By Claudia Black, Ph.D., Senior Fellow and Clinical Architect of the Claudia Black Young Adult Center at The Meadows
Triggers are specific memories, behaviors, thoughts and situations that jeopardize recovery - signals you are entering a stage that brings you closer to a relapse. The process is much like riding a roller coaster that loops over itself. Once the roller coaster car gets to a certain spot in the track, a threshold is met, there is no turning back, and it starts the downward loop. Just as gravity has a motivating effect on a roller coaster, brain chemistry has a similar effect motivating triggers. When people use substances or engage in escape behaviors the brain releases neurotransmitters such as adrenaline and dopamine that trigger the brain’s pleasure/reward center; or it may release serotonin which lessens anxiety and depression.
Will power alone is not a defense against a relapse. Recovery is achieved, maintained and enjoyed through a series of actions. Learn to identify your triggers, and with each one identify a plan that anticipates and de-escalates the power of the trigger. With that, your reward is another day of sobriety and endless possibilities.
Romanticizing involves a tunnel focus only on the positive feelings you associate with the behavior, it is glamorizing using behaviors and in the moment totally forgetting about the negative consequences.
Getting overwhelmed at times is to be expected, but it’s very easy to slip into romanticizing without any insight as to how you got there and at that moment you enter a slippery zone, touching the trigger. While romanticizing is in and of itself a trigger, it is often in tandem with an external trigger such as noises, sights, sounds or even tastes. You could be watching a movie and the next thing you know it is depicting the power of alcohol, drugs and sex in a positive way and you are off into romanticizing. Or you’re listening to the radio and an advertisement for a drug comes on, and you think about your pain pills as the commercial goes on to tell you how much better you’ll feel, and off you go. Or you’re watching a ball game on TV and as you watch you can almost smell the popcorn and peanuts and you see the spectators drinking large cups of beer and everyone is smiling like it’s only a good time.
Take a few moments to think about how you romanticize your addictive behavior: What do I find yourself thinking about? What is the romanticizing covering up? What am I forgetting to take into account?
Recovery is the ability to tolerate your feelings without the need to medicate, engage in self-destructive or self-defeating behaviors and thoughts. Addicts have used their behaviors and substances for years to separate from their emotional states. And there is so much to feel about—guilt for how your behavior has hurt others; sadness for your losses; anger with yourself; fear of what is in front of you; shame for thinking you are inadequate, not worthy. You can act out in response to every feeling imaginable.
Any person or situation can trigger threatening feelings. You are upset when you realize your friends are reluctant to include you on a weekend outing because you created a scene last time. You want the people you work with to like you but you are anxious that you will be rejected, or not welcomed. Your sister won’t let you babysit her kids anymore and you feel guilty, sad and angry. You just met with your ex-wife and you walk away angry, like always when you see her.
You are working hard in your recovery and you know you are doing pretty well, but it still isn’t easy to have these feelings and not be reactive. You lessen or get rid of feelings when you own them, talk about them, or in some cases engage in problem-solving. It is when you try to divert, ignore, and numb that you get into trouble. Feelings are a part of the human condition and you can’t escape them, so the goal is to learn how to tolerate the feelings.
Recognize the gifts that come with feelings. Feelings are cues and indicators telling you what you need. Loneliness tells you in your humanness you need connection, fear can offer you protection, sadness offers growth, guilt is your conscious, offering direction for amends. It is critical for you to have this insight, and more importantly to start to take ownership of recognizing the feelings when you have them. It is vital to learn how to be with the feeling and how to appropriately express it. It is also necessary to find safe people in which to share your emotional experiences.
So when you recognize your feelings ask yourself …
What do I need? What feelings are ones I go to any length to avoid? What is the price you pay for hiding or masking those feelings?
Coupled with the trigger of feelings is the fact those feelings are often associated with loss. By the time you get to recovery you have had multiple losses in your life, often losses related to childhood, many times due to being raised with abuse, addiction, mental illness, etc. While you may have experienced trauma within your original family, the pain of loss may be from a specific situation; You may have experienced the loss of relationship with your parents or children; or the death of friends, family; or abortions, career or work opportunities missed. As an addict, you are likely to have losses related to health issues. Perhaps you have Hepatitis C, or HIV, or injuries due to accidents.
The goal is not to dwell on your losses, but to not live in the pain and anguish of them which is what happens when you don’t acknowledge them and what they mean, triggering you back to your using behavior. With some loss, you can only grieve, and ultimately come to find some meaning from your experience, with others in time, you can attempt to repair damaged relationships.
