Sound Sleep Makes for Sounder Addictions Recovery

Sleep disturbances are a sad fact of life for many people in recovery from substance use disorders. Sometimes sleep problems put people at risk for addiction, sometimes people develop sleep problems because of the drugs they take, and sometimes both. But causality aside, the correlation between disturbed sleep and substance use disorders is indisputably high.

Sound sleep aids addictions recoverySleep disturbances are known to occur across widely different substance use disorders, including nicotine, alcohol, opioids, and cocaine. Alhough sleep disturbance is a common experience, different substances affect sleep in different ways.

Alcohol helps people fall asleep faster and increases slow wave sleep in the first half of a sleep period. For this reason many people have turned to alcohol to cope with sleep problems, especially if they have a co-occurring mental disorder. Yet alcohol disrupts the second half of a sleep period, reducing overall REM sleep for the night and ultimately making sleep problems worse.

People dependent on cocaine and alcohol tend to have disturbed sleep architecture as they age, with increasing REM (Rapid Eye Movement) and accelerated age-related decreases in slow wave, stage 3 sleep. People trying to become abstinent from cocaine report better quality sleep, but one study reveals that even as their perception of sleep quality goes up, their actual quality and quantity of sleep goes down. People recovering from cocaine substance use disorders may therefore be at higher risk of relapse because of poor sleep without knowing it.

Opioids are notorious for detrimentally affecting sleep, but in a different way. Long-term opioid use causes sleep apnea (in 30-90% of long-term opioid users) and otherwise disrupted breathing, sometimes resulting in hypoxia, and contributing to fatal overdose. Unfortunately, though indefinite buprenorphine and methadone maintenance are most promising for treatment of opioid substance use disorders, methadone is documented to cause sleep problems and burpenorphine may as well.

Studies of alcohol substance use disorders have demonstrated that greater severity and frequency of sleep disturbances put people at greater risk of relapse. Researchers think this correlation may be generalized to all types of substance use disorders. Berro et al., in 2014, found that sleep deprivation affects the dopaminergic systems in the brain in a similar way to psychostimulants, like cocaine. They hypothesized that sleep deprivation could prolong recovery by extending the association of cocaine with environmental cues, and so cause people to relapse.

Poor quality sleep is known to cause other health problems, and to compromise immune function, an especially grim prospect for any person who contracted HIV or hepatitis while using. Improving sleep quality is thus an important goal for anyone in recovery to reduce risk of relapse and reduce craving, and also to improve quality of life overall.

Addictions treatment providers may help their patients tremendously by providing cognitive behavior therapy to encourage beliefs and behaviors that improve sleep, and to refer people in recovery to sleep specialists when possible.

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This post is one our series of reports on what the current science says about addictions and addictions treatment.

Partial list of reports, listed most recent first:

How to Talk with Someone About Getting Help with Addiction

If you’re concerned about someone’s drinking, use of drugs, spending, gambling and other behaviors that might qualify as addiction – using or doing that continues despite negative consequences – and want to talk with them about it, here’s a suggested to-do list based on my personal and professional knowledge and experience.

Truly inform yourself about addiction. What most people think they know about addiction is belief-based, not evidence-based. My suggestion is to start with information from NIDA, a division of the National Institute of Health. NIDA’s publications on the science of addiction meet these rigorous standards. If other sources you read don’t link to sources that also use these standards, I suggest distrusting them. What works and didn’t work for one person cannot be generalized as applicable to your person.

Helping requires negotiationSeparate the condition from the person. Addiction is identifiable at the molecular level as a brain abnormality. While the first drink or drug or action or subsequent ones may have been the person’s “fault,” once addiction occurs, brain changes can impair the person’s ability to use judgment, make decisions, and choose based on criteria – whether good or bad. The abilities to make plans and to follow through with them are impaired. The ability to learn from the error of one’s ways, to learn from punishment or reward, to be shown a fork in the road and implored to take this path or that path and to decide which is the most helpful – all impaired. The person looks like the person we know, but the brain no longer works the way it used to. Addiction presents a horrifying double bind. The individual’s very skills and abilities that help make them who they are – and are needed to stop doing something – are the very ones that are impaired.

“People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.”
– Nora D. Volkow, M.D, Director of the National Institute on Drug Abuse (NIDA), quoted in What We Take for Granted

Know what you’re asking the person to do without. People with addictions describe the experience of using or doing as a feeling of love, a sense of belonging, bliss, meeting an unmet need, oblivion, sacred space, the only way to be pain-free, relax, sleep, be around others, and many others. Many people with addictions have anxiety, depression and other mental health challenges, trauma symptoms, issues of temperament, physical pain, and debilitating sleep disturbances for which drinking, using or doing provides the only relief.  Pause to reflect deeply on what purposes you think using or doing serves in the person’s life. Suspend judgment. Imagine you are the person and use this simple cost-benefit analysis tool from SMART Recovery to get a sense of what it might be like for the person to give up drinking, using or doing. To deepen your insights, put the items you’ve listed, regardless of the section, in rank order.

Know what you’re offering as a replacement. When people with addiction stop drinking, using drugs, or engaging in an activity, many are thrown into an acute state experienced as mind-breaking, spirit-shattering, life-threatening distress. And, for many, for the rest of their lives, they have to do without something that met needs that nothing else can meet. Based on your best judgment of what needs the person has that are met by their use of alcohol, drugs, or activities, what is your plan to get their needs met if the substance or activity is removed?

Specifically, what’s your short-term plan to help the person deal with acute suffering? (This guide to getting health care for addictions may be helpful.) What’s your long-term plan to help the person handle the on-going whine of distress that could spike at any time? Relapse relates for alcoholism, for example, don’t drop significantly for 5 years. “Just stop” is not a plan. The person has tried that plan more times than you can ever know. Drinking, using and doing again, when a person is experiencing what feels unbearable, is not weakness, but mercy.

Your plan will depend upon your locale’s resources. Feel free to use this guide to getting help with addictions in the Blacksburg, Virginia area to customize your own plan. (If the person has an opioid addiction, more specifics are at the end of that guide, and here and here and here for myths about heroin.)

Ask: “What do you think would be helpful?” Once you understand that addiction is medical, not personal, i.e. neither about the person nor about you, and you’re savvy about your locale’s addictions treatment resources, you know what’s on offer. With goodwill, good intentions, a clear mind and calm heart, you can essentially enter a business negotiation. You want the person to buy some combination of addictions treatment products and services but which ones match this person’s needs and preferences? You have to ask to find out. Then you’ll have to discover whether or not what you’re offering is perceived as valuable enough for an exchange.

What we know isn’t helpful and we know doesn’t work: negative consequences.

