"On Healing" March 2005

Posted on Mon, Mar. 21, 2005
Substance abuse takes toll on abuser, families
By Dan Gottlieb

Dr. Dan: Can you address the effect of addiction or alcoholism on the addict's family?

So often we read about the reasons for substance abuse and possible cures, but little about the fallout on the family. Do we abandon addicts when they refuse treatment because we too cannot be pulled down by its horror? The survivors wrestle with guilt when we say, 'Don't call me, I can't take it anymore.' You want to keep the person you loved - before their addiction - in your life. But to witness the downward spiral, after a half dozen rehabs, often becomes overwhelming. Yet by discontinuing contact, we feel we're abandoning them, isolating them further.
- Anonymous

Dear Anonymous: Alcoholism and addiction are terribly complicated diseases. First, substance abuse is a biological disease with a genetic component. Brain chemistry is affected, and often substance abuse is a form of self-medicating for other brain disorders such as depression. There is a psychological component; alcoholics usually come with very low self-esteem and great shame. And there is a spiritual component. Often alcoholics have no faith in anything besides alcohol. Many say it is no coincidence that alcohol is also called "spirits."

So despite recent breakthroughs with medications, we still cannot get substance abusers to treatment unless they are willing. So here we are, watching someone we love spin out of control and maybe putting their lives in jeopardy.

All 12-step programs begin with Reinhold Niebuhr's Serenity prayer: "Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."

So, first you try to change what you can because no one could stand idly by as a loved one spins out of control. Typically, we start with pleading, which quickly deteriorates to confrontation. Then, we stay awake all night, trying to think of the right phrase that will unlock their mind and break the denial. Soon, we move on to finding the right doctor, clinic or detox program.

At the extremes, people have tried intervention in which a leader organizes friends and loved ones to confront the substance abuser in an effort to break down the denial. Sometimes it works. Sometimes.

And then what? Then it's time to revisit the Serenity prayer and realize you are dealing with something you cannot change.

By the time you are staying up all night, counting empty bottles, lying to relatives or hiding car keys, you also need help. That help could take the form of counseling or family therapy.

But whatever you do, I recommend you do Al-Anon as well. This 12-step program is for families of substance abusers and follows the same model as Alcoholics Anonymous.

Eventually you will come to realize that you cannot change the alcoholic. However, there is much that can be changed. Everyone who has loved or lived with a substance abuser has felt impotence and helplessness. Most have felt great fear and anger. And at the root of these emotions is grief. We long for the person we loved before they started this downward spiral. Rarely can we change their behavior, but we can change how we deal with it.

Acknowledging your powerlessness and giving up control is a good beginning. Often your spirituality comes into play. You must have faith that you can survive this regardless of whether the alcoholic stops drinking. The group will help you identify and care for these very difficult emotions. And, in time, you will help others through a crisis.

But, first things first. You cannot do anything for anyone until you reclaim your life. Do so with care and compassion. Love helps a great deal. Focus your attention on those you love and enjoy loving them. Then try to love yourself. You need it.

Posted on Tue, Mar. 08, 2005
Let’s share our goods for the good of others
By Dan Gottlieb

President Bush's vision of an "ownership society" sounds pretty good on paper. And there is some research suggesting that ownership, especially in poverty areas, helps foster a sense of well-being and security.

Ownership also has its downside. In his novel The Source, James Michener describes a fictional character named Ur whose family had lived in caves for millions of years. And for all of those years, the women planted while the men traveled, sometimes for months, to hunt.

Then Ur married a woman who came from a different tribe - one that built their own stone huts. After some discussion, she persuaded Ur that if they had their own hut, they would be free of the rules of the cave. Shortly after their new home was built, Ur could no longer go very far to hunt; he was fearful that his new home would be harmed.

Moral: The first evidence of ownership is also the first evidence of anxiety.

"It's your money, you should decide where to spend it" is this administration's mantra. Not so fast. True, some of the money I have put into my Social Security account over the years may come back to me when I retire, but there's a larger picture. With all the contributions all of us have made to Social Security, we have been building an account for the common good. It helps feed elderly people who can no longer work. It provides a bit of a safety net for families. It gives people in our society the chance to maintain a level of dignity that they wouldn't have if they were indigent.

