundane and worthless.

It is important for the individual to begin the freedom to explore these doubts, and to begin to get their own understanding of what a life in balance may seem like. It is a good idea to stress that the idea of balance is primarily an internal process, one that is likely to bring a degree of inner stability and peace that may make the idea of balance seem more attractive.

For many people who are alcoholics, the emotional and mental swings that come with active alcoholism can be almost as destructive as the alcohol itself.

This emotional unmanageability can often be seen as an integral part of step one, although it may take the individual some time to realise this.

Achieving a degree of internal stability and emotional balance is the nature of the recovery process as outlined in the 12 step program of Alcoholics Anonymous, the principles of which had been adapted and used by many rehabs in their own addiction treatment programs.

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What are Dual Diagnosis Rehab Centers?

The term dual diagnosis has in many ways achieved more of an important sense of status than it actually deserves.

In literal terms, it means someone who is an alcoholic and is also addicted or has been addicted to other types of drugs, both prescription and nonprescription.

In the world of rehabs, dual diagnosis is a very common understanding of many individuals who present as needing help with either an addiction to alcohol or drugs.

Many people who are alcoholics start off using alcohol and at some point in there life will start using various types of drugs as well. There may be many reasons for this both internal and external.

Equally many people who start off using various types of drugs for a number of reasons also at some point find themselves using alcohol and being addicted to alcohol.

They may or may not be alcoholics, but the combination of alcohol and drugs can make it an almost impossible distinction to make.

When any individual gets to a point in their life when they seek help, the combination of alcoholism and drug addiction will have taken its toll in many ways.

Anyone entering rehab needs to be assessed as to whether a medical detox needs be undertaken, and if so that the rehab has medically qualified personnel who are experienced and able to undertake and oversee such a detox.

In this context it is crucial important that the rehab staff have experience of a wide range of different types of drugs that the individual may have used.

Knowing what drugs may be in the individuals system as well as alcohol is key for managing withdrawal effects in a safe and secure manner.

Once any medical detox has been assessed and undertaken if needed, then the individual will begin the process of whatever therapeutic work that the rehab offers by way of its treatment programs. In this sense it doesn’t really make much difference whether the individual has been an alcoholic or has had an addiction to drugs.

This is simply because the focus of the therapeutic work will be on helping the individual to understand the nature of their alcoholism, and what have been the triggers for their drug use.

The rehab will try to help the individual to begin to understand the process of alcoholism as an illness, and try to help the individual see that their emotional make-up and their emotional drives are one of the main focuses for the recovery work.

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What is the Cost of Drug Rehab Centers ?

Anyone thinking of going into a rehab would be well advised to get a firm understanding of the cost involved, as well as exploring cheap or free alternatives prior to making the decision to enter rehab.

Most rehabs, if not all, deal with alcoholism and/or drug addiction as well as a range of other potential addiction problems.

The majority of rehabs offer a 28/30 day residential inpatient program, which is the standard for that industry, and is what most people think of when they talk about going into rehab.

The cost of this 30 day residential stay can vary quite widely, and most rehabs do not disclose any of this information publicly.

The one exception is Hazelden who give guidance that an average cost of a residential stay in one of their treatment centers is approximately US$30,000 for a 28 day stay.

This figure should only be taken as a guide, and actual figures can vary quite considerably.

At the luxury end of the rehab market, rehabs in Malibu and other exotic locations can cost upwards of US$80,000/US$100,000, per 30 day stay

Rehabs can argue that one of the reasons they do not disclose their costs, is because they negotiate them directly with health insurance companies. Most people who enter rehab as a residential inpatient will probably look to have the cost of their stay covered under a health insurance plan.

Even if this is the case, the client needs to be careful as they can be additional costs incurred for a variety of optional extras that are offered as part of the rehabs treatment programs. These additional costs can often refer to extra medication, alternative therapies and even things like a medical detox.

Any additional costs that are likely to be incurred may not be covered under someone’s insurance plan should be advised prior to admission to the rehab, and agreed accordingly by the individual.

Although most people entering a rehab will do so as a residential client, there are other options. Partial Hospitalisation Treatment (PHT) refers to a daily treatment program, where the individual attends some type of rehab program during the day, and then returns home in the evening.

This is obviously considerably cheaper, as there is no residency involved.

The other option offered by some rehabs is what is known as Intensive Outpatient Program (IOP) , where the individual client will work at their normal job during the day, and attend some type of treatment program course in the evenings.