Persistence in spite of negative consequences defines addiction. Therefore, negative consequences don’t arrest or cure addiction. Emotional punishment such as shouting or the silent treatment are akin to psychological abuse and are destructive to you and to your person. Physical punishment – including getting locked up in rehab or jail – can traumatize the person, which is already a pre-existing condition for many people with addictions.

Plan for yes. Plan for no. If the person says they want help, you better be able to act on that immediately, i.e. put them in the car and start driving. If you don’t know your locale’s resources and you don’t have things lined up, you’re going to put that person in a world of hurt. Any delays decrease chances for engagement in treatment. They’ll very likely have to return to what they were doing and their trust in you will be harmed. If the person doesn’t want help, this will require a terrible judgment call on your part. It’s time to use the cost-benefit analysis tool on your own dilemma. Just replace “using/doing” with “helping,” be sure to rank order what you list, and see what comes up for you.

“Love, evidence & respect.”
Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

Acknowledge the complexity of the situation. People with addiction continue to do what they do for reasons that make sense to them – even with impaired cognitive functioning –  and, with a little imagination and empathy, we can make sense of those reasons. Given that people with addictions, depending upon the substance or activity, may or may not experience dependence, given that addiction is classified as a brain disease, and given that the brain’s executive functioning is impaired by addiction, well, who would know how to talk with someone about addiction or would know what to say? By what criteria would we measure rightness or wrongness of a layperson’s – even a professional’s – attempt to broach the subject? For both parties, it’s a wicked, wicked problem.

When attempting to help people with addictions, I use the words of Maia Szalavitz for guidance – sometimes as prayer: “Love, evidence & respect.”

Photo by Zane Queijo

Addiction Recovery with Others is Easier than Recovery Alone

Recovery from addiction is incredibly time consuming. The stakes are so high; people in recovery must spend their limited time, resources, and energy on treatments and practices that help the most. Support groups have been criticized, especially 12-step groups, for low or inconsistent results. Why should anyone serious about recovery bother attending?

Quite simply, recovery with others is easier than recovery alone.

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Many psychologists have dedicated their careers to understanding attachment theory and how attachment styles can affect the ways people develop. Attachment theory examines the quality of infant relationships with their caregivers, and correlates these relationships with the quality of relationships people have later in life. Basically, the more securely an infant bonds with a caregiver, the more secure that infant will feel in other relationships later in life.

Psychologist Mary Ainsworth was the first to classify three attachment patterns or styles based on infants’ responses to the “strange situation” procedure, which involved a researcher observing the mother and infant in a series of 8 situations while hidden behind a one-way glass. The situations were a standard set of combinations of the mother, baby, and a stranger (mother and baby alone, stranger and baby alone, baby alone, etc.). The infant’s behavior was scored in each situation based on four types: proximity and contact seeking, contact maintaining, avoidance of proximity and contact, and resistance to contact and comforting.

Ainsworth developed the attachment styles based on the results of this experimental and scoring procedure. Attachment theory has since been expanded to evaluate adult attachment styles as well, and the 3-style framework has been expanded to 4 attachment styles: secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant.

Attachment styles are extremely important because they describe the quality of a person’s relationships, which influence just about every aspect of a person’s life. A 2013 study of 5,692 people found that insecure attachment styles were associated with greater likelihood of suicidal ideation and attempt, and mental disorders overall. Secure attachment styles were associated with the opposite trend.

Dr. Philip Flores, a psychologist examining the importance of early attachment styles on the development of addiction, has written that substance use is an attempt to self-medicate the stress of ineffective attachment styles. Substance use ultimately results in further distance rather than the desired closeness and connection.

The primacy of social interaction is studied by neuroscientists as well. Neuroscientist Matthew Lieberman gave a Ted Talk on how social interaction is vitally important for healthy, fulfilling human lives, and may even precede food, water, and shelter in importance. In fact, increasing evidence suggests that social pain is processed very similarly to physical pain in the brain; the body processes social pain as a threat to existence.

A recent article in the New York Times, How Social Isolation is Killing Us, documents evidence of increased loneliness in America and the effects. Since the 1980s, the number of Americans who report loneliness has doubled, and that 1/3 of Americans over the age of 65 live alone. The article emphasizes that, “Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions.”

So it’s clear that everyone benefits from social connection, but how much we need still goes unanswered. People with addiction still need to know whether support groups are worth the bother. While neuroscience is still working on understanding how psychotherapy, group therapy, and even basic social interaction works in the brain, psychologists are working on questions of efficacy.

Evidence indicates that support groups for addiction help people stay in recovery. Researchers in 2011 assessed 1,726 patients at 3, 6, 9, 12, and 15 months after residential treatment, and concluded that support groups help people in recovery change “people, places, and things,” reducing triggers for craving and relapse. The researchers published a follow-up study in 2012, analyzing potential reasons for improved outcomes, and found that patients surrounded by pro-abstainers were more likely to stay abstinent than patients surrounded by pro-drinkers. Another study in 2012 found that stronger AA group cohesiveness, a sense of belonging, predicted increased participation and abstinence in group members. Other researchers, in 2011, have taken a closer look at some of the reasons for support group successes, and found that AA groups may increase self-efficacy, a person’s belief that he or she can succeed and recover.

According to these studies, building stable social networks appears to yield better results for people in recovery than going it alone. So far, it seems, what matters most in addictions recovery groups is the level of belonging people feel. (Sebastian Junger explores the universal human need for belonging from a sociological perspective in his book, Tribe.)

While the research supporting recovery groups is not as conclusive as we would like, neuroscientists are currently testing the efficacy of oxytocin as a treatment for addiction. Known fondly as “the love hormone,” oxytocin performs many roles in the body. Oxytocin is naturally released in response to positive social situations, such as during childbirth and family bonding, and when seeing the face of one’s partner. Oxytocin is also found to be released in response to certain drugs.

“Heroin, it’s my wife and it’s my life”
– Lou Reed, “Heroin

Lou Reed was never alone in feeling love for his drug of choice. People subjectively and literally describe addiction as falling in love with a substance or activity, and love as becoming addicted.

In 2014, a group of researchers chose to study prairie voles, Microtus ochrogaster, who are notorious for forming life-long partner bonds. From previous studies, the scientists knew that oxytocin is crucial for healthy pair bonding between prairie voles. When they gave the prairie voles amphetamine, the prairie voles failed to bond. Amphetamine had disrupted the oxytocin and dopamine pathways in their brains, responsible for partner formation. The researchers concluded that oxytocin and dopamine systems are important both for addictions treatment and for social bonding, probably for humans too.

