How do we become enslaved by addiction? That question is asked - and answered in a recent issue of the GOOP newsletter devoted to the topic of addiction. GOOP is a lifestyle website written by actress Gwyneth Paltrow.
Paltrow wonders, "How do we become enslaved by addiction? What is addiction?" and "What makes so many of us prone to addiction in its various forms? What causes us to be open to this enslavement? And how do we begin to undo it?"
These questions are put to various sages, including a Kabbalah scholar, a Zen master, a bestselling mind-body author, an Episcopal priest, a psychologist and a Sufi shaikh. See the newsletter for their insightful and diverse responses.
The Meadows was included in Paltrow's list of further resources.
Note: This article was originally published in the Spring 2007 edition of Cutting Edge, the online newsletter of The Meadows.
The Therapeutic Genius of Pia Mellody
By John Bradshaw, MA
Pia Mellody joins the company of those who have created highly effective therapeutic models and who can put their theories into practice with unusual skill. Pia's approach is phenomenological, resulting from her own painful struggle with codependency, as well as from thousands of hours spent interviewing and working out healing strategies with patients at The Meadows.
Pia began her unique journey as the head of nursing at The Meadows. In her early days, she suffered from low self-esteem, unhealthy shame, and a hyper-vigilance that accompanied her need to be perfect in every aspect of her work and life. She lived in that lonely place of non-intimacy, polarization and silent anger that most codependents experience.
Pia decided to get some help for her problems at another treatment facility, where she found the experience not only frustrating, but ineffective. Her problems did not seem to fit into any consistent category of the Diagnostic Manual. When she completed treatment, she continued to try to make sense of her raw pain and confusion, reaching out to others to try to get assistance in alleviating the distress. She was grappling with an inner distress exacerbated by a sense of defectiveness, the inability to engage in really good self-care, and living in reaction to other people. Thanks greatly to her, this condition is now called "codependence." At that time, there was no coherent theory or therapy for the problem.
Early Roots of Codependency
Prior to Pia's work, some relevant work had been done concerning the reality of codependence. Ludwig von Bertalanffy's work titled General Systems Theory had filtered its way into several arenas of psychotherapy, notably Ronald Laing, Virginia Satir, and The Palo Alto Group (Gregory Bateson, Don Jackson, Paul Watzlawick and John Weakland).
In 1957 in Ipswich, England, John Howell concluded that the entire family itself was the problem, rather than just the symptom-bearing individuals. Dr. Murray Bowen developed "The Bowen System" of family therapy. He clearly posited the whole family as the problem, maintaining that the most distressed and under-functioning person in the family triggered the rest of the family into over-functioning behaviors. The more the family members over-functioned, the more the distressed person under-functioned. Thus, the more the family tried to change, the more it stayed the same. Bowen was convinced that the whole family was in need of therapy. Bowen did not use the word "codependency," but he emphasized that, like a mobile, every member of a diseased family was dependent on his or her other family members.
Dr. Claudia Black, currently a Senior Fellow at The Meadows, wrote a now classic book called It Will Never Happen To Me. In it, she described the symptoms she carried as an adult that stemmed from living with an alcoholic father and a co-alcoholic mother. Dr. Black made it clear that her whole alcoholic family was diseased, and that each member was codependent on the alcoholic father.
Soon hands-on clinicians like Dr. Bob Akerman and Sharon Wegscheider Cruse (a protégée of Virginia Satir) were describing the symptoms of the adult children of alcoholic families as "codependent," although no one knows who first used the term "codependency."
I did a 10-part series on PBS in April 1985 that met with a huge public response. In it, I used a mobile to describe the family system, moving it energetically to show how the whole family is affected in dysfunction, and allowing the mobile a lightly moving homeostasis to show its functional state. I devoted two parts of this TV series to issues I called "codependency," although my grasp of the concept was still vague and lacked a consistent theory of explanation.
Outside the recovery field, which deals with addictions of all kinds, was the work of Karen Horney and Theodore Millon. Horney's Neurosis and Human Growth presented many descriptions of a dependent personality. Horney's description touched upon many of the primary symptoms of codependency, which Pia Mellody later organized into a coherent theory. According to Horney, those lacking healthy adult autonomy and interconnectedness sought their fulfillment and a sense of self from other people. For these people, relating to other people became compulsive and took the form of blind dependency. Horney used the phrase "morbid dependency."
In the International Encyclopedia of Psychiatry, Psychology and Neurology, John Masters wrote: "I think that mainline academic psychology has not done enough extensive work on dependency as it relates to codependency as an identifiable personality disorder. Codependency is now seen by many to constitute a painful problem for certain clusters in our society. We are on a primitive frontier with regard to understanding codependence."