Resentment is also a feeling but I think it warrants its own place as a significant trigger. Resentments are often built on assumptions, When you don’t look at me I assume you think you are better than me. When you don’t include me in a social gathering, I am assuming you think I am not good enough to be with you and your friends. They are also built on entitlement, which is a form of unrealistic expectations and impatience. For example:
I have been in recovery six weeks now. I resent the fact that my wife still doesn’t trust me. Now that I am clean and sober my boss should give me that promotion I deserve.
The attitude in both examples is not just that you should be rewarded for doing well, but that you should be rewarded for the sacrifices made. After all, you have given up your alcohol, your drugs, and/or the addictive behavior and therefore deserve to be rewarded. The problem here is that you are still more connected to the loss than to the gifts of sobriety. Ways to move from resentments are – when assuming, check it out; put yourself in someone else’s shoes (it may allow expectations to be more realistic); identify and own the feelings the resentment is covering (often it’s a cover for feelings of inadequacy and/or fear); be willing to live and let live.
Some questions to consider:
What does it mean for me to hang onto resentments? What would it mean to accept that I have been hurt or wronged and that I can no longer change that? What does it mean to take responsibility for my own feelings? Ultimately who pays the price for hanging onto resentments? Today am I willing to let go of resentments?
You need to identify specific triggers that are people, places, and situations that are high risk. Slippery people could be your ex-lover, certain family members, past using/party buddies. A slippery place might be a bar you used to frequent, a casino or an area in your community where you cruised. Slippery situations could be an emotionally charged social gathering, such as a wedding, a family event, or vacation setting. In essence, any place that triggers a positive association with the use of your drug of choice.
Medication may be also a trigger for which you need to be accountable. While there are situations where medication is needed, you are at high risk of abuse. You need to be proactive in how you are going to cope with this situation because it is likely your brain is going to remember a good feeling, saying more is better. Just because you are agitated, doesn’t mean you need a prescription pill. Again, there are situations where medications are necessary, but self-diagnosis and/or self-prescribing only create a recipe for disaster.
What are the people, places or situations that are potential triggers? What creates the greatest safety for me to not get triggered? What triggers can I avoid? If I can’t avoid a certain place, can I lessen the contact or time? Is going into this slippery situation worth the risk?
While some decisions around triggers are absolute, others are not necessary for your entire life. Know your triggers and make a plan accordingly. In the face of a trigger, what do you need to do? What do you need to tell yourself? Who can you reach out to for support and or problem solving?
1) Practice staying in the present, don’t sit in the past or project into the future
2) Validate the gifts of recovery for the day – practice gratitude daily
3) Identify, build and use a support system – you need to stay connected. History and experience has proven time and time again, that recovery is not a solitary process, and cannot be sustained in isolation.
4) Trust your Higher Power is on your side
Whether you are new to treatment or transitioning from inpatient treatment, you may need a program that helps you to build skills for maintaining your sobriety. In addition to its “mainstream” intensive outpatient program, The Meadows Outpatient Center offers a program designed specifically for young adults, ages 18 – 26. The Claudia Black Young Adult Outpatient Program is designed to foster the development of the individual while helping them build skills to prevent relapse as they transition into a more fulfilling and self-sufficient life. Call today for more information: 800-244-4949.
Gay, Lesbian, Bisexual, Transgendered Issues
by Michael Cooter, MSSW, LCSW
Imagine growing up in a world where your identity is always, if not frequently, being challenged due to external reality. Your external perceptions are profoundly incongruent with your internal experience. The GLBT individual, for instance, sees the world as predominately heterosexual: opposite-sex partners, rituals celebrating these relationships, and their related paths to validation.
Transgendered individuals' internal perceptions regarding their own gender do not match others' perceptions of them. To survive, one engages in fantasy, compartmentalization, hypervigilence, and other adaptations to navigate daily existence. This is a common experience among many gay, lesbian, bisexual, and transgendered individuals.
This need to conceal, hide, and withhold the authentic self leads to a significantly adapted response that psychologically manifests itself in a variety of secondary symptoms. These symptoms can best be identified using The Meadows' Model of treatment.
To portray oneself dishonestly leads to a disruption (trauma) in one's usual path of development. The Meadows' Model addresses the core issues associated with such a disruption: self-esteem, boundaries, reality, dependency, and moderation. GLBT individuals struggle with issues of self-esteem prior to, during, and after the coming-out process. Many who have internalized shaming and homophobic messages about their inherent value will attempt to cope with this "carried shame" by becoming perfectionistic, or "better than." Others have no sense of inherent worth and believe the messages that they are "less than," or not as good as their heterosexual counterparts. Both defenses result from growing up in a predominately heterosexual world.
Carried shame plays a powerful role in the development of dependency on mood-altering chemicals and the chronicity of mood disorders. For the GLBT client in particular, issues of carried shame must be identified and processed in order to reach a hopeful recovery. If such issues remain unaddressed, the patient is vulnerable to interactive addictions and relapse in primary addictions/mood disregulation.