Now scientists are investigating the use of oxytocin as a treatment for addiction. So far studies have documented that oxytocin alleviates withdrawal symptoms and craving (Mitchell et al., 2016; Baracz and Cornish, 2016; Peters et al., 2016Sarnyai and Kovács, 2014Stauffer and Woolley, 2014; Bowen et al., 2014; Carson et al., 2013). Preliminary evidence suggests that oxytocin may be effective for methamphetamine, alcohol, and opioid addictions. Scientist Jennifer Mitchell is beginning a clinical trial with volunteers to test whether oxytocin may be safely and effectively used to relieve the stress response, with the ultimate goal of treating active-duty military personnel for PTSD and alcohol use disorders.

The addiction-love connection is promising as a direction for neurobiological research, beyond oxytocin alone. We stand to improve our understanding of both addiction and love, and how even in healthy brains, love provides the most important incentive for human behavioral learning.

We don’t know whether oxytocin will continue to hold up as an effective pharmacological intervention for addiction. We don’t know either whether addicted individuals need supplemental oxytocin to gain satisfaction from social connection in recovery. We don’t know for sure whether people in recovery can get the same benefit from spending more time around others they care about. We don’t know how much social interaction any person needs, really, and it probably varies from person to person.

We do know that everyone needs some social connection to develop properly, and to be stable later in life. Studies examining the efficacy of support groups emphasize that belonging to a stable group, committed to recovery, improves a person’s chances of staying in recovery from addiction. Social support, especially high-quality support from close friends or family members, is generally important for mental health and for coping with chronic stressors and stressful life-events. Yet, as helpful as it is, social support is not sufficient to prevent severe mental disorders, or to reduce their effects once they have developed. Social support is not a replacement for treatment.

Still, while we continue learning more, the safest bet is to recover together, not alone.

This post was last updated 5/4/17.

Trauma and Addiction: Common Origins and Integrated Treatment

addiction-trauma connection

As much as anything can be known, we know there is a strong connection between trauma and addiction. Of a sample of over 10,000 men and women, 34% of those with PTSD had one or more substance use disorders (SUDs). About two-thirds of people with substance use disorders have experienced trauma in their pasts, and about half meet the criteria for PTSD.

Scientists have investigated the trauma-addiction connection and, while causality cannot be proven, current evidence indicates that trauma causes addiction rather than the reverse. Maia Szalavitz, in her book Unbroken Brain, reports that, “Even just one extreme adversity – like losing a parent or witnessing domestic violence – before age 15 doubles the odds of substance use disorders, according to a study of the entire Swedish population” (Unbroken Brain, 65). Consistent with the self-medication hypothesis, the theory that people use substances to cope with psychological distress, PTSD tends to precede and predict SUD.

Furthermore, scientists have discovered common biological mechanisms for the development and persistence of both PTSD and SUD. For example, both disorders involve dysfunction with the same neurotransmitters (though researchers don’t yet understand how they are specifically involved in the development of comorbid PTSD and SUD).

“Dopamine, norepinephrine, and serotonin have been independently implicated in mechanisms associated with PTSD and A/SUD such as reward, impulsivity, arousal, and anxiety.” – Norman et al., 2012

Norman et al. also reports that the neuroendocrine system, responsible for processing stress, is affected by both PTSD and SUD. Corticotropin-releasing hormone (CRH) is secreted under stressful conditions, and is found in higher concentrations in patients with PTSD. It is associated with higher drug intake in rat studies, as well as stronger cravings in human studies. CRH  is also known to worsen withdrawal symptoms.

“In other words, individuals with PTSD may experience elevated CRH in the brain which may increase the euphoric feelings caused by many drugs and/or worsen withdrawal symptoms. Additionally, CRH elevations seen during withdrawal may increase hyperarousal symptoms, which in turn may increase other PTSD symptoms triggering relapse (i.e., self-medication).” – Norman et al., 2012

Given the strong statistical and biological connection between PTSD and SUD, it makes good sense to study treatments that address both disorders at once. Meta-studies examining treatment efficacy for comorbid SUD and PTSD have documented that trauma-focused treatments reduce symptoms for both disorders more effectively than SUD treatments alone (Norman et al., 2012Berenz and Coffey, 2013). Pioneering researchers, including Jennifer Mitchell, are exploring the possibility that oxytocin, the hormone that allows people and other mammals to form social bonds, may lessen the stress response and treat both PTSD and addiction.

Pharmaceutical and behavioral therapy treatments for PTSD abound, but certain treatments have more scientific support.

are all effective therapy treatments for PTSD, supported by randomized controlled trials and meta-studies of the PTSD treatment literature (Haagen et al., 2015; Gerger et al., 2014Ehring et al., 2014Watts et al., 2013). A meta-study of pharmacological interventions for PTSD found that serotonin selective reuptake inhibitors (SSRIs) are most effective for treating symptoms of PTSD, such as depression.

PTSD and SUD therapists alike have been suspicious of exposure-based treatments for years. For example, well-known trauma therapist Babette Rothschild shares case studies of patients she has treated who were retraumatized by exposure therapy. Rothschild also writes in her book, Trauma Essentials: The Go-To Guide, that there have been both documented and unofficial reports of high dropout rates from prolonged exposure treatments, citing Kubetin, 2003. This article by Kubetin, published in Clinical Psychiatry News magazine, quotes Dr. Richard Bryant reporting that 20% of patients (sample size of 40) find prolonged exposure therapy too intense to continue and another 20% do not respond to the therapy within 6 months.

However, the position that exposure-based therapies are retraumatizing is not supported by the literature. A meta-study examining the potential contraindications of PE found that while PE is not advised for patients who are actively suicidal, the treatment is safe for patients with other comorbidities, including substance use disorders. Another meta-analysis, examining dropout from trauma treatments, found no difference in dropout rates due to the degree of clinical attention placed on the traumatic event.

Prolonged Exposure Therapy has been shown to be effective in treating PTSD with many different origins, as well as comorbid PTSD and SUD (McCauley et al., 2012; van Minnen et al., 2012). Randomized controlled trials of PE for comorbid PTSD and SUD have demonstrated greater benefits for patients receiving PE than those receiving cognitive behavioral therapy or usual treatment for SUDs (Sannibale et al., 2013; Mills et al., 2012).

Still, just as a single case cannot be stretched to apply to all cases, statistics do not invalidate an individual’s experience. If a patient is experiencing worse symptoms after beginning exposure therapy, the treatment should be stopped. People may feel worse at first in exposure therapy, and often in other psychological therapies too, as they address the problems they have been having. But if they continue to feel distressed after a period of time decided upon by both patient and provider, other treatments need to be explored.

The significant relationship between trauma and addiction, and the success researchers have seen in integrating trauma and addiction treatments is well-established. Evidence-based trauma treatments, such as PE, EMDR, and CPT, should be a first-line approach for the 50+% of SUD patients with comorbid PTSD.