Psychiatrist Dr. Timmon Cermak, in Diagnosing and Treating Codependence, argued that codependency was on par with other personality disorders. "To be useful though," wrote Cermak, "codependency needs to be unified and described with consistency. It needs a substantive framework and, until this is done, the psychological community will not recognize codependence as a disease."
Enter Pia Mellody
It was at this point that a young nurse stepped onto the arena of modern psychology and made an extraordinary contribution.
One day, Pia Mellody walked around the corner of a building and had a moment of clarity. She thought of AA and how alcoholics start recovery by simply telling the stories of their troubled drinking. They share their experiences and strength in embracing their shame and their first glimmers of hope.
Pia realized that hundreds of people had passed through her office at The Meadows with stories very similar to her own. For one thing, a large majority had been abandoned, abused and neglected as children. Pia had long suspected that her own symptoms stemmed from her traumatic childhood and severely dysfunctional family system.
At this point, Pia began interviewing the many people who came to The Meadows with stories of abandonment, neglect, abuse of all kinds, and enmeshment with a parent, the parent's marriage or the whole family system.
As Pia interviewed person after person, a unique and clear pattern emerged. All had five similar symptoms:
They had little to no self-esteem, often manifested in the carried shame of their primary caregivers;
They had severe boundary issues;
They were unsure of their own reality;
They were unable to identify their needs and wants;
They had difficulty with moderation.
These symptoms together marked an extreme level of immaturity and a level of moral and spiritual emptiness or bankruptcy. Patients shared their sense of relief in just being able to identify and talk about the distress they were in.
With an interviewing approach fueled by her intuition, Pia Mellody had discovered what she called "codependency." She had come to understand the word "abuse" in a much broader context than clinicians had previously understood it. Pia also showed how codependents carry their abusive caretakers' feelings. Our natural feelings can never hurt or overwhelm us; their purpose is to aid our wholeness. Our anger is our strength, a boundary that guards us. Our fear is our discernment, warning us of real danger. Our interest pushes us to expand and grow; our sadness helps us complete things (life is a profound farewell). Our shame lets us know the limits of our curiosity and pleasure; it becomes the core of modesty and humility. And our joy is the marker of fulfillment and celebration. "Carried" feelings lead to rage, panic, unboundaried curiosity, dire depression, shame as worthlessness or shamelessness, and joy as irresponsible childishness.
Pia later saw the five core symptoms as leading to secondary symptoms: negative control, resentment, impaired spirituality, addictions, mental or physical illness, and difficulty with intimacy.
Pia believed that alcohol and drug addiction, sex addiction, gambling addiction and eating disorders must be treated before the core underlying codependency can be treated.
Understanding that addiction is rooted in codependence is another contribution that Pia helped to clarify. Years ago, Dr. Tibot, an expert on alcoholism, saw that there was an emotional core to alcoholism that he called the "disease of the disease." Pia's work has certainly corroborated that intuitive insight.
Pia Mellody's most important contribution may be how she and her groups of suffering codependents worked out strategies of healing. They did this through trial and error. The results were so striking that The Meadows encouraged Pia to develop a workshop titled "Permission to be Precious." It was an instant success, and Pia began to take it to different cities around the U.S. Soon she wrote a book, Facing Codependence, with Andrea Wells Miller and J. Keith Miller. Later she developed a powerful approach to treating love addicts and their counterparts' avoidant addictions. Her most recent book, The Intimacy Factor, is the only relationship book that treats the core "grief feeling work" around early abuse, neglect and abandonment. I believe that other self-help relationship books fail because they do not address these fundamental issues. "Feeling work" involves exposure, vulnerability and what Carl Jung called "legitimate suffering." Pia has done her share of that and has the know-how to gently nurture others through this work.
Pia's work has become the core model in treating addictions of all kinds and the core of codependence they rest upon. She has personally led hundreds, probably thousands, of people suffering from codependency into recovery and wholeness.
Pia answered Dr. Timmon Cermak's challenge to do the work that established codependency as a treatment issue. She not only found a consistent way to conceptualize this source of suffering, but she found the know-how to address it.
The time has come for a broader recognition of Pia's art and genius.
By Thomas Best, MD, Director of The Meadows
The Meadows is offering a new program called the "Integrated Evaluation." This program combines our groundbreaking Survivors Week workshop with a state-of-the-art evaluative process.
In addition to attending the workshop, each client meets with a treatment team consisting of a psychiatrist, primary care physician, addiction medicine specialist, clinical psychologist, and nutritionist. The evaluation team works collaboratively to ensure that clients receive the most thorough, integrated, and comprehensive evaluation.