Both these options of PHP and IOP are often offered by rehabs themselves, or sometimes by independent nonprofits or charities as their main focus of work.

It should also be remembered that many people get clean and sober simply by going to meetings of Narcotics Anonymous and Alcoholics Anonymous, which are free and widely available wherever you live.

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Awareness, Acceptance and Action

These are often referred to as the 3 A’s, and tend to be essentially one of the slogans or sayings that are widely used in Al-Anon meetings.

Whilst sayings like this may be the preserve of certain 12-step fellowships such as Al-Anon, the significance and importance of these sayings reaches far beyond one fellowship or one meeting.

The value of this slogan of Awareness, Acceptance and Action is that it puts in very simple terms the process that people go through in terms of acceptance of an individual’s alcoholism or other addiction, and the process of recovery that follows it.

Awareness that an individual has a problem with alcohol can come quickly or slowly to the family and friends of that individual, whereas the individual themselves is most likely to take a lot longer to acknowledge that they have a problem.

For the family and friends of an alcoholic this presents real problems in terms of a quandary as to how they accept it and what they do about it.

The awareness that there is a problem with the individual can also lead them to understand that there is a broader problem within the family and that they are affected by the individual’s alcoholism whether they like it or not.

Awareness of a problem does not necessarily bring acceptance of it.

Awareness, Acceptance and Action

People can become aware of an individual’s alcoholism or other problems and simply refuse to acknowledge that it is true. Acceptance of a problem is often seen as self-defeating or surrendering to a truth that people do not like.

It is often a much healthier way forward to understand that acceptance simply means an acknowledgement of the reality of the situation, whether the individual likes it or not. An individual can accept a situation as being reality, without liking it or in some way wishing it was different but realising that it’s not.

This sense of acceptance of a problem in another individual, be it alcoholism or something else, inevitably brings forward the possibility of action of doing something about it.

What that action is, or what the individual chooses to do can vary quite widely, but the sense that they have some degree of control over the situation once they have accepted it, means to have choices that they did not have before.

Action can also mean no action in terms of not doing anything. So long as not doing something is a conscious choice it is as valid in its own right as doing something.

Anyone dealing with active alcoholism is going to face hard choices and difficult decisions, and the fear of making the right or wrong decision often only enhances the difficulty of these choices.

The way forward with any really difficult decision is to bring it back to the nature of the process, and to realise the enormity of the environment within which the individual is trying to move forward.

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Awareness….

Anyone dealing with someone else’s active alcoholism is often baffled by the seeming lack of awareness that seems to pervade the thought process and the actions of the alcoholic themselves.

It seems pretty obvious to everyone around the alcoholic that they have a drink problem, and the obvious solution is for them to stop.

Even if they are unable to stop it is expected of them that they will have an awareness of the fact that they are addicted to alcohol and cannot stop and seek help. For many people the reality of working with an active alcoholic is very different.

Not only will an alcoholic deny that they have a problem with alcohol, they will go to extraordinary lengths to prove that they do not have a problem with alcohol, that in fact alcohol is a minor if inconsequential part of their life.

This denial of the fact that they have a problem is a huge and frustrating element to the whole recovery process for the alcoholic themselves, and to anyone else trying to help them.

As with any illness, the notion of recovery means that you get better. For anyone who is an alcoholic this process of getting better does not necessarily mean that an individual stops drinking.

There are many anecdotal instances of an alcoholic who has stopped drinking, but does nothing else with their recovery, and their partner or family after a while urge them to start drinking again because they are so miserable without it.

This often laughable but tragic situation goes to the heart of an individual’s process of dealing with alcohol and their alcoholism.

Any individual who is an alcoholic is most likely some point to start believing that alcohol is their friend, is the solution to their problems, and is essentially the only thing that is really holding them together.

They will base their denial of the fact that they have a problem around this belief system, subconsciously.

The reason why awareness is such a major issue, is simply because once any individual becomes aware of anything in their life it is impossible to turn the clock back.

Once an alcoholic becomes aware that alcohol is in fact the root cause of their problems not the solution, they are placed in an almost intolerable position in terms of living with the reality of their alcoholism, whilst at the same time holding onto a belief system that is holding them together but essentially killing them at the same time.

This is a very scary prospect for an alcoholic, and one that will only deepen and get worse the more the alcoholic clings to the belief that they need to drink in order to survive and stay alive.