In fact, if trauma is a causal factor in the development of addiction, trauma treatment may be one of the most important preventative measures to invest in to reduce addiction rates across the country.

Image by No Lotus Design, used with permission.

This post was last updated 5/4/17.

How Ithaca, NY Is Addressing America’s Opioid Epidemic

The mayor of Ithaca, NY has not seen his father since he was 6 years old due to his father’s struggle with a crack addiction. As mayor of an educated and forward-thinking town, he acted decisively to address addiction head-on, as a whole community. He assembled the Municipal Drug Policy Committee and told them to come up with the most ideal solutions they could based on latest evidence.

“Don’t think about money, don’t think about politics, don’t think about anything except for solutions … Whether you like an idea or not, that doesn’t really matter. Figure out what it is you can support and be part of it. If you don’t support a part of it, don’t fight it. What if it saves a life?” Travis Brooks, of the Greater Ithaca Activities Center, reported about his experience on the committee.

The Ithaca PlanThe report the Municipal Drug Policy Committee came up with is 64 pages long and titled “The Ithaca Plan: A Public Health and Safety Approach to Drugs and Drug Policy.” In an interview with the Ithaca Journal, Mayor Myrick describes the plan as having four pillars: prevention, treatment, law enforcement, and harm reduction.

Prevention in The Ithaca Plan is not limited to efforts people have made in the past to scare kids away from drugs, such as D.A.R.E. or “Just Say No.” Myrick explains that these programs have not been effective because they do not address the underlying problems that put people at risk for addiction, such as poverty and mental illness.

“So instead of just telling kids “Don’t do drugs,” if we could make sure that they were more engaged, maybe we wouldn’t even have to tell them not to use drugs. They wouldn’t want to in the first place. The same thing with drug dealing, because often the people engaged in drug dealing are doing it because they’re locked out of the mainstream economy.”
– Mayor Myrick, quoted in the Ithaca Journal

The Ithaca Plan stresses that treatment for opioid addiction must include medications and a detox facility in town. Presently the nearest facility is in Syracuse, NY, an hour and a half drive away.

Law enforcement is included in the plan not to put more people behind bars, but rather to engage officers in helping direct people into treatment instead. The Ithaca Plan models their law enforcement approach after the LEAD program in Seattle, WA.

The Municipal Drug Policy Committee is already working on their fourth pillar, harm reduction, proposing that the first safe injection facility in the US be opened in Ithaca. Safe injection, while not providing drugs, gives people with opioid substance use disorders a place off the streets to shoot their drugs in safety, with clean needles (a harm reduction measure known to reduce disease transmission) and a staff of nurses at hand. Safe injection facilities would give people a place to enter treatment when they are ready with a full set of options on hand, as well as a place to have other maladies addressed.

“They will have just had their fix, so that won’t be their first priority, and they might say to the doctor there, ‘Actually my tooth has been hurting and I have a puncture wound that has gone bad,’” Mr. Myrick said. “You can begin to treat the other physical things and get them prepared for their moment of clarity.’’
Ithaca’s Anti-Heroin Plan: Open a Site to Shoot Heroin, The New York Times, 6/22/16

Mayor Myrick expects that many parts of The Ithaca Plan will require jumping legal and financial hurdles. The full Plan is anticipated to take years to enact.

“I think we need a comprehensive plan because I think every community does. I think the federal government needs a different plan, but they’re not doing it, and the state’s not doing it. So we sort of had to do it ourselves. And we did it ourselves not because we’re the heroin capital of America — our problem is no worse than anywhere else — but we do lose people just like you’re seeing everywhere across the country.”
– Mayor Myrick on why Ithaca needs such a comprehensive plan

Those hoping to follow Ithaca will note that the process was gradual, gentle, and non-exclusive. Before the Municipal Drug Policy Committee wrote The Ithaca Plan, Ithaca’s mayor introduced the issue to the public, expressing the community’s great need for action and explaining why he had formed the Committee seven months prior. The Ithaca Plan’s unveiling was a public event, complete with an invitation to Ithaca citizens to attend. Mayor Myrick and the Municipal Drug Policy Committee acted in a way that speaks to their faith in Ithaca’s willingness to learn and to keep open minds to new solutions, no matter how controversial.

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In her presentation “What’s a Town to Do About Addiction?” in Blacksburg, Virginia on August 3, 2016, author Maia Szalavitz referred to community initiatives to address addiction in Ithaca, New York.  This post is follow up on her suggestions.

A video and transcript of Maia Szalavitz’s presentation is here.

What’s a Town to Do About Addiction? Let’s Continue the Conversation

Let’s continue the conversation about what a community can do about addiction started by Maia Szalavitz ‘s visit to Blacksburg, Virginia!

Continuing the Conversation:
What’s a Town to Do About Addiction?
A Community Discussion

Wednesday, August 31, 2016
7:00 PM
Blacksburg Library
200 Miller Street
Blacksburg, Virginia

The event is free and open to the public.

Blacksburg conversation on addictions begins!

If you’ll sign up on the Facebook event page we’ll know how many chairs to set up!

If you’d like to prepare for the conversation, feel free to try any or all of these:

For more information, please contact Anne Giles, [email protected], 540-808-6334.

. . . . .

Handshake Media, Incorporated was honored to present “What’s a Town to Do About Addiction? A Conversation with Maia Szalavitz, Author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction” on Wednesday, August 3, 2016, at New River Valley Community Services in Blacksburg, Virginia.

Anne Giles made the introduction, Mike Wade of New River Valley Community Services filmed the presentation, and Shawn You and Daeshaun McClintock of Mor11 Media photographed the event. Laurel Sindewald transcribed the presentation, with almost 9000 total words spoken in about one hour.

In her presentation, Maia Szalavitz mentions initiatives in Ithaca, NY. We’ve compiled a report here.

Photos from the event are on Facebook here.

The invitation describing the August 3 event is here.

For more information about local efforts to organize an effective response to local addictions challenges, please contact Anne Giles, [email protected], 540-808-6334.

A page with the above information, the video, plus a transcript of the presentation, is here.

What I Would Do to Help a Loved One with an Addiction in the New River Valley

I live in Blacksburg, Virginia. Blacksburg is located within Montgomery County, and within a larger area generally termed the New River Valley (NRV) in Southwest Virginia. Blacksburg, Virginia, according to the U.S. Census Bureau, has over 46% of its population living in poverty. More than 16,000 people in my locale have problems with alcohol and other drugs. In terms of receiving or allocating funding for health care, Virginia is ranked poorly with other states. This means we have scarce health care resources and high demand for them.