At The Meadows, we teach and work with patients to identify and release the internalized shaming messages associated with sexual orientation and gender identification. We support and guide patients in releasing "carried shame" resulting from cultural, peer, and family experiences. We believe, embrace, and support all people in celebrating their inherent value.
Michael Cooter, MSSW, LCSW
Director, Strategic Relations
Michael has previous experience working with The Meadows. He previously worked as a primary therapist, workshop facilitator of Love Addiction/ Survivor's groups and co-facilitated PIT trainings with Pia Mellody. Michael has extensive experience working with individuals impacted by specific combat related trauma. This includes almost five years work with post deployment trauma working with the Department of Defense. He maintains a private practice in Phoenix working with individuals, partners, and families.
In the eyes of a child money is alive. Money leaps out of machines in a mysterious way and solves problems or creates others. Money jumps in the middle of parental arguments and draws its sword, threatening to separate a child from his family. Money leaves powerful messages in marriages; it "wakes" up emotions as it "writes letters" to the family in the form of bills or makes phone calls to the household in the form of bill collectors. Money-talks are frequently the most emotionally charged conversations that a child hears, and children become aware of the social implications of money as soon as they become aware of, and responsive to, others. Money becomes a god that Mother sacrifices Motherhood to obtain and Fathers forsake home life in pursuit of "making a living". Money is the visible representation that a child sees as individuals connect one to another and exchange the green stuff. A child observes the social contracts of money between people and knows that money itself is social; it creates agreements, happiness, and pain as it pulls people together or separates them forever.
Understanding our client's financial and work dilemmas requires much more skill than just offering them the telephone number for credit-consolidation companies. The behaviors themselves can be as varied as trauma repetition, mood-altering experiences, or acts of defiance, as well as many other possibilities. Debt may be for one individual an act that quiets a suppressed and unconscious fear of separation; for another it might be an angry response to feeling confined and trapped; to a third it might mean an anesthetizing behavior allowing one to "zone out".
Healing wounds made by money and work is best approached as if the behaviors themselves sat on a three-legged stool - not to be understood unless all three legs are available. For clinicians the first leg is to understand the Attachment and Trauma issues that arise out of early childhood experiences that serve to create templates for adult behaviors. The second leg is isolate the exact Temperament - answering the question that it is both nature and nurture that give us our attitudes and behaviors with money and work. The third leg is Affect - when we help our clients to understand that the phenomenon of debt creates feelings of emotional pain and fear - and sometimes it is the emotion itself that is most attractive to a traumatized individual.
The money and work disorders create a collage of dysfunctional behaviors. Clients may display a pattern of compulsive shopping, spending and/or debting; some may have progressed into hoarding or shoplifting. Other clients become obsessed with money or work, and some retreat into deprivation and under-earning. Some gamble, either in traditional ways with slot machines and gaming tables or with high risk investments and business adventures. Still others might find themselves paralyzed by the wealth they have inherited or with which they have grown up, and are now unmotivated and untrusting, alone in a threatening world. Assessment of money disorders frequently shows a correlation between adaptations such as gambling with embezzlement, shopping with shoplifting, workaholism with at-risk entrepreneurship or embezzlement, or compulsive giving with relational issues (the "Financial ALANON Factor"). Regardless of how the puzzle pieces fit together to create the unique profile, the treatment follows a predictable course.
Specific steps that need to be taken by clinicians wishing to approach and understand the emotionally-charged, compulsive work and money behaviors include:
(1) An Assessment of disordered patterns of work and money.
(2) An Evaluation of client's temperament and confirmation of underlying personality-specific innate fears.
(3) Childhood memories narrative to determine template(s).
(4) Re-scripting of cognitive distortions regarding finances and work.
(5) Vision work to establish clear goals for future behavior.
(6) A relapse prevention plan based on knowing risk and trigger issues.
Money trauma and the related adult behaviors surrounding money are the unspoken burdens of shame that often take our clients into relapse. In the past twenty years we have made great strides in healing the wounds of sex addiction and we can now talk about sex openly. The time has come for us to talk about money as well and conquer the shame that has kept this subject in silence for too long.
Bonnie A. DenDooven
Bonnie A. DenDooven, MC, LAC, a family workshop therapist at Gatehouse Academy, is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work behaviors, she is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the "un-DSM").
The holiday season can be a time of joyous celebration with our loved ones, a time when we begrudgingly drag ourselves to dreaded events, or a time when feelings of loneliness can be overwhelming. For many of us, some combination of all three is present this time of year. In many cases, the holidays are a time when stressors, triggers for relapse, and old wounds are more abundant.