Offered at The Meadows for more than 20 years, the Survivors Week workshop examines the origins of adult dysfunctional behaviors by exploring early childhood issues; these can play important roles in various addictions, mood and anxiety disorders, painful relationships, and other emotional issues. In this revolutionary educational and experiential process, participants learn to identify and address family-of-origin issues that took place from birth to 17 years of age. The primary focus of the workshop is to learn to deal with the emotions that accompany any less-than-nurturing past event, and then to work on resolution of the consequential grief and anguish.
Each participant will meet with a member of our highly trained psychiatric staff who will provide a thorough psychiatric consultation. All of the psychiatrists at The Meadows are board-certified by The American Board of Psychiatry and Neurology, and all have received training in The Meadows' therapeutic model. They strive to view a person's mental health issues in a holistic context and consider all therapeutic options.
The in-depth medical evaluation includes a comprehensive history, physical examination, and thorough laboratory workup. A medical evaluation is extremely important when diagnosing and treating mental health concerns. Often there is a direct correlation between medical issues and psychiatric symptoms. When the underlying medical issue is diagnosed and treated appropriately, the troublesome psychiatric symptoms may remit without medication. A medical examination is also very important in the evaluation of alcoholism and drug addiction, as these disorders frequently lead to medical problems. Our board-certified primary care physician is also certified by the American Society of Addiction Medicine. Psychological testing is also valuable to the assessment process. The results are interpreted by The Meadows' Director of Psychology. Finally, a thorough nutritional evaluation addresses the nutritional needs of the client and any potential problems with food, such as an eating disorder.
At the conclusion of the week, the client meets with our professional staff to discuss the preliminary diagnostic findings and treatment options. A complete report is then sent to the client within two weeks.
For more information, please call 800-632-3697.
Note: This article was originally published in the Spring 2006 edition of Cutting Edge, the online newsletter of The Meadows.
History & Addiction
by Claudia Black, PhD, MSW
Like every aspect of mankind, addiction has its own history. Long before anyone understood the core problems of addiction, people became hooked on substances. The following is adapted from Claudia's videos The History of Addiction and The Legacy of Addiction.
Chemical dependency has plagued humankind since man first crushed grapes. Each millennium has treated the problems that addiction brings with a methodology unique to the times. Historically, society, as a way of treating those addicted, has imprisoned them, banished them, put them in mental institutions, religiously converted them and, in today's world, treated them.
What has not changed is the impact of chemical dependency, particularly on those addicted and their families. Herein lies the story.
The roots of addiction are deep and ancient, and the methods used to deal with addicted persons are historically bizarre. The Egyptians used to flog drunkards; the Romans created Bacchus, a God of wine and revelry; and the Turks "cured" drunkenness by pouring molten lead down the throat of the inebriate, perhaps the first example of aversion conditioning - crude, but effective. The Greeks believed that the use of amethysts, beautiful deep purple stones, would ward off drunkenness. They festooned their cups with amethysts, wore them when drinking, and even ground them up and put them in the wine they drank.
An example of an early addict we might recognize is Alexander the Great, king of Macedonia in 350 B.C. By the age of 31, he had conquered the world and, during all his mighty triumphs, had abstained from intoxicating beverages. However, after his great triumphs, in a short span of two years, Alexander became an alcoholic and ended his career in a series of insane escapades.
He burned cities at the request of a courtesan and killed his best friend, and his demise came in a contest of wine drinking. Alexander the Great was 33 years old when he drank himself to death.
Wine making and its export became the economic basis of the Roman Empire. With the collapse of the empire, religious institutions, particularly the monasteries, became the source of brewing and wine making techniques. It was not until the 19th century that the production of beer, wine and distilled beverages became efficient and cheap enough to supply inexpensive alcohol to the masses.
Throughout the 19th century and into the early 1900s, alcohol and various drugs - notably morphine, cocaine and chloral hydrate - were used in various combinations as medicines. These "patent" medicines were highly addictive; alcohol content was as high as 95 percent. By the mid-1800s, the problem of addiction was major and growing. A physician from Battle Creek, Michigan, traveled extensively and used charts to show the effects of alcohol, drugs and nicotine on the body. Today, you would most likely recognize him as the founder of Corn Flakes. His name was Dr. John Harvey Kellogg.
In the 1840s, the first large temperance group, The Washingtonians, was born. The origin of this movement was a drinking club that met nightly at Chase Tavern in Baltimore, Maryland. One night, 20 chronic drinkers, in a spirit of jest, sent two of the younger members to a temperance lecture. Upon their return, the two men presented a favorable report of the lecture, and an argument concerning abstinence began. This argument would last four days and ended when six of the members announced their decision to support an abstinence society. This became a huge movement, with a membership of almost five million Americans by 1845 -notable because it probably marks the beginning of modern-day addiction recovery.