Scarcity requires scrambling.

Disclosure and disclaimer: I am a counselor at New River Valley Community Services. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employer.  This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Reaching out to help someone with addictionIn this post, I elaborate upon What You Can Do to Help Fight Addiction with specific details on what to do for a loved one with addiction in our area.

This list is based on my experience in getting help for myself and others. Some readers may find themselves outraged by the workarounds needed to get addictions care. I have no time for outrage or debate. I may not want to be a do-it-yourself addictions treatment care coordinator, or may feel unqualified or ill-prepared to do so, but addiction is a critical illness and right-here, right-now, I need to get my loved one care.

“Love, evidence & respect.”
Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

How to Help a Loved One with Addiction in the NRV

If I discovered my loved one had an addiction and I wanted to get him or her addictions treatment in my locale, this is what I would do to address immediate needs.

[A .pdf version of this guide – last updated 9/19/16 – is available here.]

0) SAFETY FIRST. Unfortunately, much addictions treatment in our area begins with a medical or legal emergency resulting from untreated addiction progressing to an acute stage. If my loved one, or I, or anyone present is in danger or is behaving dangerously, that must be addressed first. I may need to remove myself and vulnerable people immediately – even if I long to stay and help my loved one or fear his or her anger, even retribution – then call 911.

Important: The rest of this list is based on getting help for a loved in an urgent situation, not an emergency situation. The loved one is able to converse, perhaps unwillingly, but perhaps willingly enough to co-create next steps.

1) Lead with my heart to support my loved one.

Hug my loved one. Say, “I am so very sorry you have developed this health condition. It’s too bad but you are not bad. I love you and I am here for you.”

Realize I need to become my loved one’s care manager and advocate. My loved one is ill. Few can take effective action when they don’t feel good.

2) Lead with my head and prepare to take strategic action.

Recognize my loved one needs full physical and psychiatric evaluations to determine the dimensions of his or her particular case. Addiction is often accompanied by mental illness, physical illness, emotional and physical pain, and trauma. Issues of temperament and personality may need assessment. All of these factors need to be considered and evaluated by medical professionals to determine what principles of effective addictions treatment need to be activated for my loved one.

Blood work needs to be done to test for the presence of function and dysfunction, both to diagnose illness and to assess suitability for medications. Ideally, these assessments would be done by one specialist or a team of specialists, but I may need to cobble this together from multiple sources. From all this data, the first version of an individualized treatment plan can be devised.

Realize I need to get my loved one “in the system” ASAP. Wait lists exist for all services.

Realize that understanding addiction is a health condition needing health care – rather than believing it is a moral problem needing punishment – is new. I will need to listen carefully to what care providers advise. In 99% of my contact with local health care providers, I have experienced them as caring, determined, and resourceful. But if I hear disrespectful, shaming statements, or presentation of beliefs rather than science about addiction, I can’t walk away because I’ll just be put on another wait list. I’ll need to work with this care provider and his or her views in order to receive the piece of data this provider can offer. I must do what I can to protect my vulnerable loved one, but I may, at times, feel challenged to manage my own emotions.

Prepare to document. I’ll need to get copies of all previous medical reports for as many years back as I can find them, keep them organized in reverse chronological order in a binder, and take that binder to all appointments. I’ll need a list of all current and past medications. Our multiple health care providers have electronic health record software programs that don’t “talk” to each other so care providers may not be able to “see” data from other providers. Data from previous years may still be in paper file folders rather than available electronically. I’ll only have a few minutes with each care provider so I need to have a one-page summary at the front of the binder, then the medications list, so the care provider can be oriented to my loved one’s case quickly. I’ll need to update the summary after each appointment.

Consider the ER. If my loved one is in a state of emergency, I will call 911. If my loved one is not in a state of emergency, I need to know that it is through the emergency room that many people with addiction make first contact with our local health care system. ERs help stabilize patients briefly, but are limited in the length of care they can provide, sometimes under 24 hours. Local hospitals do not provide addiction treatment, medication-assisted treatment, or prescriptions for detox or pain meds. If my loved one is released without immediate follow-up care, relapse is probable.

Depending upon the system in which the ER operates,  referrals will be made to additional treatment through these emergency evaluation services. Referrals from those services are to local treatment providers. Many referrals are for treatment at in-patient facilities, few of which have beds available immediately, most of which require health insurance or a needs-based assessment prior to admission. If my loved one is considered a threat to himself or herself or others, a stay at a mental hospital is required. An ER visit may result in a range of outcomes, including release of my loved one into my care, to a stay at a mental hospital, possibly in another part of Virginia. When I/we leave, I will be sure to get a printout of lab reports and treatment notes, or return the next day for copies of them to add to my documentation binder. Again, in an emergency, I would call 911.

Consider urgent care. I have taken several people with health insurance coverage with illnesses or injuries that have resulted from addiction – not for addiction itself – to Velocity Care urgent care centers and have been impressed with how quickly the person is seen and how much attention each person is given by the care provider. Velocity Care also hands me a printout for my binder without asking. If my loved one is in a state of physical or mental emergency, however, they will refer us to the ER and it is a wasted trip.

Ask my loved one, “What help do you think you need first?” Although I’m nearly insane with worry and I see my loved one is in dire condition – but I have determined I do not need to call 911 for an ambulance and my loved one is not a child for whom it is my responsibility to make decisions – if my loved one’s answer to the question, is “I don’t want or need help,” then that is where the conversation must begin in hopes of mutually-deriving a plan of action.

In my experience, my view of what is the most important next step has never been what my loved ones have thought was important. I wanted to hurry them into shoes so I could get them into my car and race them to the ER faster than an ambulance could get there. They wanted a glass of orange juice. I need to continue to remind myself that this is a person, however ill or impaired, with needs, wants, preferences, priorities, and values. In my experience, co-creating next steps has been the most difficult, frustrating, and anguish-engendering part of helping someone with addiction. When is the person too ill to make a decision? Should I step in or not? Am I respecting this person’s autonomy and right to decide next steps on a life’s path? This is a realm of terrifying uncertainty, sometimes requiring life-and-death judgment calls, all made in the context of respect for human dignity.

3) Make appointments.

Start trying to get an appointment with a psychiatrist now. Most psychiatrists require a referral from a primary care physician (PCP) so an appointment with a PCP needs to be made ASAP. The PCP will make the appointment and can get back to me. Hearing back from the PCP, plus the wait to see the psychiatrist, and can take 6 months or more. Whether or not my loved one has insurance, whether or not I have a clue how we’re going to pay for it, whether or not my loved one may be able to make the appointment, I’m going to make an appointment now knowing I’ll have 6 months to figure out the money.