This season also brings the opportunity to continue or start off the new year in recovery mode. We at The Meadows would like to offer you a 12 Step plan for doing just that. We honor the work that many of you have done to re-engage in your life, leaving old habits behind. We also honor those who continue to struggle with addiction. Below is a 12 Step guide for surviving the holidays in sobriety - "the 12 Steps of Holidays Anonymous," if you will. (Disclaimer: The steps below are loosely based on the 12 Steps of Alcoholics Anonymous and are not a replacement for them.)
The 12 Steps of Holidays Anonymous
1. Make sobriety your first priority. Acknowledge the vast amount over which you are powerless (your family situation, the location of events, etc.). Be aware that you are, however, empowered to choose to maintain what you have lovingly worked so hard to achieve. Assess what you want and need for your sobriety and relational engagements with others.
2. Believe that you can be restored to sanity. Plan ahead and have realistic expectations. If your family looks more like The Family Stone than Ozzie and Harriett, ground in reality and be open to the flaws and imperfections of your family system. Detach from expectations and practice acceptance and forgiveness.
3. Turn your care over to a higher power, or at least someone with more experience staying sober during the holiday season. Have a safety plan. Speak with your support network prior to the holidays and share any concerns and plans. Remember that, in previous years, many of your peers in the program have survived and thrived during the holiday season. Some common techniques used in the recovery community include driving yourself to events so you can leave whenever necessary, taking the number to a taxi service if driving yourself is not an option, asking a sober friend to accompany you, or hiring a sober escort. Keep in mind: The impact of bringing someone with you or leaving an event early is small compared to the impact of a relapse on your relationships with your loved ones and self.
4. Make a searching and fearless inventory of yourself, and practice boundaries and grounding. Setting limits is a loving and respectful thing to do for yourself and others. If you have awareness that you are willing and able to participate in a holiday activity for one hour rather than five, set a limit with yourself and share this limit with your loved ones or holiday celebration peers.
5. Admit to God, self, and one other person any concerns and potential triggers you may have going into the holiday season. Remember: Those around you cannot support you unless you are willing to be rigorously honest with yourself and your sober support system, i.e., your sponsor, home group, and therapist.
6. Be entirely ready to remove all defects of character. Remember this is for you only; your willingness to assist family members in identifying and removing their defects of character before they are ready avails no one and is NOT relational.
7. Humbly ask the higher power of your understanding to remove your shortcomings, recognizing that your shortcomings do not subtract from your value. Be respectful of others. If one of your tendencies is to judge others, make a resolution to contain your comments on Uncle Marvin's lovely twinkle-light reindeer sweater (not that there's anything wrong with battery-operated clothing).
8. Make a list. Chaotic, last-minute trips to the mall can be destabilizing and stressful. Honor yourself by not overextending to make others happy. Take a personal inventory of yourself and your finances. This is a self-care technique that can help you turn inward and avoid future resentments. Also, don't forget to include yourself on your gift list. Gifting oneself, in a moderate way, is an act of self-care and acknowledgment.
9. Make direct amends, except when doing so would injure others. Remember that one of the ways to make amends is with living amends. You can do this by maintaining your sobriety, acting within your value system, and being respectful of others. You may believe this is a good time to speak with those you have harmed, but do so with conscious thought. Grandma may prefer to spend her holidays watching the grandchildren unwrap gifts rather than discussing a way you can pay her back for totaling her car.
10. Continue to take personal inventory and, when you are wrong, promptly admit it. Remember HALT (the basics of self-care: Hungry, Angry, Lonely, Tired). In times of stress, we become more susceptible to allowing some of our defects of character to leak out. If you act outside of your recovery and value system, make prompt amends to avoid allowing unnecessary feelings of guilt to overtake the celebrations.
11. Seek through prayer and meditation; the holiday season can be busy and, in some cases, stressful. This is not an excuse to skip your morning meditation, meetings, or time with your sponsor. This is a time to hold these commitments even more strongly, or to kick it up a notch. Prearrange your meeting schedule and ensure that connection, sobriety, and self-care remain top priorities. It may come in handy to repeat the Serenity Prayer in your head as Uncle Jack attempts to dominate the season with his thoughts on the current political climate. This allows you to remain connected with your higher power and accomplish relational objectives, all while nodding your head during his share.
12. If you have had a spiritual awakening, try to carry this message: Acts of service can help us to reground, stay connected to our program, and just feel darn good! The holidays can be an important time to practice gratitude and giving. If your holiday plans this year are not what you had hoped for (or even if they are), volunteer to be a sober escort, speak at a meeting, or volunteer to clean up after one. Remember: Whatever your season looks like this year, it’s still a lot better than holidays spent living in addiction.
We at The Meadows wish you a sober, safe, and successful holiday season.