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Asking for Help

Asking for help  – it has become almost something of a cliché for anyone seeking help with alcoholism or an addiction to drugs or other substances to say that they have to acknowledge that they have a problem in order for anyone else to begin to help them.

Whilst this is generally true, it is also something of an over simplification of both the individuals need the help, and the individual sense of who can help them and what they can help them with.

There is always a danger when talking about alcoholism and other addictions of over generalising about individuals and the nature of their illness or addiction.

With that caveat, it is probably fair to say that most people who are alcoholics who reach a point where they do seek help are normally in a pretty chaotic state, both internally and externally.

The journey of anyone’s active alcoholism can be varied and wide, but one common feature tends to be that most of the time an alcoholic will believe at some point that alcohol is the only thing that is really holding them together.

As their illness progresses and their life progresses, this belief that alcohol is the only thing that will hold them together is the one thing that will deepen given some sense of stability and security.

This belief will be in stark contrast to the reality of life, both internally and externally, which is one of the main reasons dealing with an individual’s alcoholism can be so traumatic and difficult.

The reality of any individual asking for help has to be seen against the background of them acknowledging that they have a problem and what they need help with.

For someone who is an alcoholic, seeking help is a hugely difficult process because of this belief that alcohol is not the problem, but they are not sure what it is.

To them alcohol has become the solution to their problems, the solution to their heads and the fear of losing that solution is overwhelmingly terrifying. It is a huge contradiction that only someone who has suffered active alcoholism can probably fully understand.

Understanding this apparent contradiction within the head of the alcoholic is a hugely important feature of any treatment program that a rehab or treatment center offers by way of help for an alcoholic or someone who is addicted to drugs and other substances.

This is often reinforced or underpinned by having a certain proportion of staff members who have either been through rehab themselves, or who are members of 12 step fellowships such as Alcoholics Anonymous, and do at some level understand the reality of this contradiction.

There is no set answer or solution to helping an alcoholic see through this denial, it is a paradox of the nature of alcoholism that this is what recovery means.

Giving an alcoholic a safe place, and a safe environment within which to begin to heal is a hugely important precondition of them being able to square the circle of their denial and move forward.

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What is Arrogance?

Asking a question such as what is arrogance is almost potentially a bit arrogant of itself.

The term arrogance can mean a lot of things to a lot of people. To many people it is a bit of a put down implying they are a bit of a know it all or they are speaking out of turn on a subject that they know little about.

To other people being called arrogant is seen as somewhat of a compliment, implying that they have a degree of authority or self-confidence that places them about other people.

Like a lot of judgemental words, arrogance can have a special meaning in the context of rehabs and treatment centres and the recovery world in Alcoholics Anonymous and other 12 step fellowships.

Calling someone arrogant, or implying to a person that they should realise they are being arrogant is normally intended as somewhat of a put down of the individual themselves.

People’s reasons for doing this can be varied, but it is often seen as something of an act of humility that they are asking the individual to accept that other people know more about something and they do.

This is a common and recurring theme in rehabs and treatment centres, that an alcoholic needs to realise that they know nothing about anything and that they should become ‘teachable’.

This type of approach is also often referred to as ‘tough love’, implying that someone is being hard on an individual for their own good and in some way being rude or hard on the individual is an act of love and something that they should be appreciative of.

More often than not, this approach of what is called tough love or of essentially intimidating another individual into beleiving they know less than the person talking to them is really an act of bullying, however it may be dressed up.

It has very little to do with the real nature of love or of helping an individual understand their situation, it is virtually always an abuse of power in an unbalanced power relationship.

Rehabs and treatment centers and 12-step organisations such as Alcoholics Anonymous should continuously be aware of the potential for any type of bullying however it may be dressed up.

Often bullying is discounted as teasing or banter or in some way the individual who is being bullied is made to feel it is their fault that they are being hurt by what is being said to them.

Their is little doubt that an alcoholic trying to get sober has built up a wall around them of denial and often bullish defences against other people trying to stop them drinking or using drugs .

This denial and these defence mechanisms are often mistaken for arrogance and a sense of overpowering personality.

In truth they are more likely to be a real sign of the individual’s vulnerability and weakness.

How a rehab or treatment center deals with individuals such as this can vary widely, but the majority will endeavour to treat the individual with the respect and love that they deserve and need.

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