If I or we can self-pay, I would make an appointment for my loved one to see a physician at TASL, the one and only medical practice specializing in addictions medicine in our locale. Clients pay directly for services and the provider does not bill insurance. Payment in person by cash is required to make the first appointment and cash or credit cards are accepted after that. TASL explains its services clearly and specifically via phone recording. Select option 3 for new patient information, 540-443-0114.

If I can’t find a way to self-pay, and my loved one has health insurance, acknowledging the need to wait half a year for a psychiatric care appointment, I would immediately make an appointment with a primary care physician (PCP), ideally with my loved one’s current PCP or, if he or she doesn’t have one, with mine. An appointment with a Nurse Practitioner (NP) can be more readily available for immediate care if the PCP is booked. I would be sure to still keep the appointment with the PCP. The NP’s assessment will become part of the data that the PCP considers.

If my loved one doesn’t have health insurance, I would assist my loved one in calling  ACCESS at New River Valley Community Services, 540-961-8400, between 8:30 AM and 5:00 PM, and asking for a GAP insurance assessment appointment. (Appointments must be made by the individual requesting an appointment. Assessments are not done on Mondays). If my loved one is assessed as having a severe mental illness (SMI) he or she may qualify for coverage through the Virginia Governor’s Access Plan (GAP). If I can bring documentation of my loved one having been diagnosed with SMI to the GAP assessment appointment, that can expedite the process. (Although the National Institute on Drug Abuse (NIDA) itself defines addiction as a brain disease, addiction/substance use disorder is not considered an SMI.)

If we can’t self-pay, my loved one doesn’t have health insurance, and doesn’t qualify for GAP insurance, I would call the Community Health Care Center of the New River Valley, make an appointment to see a physician, prepare the application forms, and start calling churches and asking for help with co-pays.

(Community members, please help me expand this section. How would a person get cash in the NRV to pay for non-covered medical expenses for addictions treatment?)

For each appointment, I would make a list of the top questions, in priority order, for which answers are sought. To get the most out of my limited time with a care provider, I need to focus primarily on information, secondarily on getting reassurance for my loved one. I will talk with my loved one beforehand, take notes, and co-create a brief list. If I can accompany my loved one, I can bring the list, listen carefully, and ask for assistance with any questions not addressed. If I can’t go, I can provide the list for my loved one to take. After each appointment, I will cross off answered questions and note additional ones for the next appointment.

Contribute to my loved one’s documentation. I would hand write or type a timeline of what I know about my loved one’s life with all of these components in order as they happened. I would include years and ages if I can: 1) first use of cigarettes, alcohol, marijuana, other substances; 2) substance use history – what did they use, when did they use it, how much did they use, and how long did they use it, prescribed or otherwise, any incidents that seemed like just teenager stuff or just overdoing it at the time? 3) onset of physical illnesses or occurrence of physical injuries; 4) traumas – deaths in the family, losses, neglect, abuse, witnessing or experiencing emotional, physical, or sexual violence; 5) incidents I remember in which the person seemed to have a very strong reaction or surprisingly little reaction to an event, 6) anything else I think might be helpful for care providers to know.

4) Get my loved one to appointments.

Cover transportation. My loved one may not have a license or a vehicle. Ideally, I would transport and accompany my loved to all appointments to listen and to help as needed. If I can’t take the person myself, I need to help them find a ride, or find them a ride myself, perhaps from a friend or neighbor. If I have a credit card and a late model smartphone that can handle the Uber app, I could arrange for and pay for transportation through my local Uber service.

Cover dependent care. My loved ones may be parents of small children, and/or may provide care for a partner, ill or elderly friends or family members, or have pets. I need to find a way to arrange for coverage to ease my loved ones’ stress and concern about beings in their care.

Cover medication costs. Physical and mental stability is the top priority for my loved one and meds will likely be needed to achieve that. If my loved one can’t pay or doesn’t have insurance, I need to think about finding a way to cover this necessary expense.

5) Follow-up on recommendations received during health care appointments.

If out-patient treatment is recommendedNew River Valley Community Services (NRVCS) is the public provider of behavioral health services and the primary provider of addictions treatment services in our locale. To be screened for services, I would assist my loved one in personally calling ACCESS at New River Valley Community Services, 540-961-8400, between 8:30 AM and 5:00 PM, and asking for a Rapid Access intake appointment.

If in-patient residential treatment, i.e. “rehab,” and/or “detox” is recommended for my loved one, I would read carefully Maia Szalavitz’s article on the rehab industry, then call providers in this area and listen carefully to what they have to say about their services. Residential treatment can be helpful to some. For others, life is distressingly disrupted. An extended absence can compromise jobs, finances, relationships with children and partners, and subject one to addictions-related stigma. Many with addictions have trauma-related issues and find that in-patient treatment can exacerbate trauma symptoms. Rehab can be enormously expensive and is increasingly under scrutiny for ineffective treatment outcomes and high relapse rates upon release. This is a decision that needs to be made thoughtfully.

If my loved one did attend residential treatment, during visits, I would do my best to co-create with my loved one a life-in-recovery schedule for us to follow that would begin at the moment of discharge. Because I can’t do my life and theirs, too, I, would create a Doodle schedule, then ask for help from my friends. At my loved one’s discharge, I would be there to transport my loved one into our best efforts to create a new life in recovery.

If individual counseling is recommended, I know of two counselors in our area who specialize in substance use disorders and both are not taking new clients. I would ask physicians and friends for referrals, screen that list for counselors who specialize in cognitive behavior therapy, the top evidence-based counseling method for addressing substance use disorders, and take the first available appointment with the first available counselor. (Few specialize in Dialectical Behavior Therapy (DBT) which is showing increasing promise as an evidence-based counseling protocol for addictions treatment.)

Understand that addiction, in early recovery, is a 24-7 condition that requires 24-7 care. Although I may assist my loved one, once stabilized, a person with addiction serves as his or her own primary care provider. I would point my loved one to these self-help suggestions:

Practice self-care. Although it’s last on the list and hard to practice in urgent moments, self-care is to what I have to continually return my attention. I need to be high-functioning to help anyone with anything. And this may well be one of the hardest fights of my life. I need food and rest. I may need counseling for myself and definitely need time with supportive friends. The self-care checklist for addictions recovery that I will suggest to my loved one can assist me with my self-care, too.

I need love, too.

. . . . .

If my loved one has an opioid addiction, I would:

Buy opioid overdose antidote Naloxone kits – available now without a prescription from the pharmacy at CVS on University City Boulevard in Blacksburg – for my loved one, myself, and others with whom my loved one has frequent contact in case of my loved one’s return to use. (See helpful discussion of Naloxone in NYT letters to the editor, 8/7/16.)