Like Alcoholics Anonymous, the Washingtonians believed in the substitution of personal experiences for lectures, and they viewed the drunk as a sick person. Perhaps most significant, they also professed a singleness of purpose: to help the drunk. But politics became an issue and would cause the movement's demise.
America's most recognizable temperance leader may be Carrie Nation. In 1888, she began a campaign wherein she and her female followers destroyed kegs of liquor and sometimes entire saloons, using stones and trusty hatchets.
In the late 1880s and early 1900s, some bizarre forms of addiction treatment were practiced. The Keeley Cure began in 1880. Using bichloride of gold, the treatment involved withdrawing the alcohol or narcotic drug and restoring the nerve cells to their original unpoisoned condition, thus removing the craving for liquor. Enemas and laxatives then stimulated the elimination of the accumulated poisonous products. (Incidentally, Bill Wilson, co-founder of Alcoholics Anonymous, was subject to this treatment in 1934.) In 1918, it was stated that more than 400,000 people had been treated by this system at various Keeley Institutes. (NOTE: Bichloride of gold did not exist.)
While not concerned primarily with addiction, the Oxford Group, a popular religious movement in the 1930s, was to play an important role in the future treatment of the disease.
But perhaps the most successful treatment for alcoholism has been Alcoholics Anonymous. Dr. Bob Smith and Bill Wilson founded AA in 1935 in Akron, Ohio. Wilson was a drunk who, after being called on by an old friend and member of the Oxford Group, was admitted for his alcoholism to Towns Hospital in New York City in 1934. He remained sober, and his work took him to Akron, where he felt the need to talk to another alcoholic. He was introduced to Dr. Bob Smith, a prominent and persistent drunk. From this meeting emerged the basic premise of Alcoholics Anonymous: one alcoholic helping another alcoholic. The original meetings of Alcoholics Anonymous were held as adjuncts to the Oxford Group on Wednesday nights at Dr. Bob's house.
Alcoholics Anonymous is a spiritually based program, and its primer is The Big Book. Proposed names for the book were One Hundred Men, Moral Philosophy, The Empty Glass, The Dry Way, and Dry Frontiers. In 1939, 5000 copies were published. Today there are four editions of The Big Book - and millions and millions of copies. Alcoholics Anonymous exists in most countries, with meetings in just about every city in the world.
In 1950, Lois Wilson, wife of Bill Wilson, founded Al-Anon, the 12-Step program for families and friends of alcoholics. Alateen was started in 1957.
In 1951, the "Minnesota Model" was developed. The foundation for treatment from the 1970s to the present, this abstinence model is based on the 12 Steps of Alcoholics Anonymous. It has become the primary protocol for residential and outpatient treatment programs in the United States and in many parts of the world.
In 1952, the American Medical Association defined alcoholism, but it would not be until 1967 that it passed a resolution identifying alcoholism as a complex disease and recognizing that the diagnosis and treatment of alcoholism are medicine's responsibility.
While abstinence-based programs would become widespread throughout the United States, treatment in the late 1970s would focus on all chemicals, not just alcohol. The word "alcoholism" was gradually replaced by "chemical dependency." There would be a resurgence of interest in attending to the family, spouses, partners and children of addicted persons. There also would be heightened interest in both young and adult children of alcoholics.
The role of the private sector in treatment has lessened, with community-based programs taking on more responsibility. Today's recovery programs treat addictive disorders, recognizing cross addictions and the need to abstain from all mind-changing chemicals. In many cases, clients are treated for multiple addictive disorders, such as gambling, chemical dependency, eating and sexual disorders, and dual diagnoses, most commonly PTSD and affective disorders.
Addiction is a complex disease, a devastating disease and a terminal disease - yet today it is a treatable disease. History has left us a long and painful legacy of addiction. Today we are beginning a new legacy: that of the reality of recovery.
The Meadows Addiction Treatment Center is excited to announce its latest web project: DrugRehabFAQ.com.
The goal of the the new site is to clarify some of the basic questions relating to a patient's decision to enter a drug rehabilitation facility. In the future, the blog will also answer questions related to the experience itself, expectations and continuing care, which is a vital factor in long-term recovery success.
Some of those questions are:
How do I know if I need rehab?
How should I decide on a rehab facility?
Should my family be involved with my rehab treatment?
For the answers to these and other FAQs, visit DrugRehabFAQ.com.