And I like that. I don't want to live in a society where people can think only in terms of "my money and how I spend it." I want a place where we share some of our resources and pool some of our goods for the good of others.

I'm sure President Bush is trying to send me a message. I think he'd like me to help solve the Social Security dilemma by learning the ways of savvy investors. But I don't want to be a savvy investor. In the long run, investing in myself will not help me - or anyone else - feel the kind of security we long for. That comes from somewhere else.

What I am most concerned about in an ownership society is what happens to us as individuals. I know many people who have many possessions. And I sometimes wonder whether they own the possessions or the possessions own them.

Will an ownership society evolve into a self-absorbed society? Will I be willing to make my annual contribution to my favorite charity if I have more anxiety and less security about the fate of my investments?

We all want security. And this administration keeps reminding us how insecure we really are. At first blush, the idea of possessing more of our money sounds like something that will make us more secure. But consider the fact that ownership is really an illusion anyway. Ultimately, we own nothing. We cannot own land; it will be there long after we are gone. The objects we think we own will come and go. Certainly, we do not possess our children; they will grow and go as they will. We don't even possess our own bodies; they will go to ground, probably before we are ready. Of everything we think we own we are but temporary caretakers.

Once we understand that, and care for those things with honor and humility, we will understand that only when we open our doors and share what we have will we finally feel secure.

Posted on Mon, Mar. 07, 2005
We all have aggressive impulses; the trick is not to act upon them
By Dan Gottlieb

Last month I wrote about a recent confrontation between New Jersey acting Gov. Codey and radio shock jock Craig Carton.

Carton had demeaned the governor's wife and her history of mental illness. Codey responded that under different circumstances, he would like to take Carton "outside." The column addressed the stigma of mental illness. And at the end, I told the governor that if he wanted to take Carton outside, I would hold his coat and take him out to dinner when it was done.

The column prompted many responses, mostly positive. But some, like Kelly, a mental-health professional from Delaware, were pretty upset about my condoning violence.

"I sometimes wonder if mental-health professionals should hold ourselves to a 'higher standard' when it comes to violence-related issues," Kelly wrote. "In truth, I was rather appalled - though, at the same time, very sympathetic - that acting Gov. Codey made such a public statement that was clearly promoting violence. Your comment about holding his coat made me react similarly."

Well, Kelly, maybe it's the testosterone, but I didn't feel appalled. If someone hurts someone I love, I want to hurt them back. Last year, my adult daughter's surgeon botched a procedure and then blamed her. When he left her hospital room, she was crying because of what he said.

When I heard this, I wanted to perform surgery on him! I wasn't thinking about being a role model or trying to understand the difficulties of practicing surgery in today's medical climate. I just wanted to hurt him.

And yes, I do hold myself up to a higher standard, not as a mental-health professional, but as a human being. Every day I try to be more compassionate and less judgmental than I was yesterday. But that also means being less judgmental of myself.

We all have aggressive impulses. I'm sure you have wanted to give an obscene gesture to the person who cut you off on the road, or slap the person ahead of you in the express line who had 20 items. Or worse.

We have been trying to manage these impulses for thousands of years. We have created laws, social norms and even religions, some would say, to protect us from, well, ourselves. Then we invented weapons and created armies to protect us from violent impulses in other people.

So we haven't done a very good job dealing with the emotions that fuel our aggression. We are quick to judge aggression and condemn violence, yet the most popular movies and television shows tend to be the most violent.

If we could just feel the aggression and not try to suppress it or act on it, we could build up some tolerance for these feelings. We would realize that pain inevitably lies behind these impulses. Underneath my anger, I hurt terribly for my daughter and felt powerless to help her. I would imagine Gov. Codey had similar feelings about what happened to his wife.

The Codey experience brings to mind a story about a samurai swordsman who went to visit a Zen master, wondering whether there was truly a heaven and hell. The Zen master responded: "How could they let anyone so stupid become a samurai swordsman?" To which the samurai took out his sword, held it over the Zen master's head and raged "I will kill you for that!" The Zen master replied, "Right now, you are in hell."

The swordsman thought for a minute, put his sword away and dropped to his knees, asking for forgiveness. "And that is heaven," the Zen master replied.

As humans, we all visit heaven and hell. Quite often.

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