Study carefully and learn What Science Says to Do If Your Loved One Has an Opioid Addiction and the New England Journal of Medicine’s report on opioid addiction released 3/31/16.

Get my loved one assessed for medication-assisted treatment (MAT), the top evidence-based treatment for opioid use disorder. Unfortunately, my loved one has an immediate need for an MAT assessment and wait lists for assessments and treatment from local public providers and providers who take insurance are 6 months or more. (Here’s an explanation of why we have wait lists for opioid addiction treatment.) To bypass wait lists, I have to self-pay. The closest self-pay source of buprenorphine/Suboxone/Subutex to me in Blacksburg is TASL, 540-443-0114. Methadone is only available at highly regulated clinics in Salem and Roanoke.

. . . . .

I am so grateful to the many who have shared their lives and struggles with me so that I could write this post in hopes that we can help many more.

This post is a work in progress. If you have suggestions, pease leave them in the comments or email me at [email protected]

UPDATE: On my personal blog, I am writing a series of posts entitled DIY Addictions Recovery for people with addictions who are seeking help for themselves.

Last updated 10/11/16

If you or someone else is experiencing a substance use and/or mental health emergency, call 911 and/or ACCESS, 540-961-8400.

Disclosure and disclaimer: I am a counselor at New River Valley Community Services. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employer.  This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

What You Can Do to Help Fight Addiction

“Love, evidence & respect.”
Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

When I talk with people about the state of addictions treatment in the Blacksburg, Virginia area, I am increasingly asked, “What can I do to help?”

Here are my suggestions:

1) If addiction is a problem right this moment, take yourself or your loved one to a doctor.

Addiction is a health condition that needs health care. In the Blacksburg, Virginia area, most medical care for addiction is offered by primary care physicians and emergency room personnel. These health care professionals can provide individualized initial care, make recommendations for follow-up care based on that person’s individual needs, and make appointments and connections for follow-up care. (Starting with a psychiatrist might be optimal but wait lists for psychiatric care in our rural area are 6 months or more.)

If challenging experiences with substance use and health care professionals have happened in the past, take someone with you/go with someone who needs help. We’re all still learning.

We can do this

2) Inform yourself.

Addiction is complex and the consequences of insufficient or incorrect information may be dire. Take matters into your own hands and learn as much as you can about addiction and its treatment. To help with getting started, I have compiled a simple list of evidence-based treatment options, reworded much of that page’s content as a personal recovery checklist, and compiled a list of local recovery resources. I also personally and professionally recommend Maia Szalavitz’s work on the science of addiction.

But don’t take my word for it. Start Googling, start asking those who are knowledgeable about addiction, use your powers of discernment, and join the growing numbers of people seeing the difference between evidence-based treatment and belief-based practices.

3) Understand the difference between treatment and  support.

Treatment is direct, personal, expert care for an individual’s unique presentation of symptoms. Support is help from volunteer survivors in adjusting to having those symptoms. To use Maia Szalavitz’s metaphor, going to a cancer support group is not equivalent to going to an oncologist. To use a business metaphor, attending a business networking event is not a “treatment” for a cash flow problem; selling something to a customer is.

Attending support groups can be hugely helpful in providing comfort, reassurance, and practical suggestions for handling having a condition. Attending support groups may be a component of an individual’s comprehensive treatment plan. Some people may find support group attendance all they need to attain their recovery goals. But attending support groups is not availing oneself of treatment.

“Families and loved ones can improve the odds for people with addiction by helping motivate them to get treatment; seeking evidence-based care; keeping naloxone on hand; and treating addicted people with the empathy, support and respect they’d offer if they faced any other life-threatening medical problem.”
Maia Szalavitz

4) Familiarize yourself with 12-step recovery.

Addictions treatment is currently dominated by 12-step recovery, although a recent article from the American Medical Association Journal of Ethics states, “TS [12-step] programs of recovery are a respectable modality to recommend to those seeking help with addiction; however, the effect is not sizeable enough for clinicians to insist on TS for everyone seeking treatment for addiction.” In addition, treatment programs and drug courts receiving federal funding that include 12-step components in their programs or require 12-step meeting attendance of their clients may be violating First Amendment rights. Nonetheless, 12-step recovery will be a direct or indirect component of local addictions treatment.

To begin to orient yourself to 12-step recovery support groups, ask someone you know who attends meetings if you can attend with him or her. If you don’t know someone, go by yourself or with a small group to an open 12-step recovery meeting. Respect those seeking help for this serious condition, observe silence, and, as a humanitarian, citizen and consumer, listen and observe.

If you or or a loved one is considering 12-step meeting attendance, perhaps you can find a way to make 12-step meetings work for you. If the content isn’t a fit, see if you can think about attending meetings for social support. In 1996, Blacksburg was designated “Most Wired Town in America.” My dream for our next accolade? “Most Recovered Town in America.” For now, however, options for addictions recovery support are limited. A SMART Recovery meeting is held in Blacksburg and on the Virginia Tech campus when classes are in session.

Addiction is a bully, very difficult to fight alone. Addictions treatment can feel that way when it mandates 12-step practices. Like the sun and the moon, for now, 12-step recovery will exist in addictions treatment. Try to find ways, personally helpful to you, to work with its existence.

5) Become aware of your feelings, thoughts, beliefs and words about people with addictions.

One of the most heartbreaking features of addiction is that it often manifests in inexplicable words and actions that hurt others. So many people have been emotionally, physically and financially harmed, abused, neglected, or injured by an addicted parent, partner, sibling, family member, community member or complete stranger. It’s understandable to feel hurt and baffled, even to want to hurt back.

To begin trying to see addiction as a health condition rather than a personal problem, try starting small. Maybe try saying “person with addiction” rather than “addict.” Try saying “person with alcoholism” rather than “alcoholic.” Even this small change in thinking about addiction can help others who have it.

6) Hold sober events.

Designate some events in your home, work place, community, and organizations as substance-free. Hold a sober holiday meal, a 5:00 PM alcohol-free business networking event, a gourmet street festival without brews or corks. (It’s just not Thanksgiving without wine, you say? Believe me, I hear you.) Help the 1 in 10 Americans and the 16,000+ in our area with substance use challenges to have something pleasant to do that doesn’t include environmental cues, the “people, places and things” notorious for triggering a return to active use.

7) Support doctors being doctors.

Did you know that in order for physicians to offer the top treatment for opioid use disorder – to prescribe medication for what’s considered a national health crisis – physicians must receive special training and approval and, once they receive it, are limited to treating 30 patients in the first year and must apply to treat a cap of 100 patients in the second and subsequent years? Did you know that wait lists to receive medication-assisted treatment for what’s been termed an epidemic – the supply of which is plentiful and often covered by health insurance – can be months long? It’s madness. More madness is ahead: that 100-patient limit is going to be extended to, wow, 275. Inform yourself, then talk to every influential person you know and ask them to help us get readily available medical care to people who need it.

8) Help watch over people who have what I have.

Having a condition that causes personal suffering, causes suffering for those I love, may cause me to do something that harms my fellow citizens – for me, driving while drinking or burdening the health care system with trips to the ER after falls – that has no cure, for which effective treatments are essentially unknown, of which so few of those uncertain treatments are available in my town, that makes me one of those people, has put me into a place of misery beyond words.

Help. Please help.

Thanks to Rosemary Sullivan, Kelly Shushok, Harry Sontheimer, Lara Hayward, my father, Robert Giles, and thousands of others for the conversations that helped me write this post.

Image credit: iStock

What else would help? Feel free to comment or to contact me and let me know.

If you are a resident of the Blacksburg, Virginia area and you or someone else is experiencing a substance use and/or mental health emergency, call 911 and/or ACCESS, 540-961-8400.

The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Last updated 8/5/16.

A version of this post originally appeared here.

The Best of Maia Szalavitz

Maiz Szalavitz has written on the neuroscience of addiction for more than a quarter of a century, synthesizing and illuminating that work in her most recent book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction

Maia Szalavitz in Blacksburg, VA

Since publication of Unbroken Brain in April of this year, Maia has written more than 30 additional articles which have appeared in multiple news sources including The New York Times, The Washington Post, and the Guardian.  She has been interviewed numerous times, including by Terry Gross of NPR’s Fresh Air and by Johann Hari with VolteFace. I have attempted to curate Maia Salavitz’s prolific work since April, 2016 here. Maia released a series of pre-publication images via Twitter that we have curated and transcribed as 5 Addiction Myths Challenged by Maia Szalavitz in Unbroken Brain.

Maia Szalavitz will be speaking in Blacksburg, Virginia on August 3, 2016.

For those who haven’t yet read Unbroken Brain, but would like an orientation to Maia’s work, I offer these suggested highlights.

If you only have time to read one article:

If you only have time to listen to one podcast:

If opioid addiction is of interest:

If addictions treatment is of interest:

If addictions recovery advocacy is of interest:

If an interview with Maia is of interest:

And if you want to have what you thought you knew about addiction torched, try these:

. . . . .

Handshake Media, Incorporated is honored to present “What’s a Town to Do About Addiction? A Conversation with Maia Szalavitz, Author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction” at 7:00 PM EST on Wednesday, August 3, 2016, in Blacksburg, Virginia.

Thanks to its generous donation of meeting space, the event will be held in the New River Room at New River Valley Community Services, 700 University City Boulevard, Blacksburg, Virginia.

Directions to New River Valley Community Services (NRVCS) in Blacksburg, Virginia

The event is free and open to the public and will include time for Q & A with author Maia Szalavitz.

Can’t attend? NRVCS will be livestreaming the event on its Facebook page on Wednesday, August 3, 7:00 PM EST.

Read the full event details here. For more information about the evnt, please contact Anne Giles, 540-808-6334, [email protected]

What Happens at a SMART Recovery Meeting?

A SMART Recovery meeting offers people who want to stop doing something – but find themselves still doing it – an opportunity to meet together with others with similar challenges. The free meeting is chaired by a volunteer trained as either a host or as a facilitator.

A facilitator has completed a 30-hour training. A host has completed a self-paced, online training that takes 4-6 hours.

Circle of welcome at a SMART Recovery meeting

I am trained as a host, not as a facilitator. At the facilitated SMART Recovery meetings I have attended, the facilitator warmly and skillfully guides participants to deeper understanding using what’s termed SMART Recovery “tools.”

At a hosted discussion meeting – the type of SMART Recovery meeting available to the community in my hometown of Blacksburg, Virginia and for which I am trained – prior to the meeting, the host has chosen a SMART Recovery activity that the attendees might find helpful or meaningful. Given that people thrive when they feel safe, the host doesn’t divide his or her attention by participating but focuses on the needs of the group and its members. To foster safety and continutity, the meeting is held using a script and the meeting proceeds in this order: check-in, discussion, activity, discussion, check-out.

In the above description, I meticulously did not use any of these terms: support, group, support group, mutual aid, mutual aid group, addiction, recovery, illness, disease, disorder, science, evidence, or research. As, happily, discussions about addiction and recovery become more frequent and these terms are used variously in multiple contexts, without meticulous definitions, they’re pretty meaningless.

And none of those terms describes my primary experience of a SMART Recovery meeting: kindness.

Maybe it’s the hope-filled discussion topics: building and maintaining motivation, coping with urges, managing thoughts, feelings and behaviors, and living a balanced life.

Maybe it’s the guidelines for discussion read at the beginning of the meeting, including “We don’t give advice. SMART Recovery encourages participants to make their own choices,” and “We don’t debate issues about addiction and recovery. We are free to speak in the language we want to, and to view addiction and recovery however we want to.”

Maybe it’s the tools and the activities that primarily ask what’s working and what might work better, rather than pointing out how bad and wrong everything is – including the individual.

Maybe it’s the use of “I-statements” rather than boundary-violating “you-statements” or “we-statements.”

Maybe it’s the time and space to speak without being interrupted or corrected.

Whatever it is that results in prevailing kindness, I sense participants’ best wishes for themselves and for others. I sense an intentional effort to bring forth the best of their hearts and minds for the time we’re together.

In her letter to the New York Times, author Maia Szalavitz wrote, “Shame and stigma are the exact opposite of what fights addiction.” In response to my Twitter tweet asking her what does fight addiction, Maia Szalavitz replied, “Love, evidence & respect.”

At a SMART Recovery meeting, I give and receive love – as much as people who may not know each other or know each other well may offer – I work together with others in ways for which there is enough evidence to support it might be helpful, and I feel respected by, and I feel respect for, people who are willing to come together to talk. 

I chortle with joy thinking that, in our kind little well-intentioned circle, we’re “fighting” addiction.

  • A hosted SMART Recovery discussion meeting is held on Sundays, 4:00-5:00 PM,  at New River Valley Community Services, 700 University City Boulevard, in Blacksburg, Virginia. Directions
  • A facilitated SMART Recovery meeting for Virginia Tech students is held when classes are in session on Thursdays, 6:30 PM – 7:45 PM at Squires Student Center, Virginia Tech, Blacksburg, Virginia. For more information, please contact: [email protected] or call 540-231-2233.
  • Recovery resources in the Blacksburg and New River Valley areas
  • Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, will be speaking in Blacksburg, Virginia on August 3, 2016. Read more

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.