The Highway To Hope
The Highway To Hope
Written by and
for people with Lived Experience - Port Alberni Community Action Team -
Families Helping Families
Today's Learning Moment – 02 27 22 Issue: The Highway To Hope.
I recently read a pretty good article regarding pain and substance dependence.
The argument was that we try everything we can throughout our lives to manage
or eliminate pain. The commentary states that we first "choose" to
use drugs to eliminate either physical or emotional pain. Then we rationalize
that using drugs is managing our pain when it really isn't. That results in
denial. The author quotes Dr Gabor Mate when referring to trauma and pain being
the underpinnings of addiction. While I see plenty of validity in this, I also
have another perspective on choice and denial. First and foremost, I see the concepts
of choice and denial as counterproductive and building blocks of shame when
referring to substance use disorder. It is judgment.
Most of us (choose) to use substances for pleasure and entertainment. However,
we do not choose to become dependent. Instead, we adapt based on the effects of
the substances on our coping mechanisms, particularly our neural psychological
mechanisms.
I contend that using substances to cope with pain, much like using any other medication or any other activity, manages that pain. It is how we learn throughout our lives. It is how we adapt to adverse events, people, places and things. In addition, it develops not through personal shortcomings or even choice but through neural development and the symbiotic relationships we have with our environments.
Consistent with Gabor's message, there are activities in the nervous system that adapt to coping. Mainly the functioning of dopamine and the creation and maintenance of neural pathways that are now understood to be the highways of addiction, if you will. Our brain is full of these highways formed through our learning and experience. The pathways used the most are maintained the best. The ones that aren't used get little maintenance. Not gone, but hardly used, if at all. Neuroplasticity refers to building new highways to develop other options, which allows us to adapt. This is what occurs when we adapt to coping with substance use to manage pain and other such triggers.
So what happens when the car we are driving becomes damaged? We must first recognize and accept that the car may be damaged. We may then learn that we want and need to fix the car. Then it is quite difficult to get to the off-ramp without knowing, recognizing or missing the signs. We need to embrace the need to get to the off-ramp, which takes information and challenge in an inviting and non-judgmental way.
Second, it isn't easy to choose the off-ramp if it doesn't look like it's going anywhere. That makes it seem unsafe.
As someone with lived experience and as a clinical counsellor for over 30 years, I find that being mindful of and radically accepting that first, these highways exist in me, and that new highway can be built through neuroplasticity. This is a much less judgmental and more empowering way of observing and learning to practice new coping skills.
The author insisted that abstinence must be achieved before learning new skills can begin. However, through my own experience with substances and in counselling countless others, I have found that learning or building this highway can be done even while using substances. People can learn new skills, and when and if they are ready, have the reasons, the motivation and can see the off-ramp to a new way, they can begin to change lanes as it were.
It is important to remember that one shouldn't open old wounds if one does not have the right tools or medicine to help heal those wounds. This is where treatment in itself needs to reconsider some of its approaches and that some old concepts of addiction need to remain in the past.
Thus, I reframe the concept of denial into possibility and hope as a way to readiness and capacity.
I can't stress enough the importance of how language is used both internally
and externally when trying to find the road to healing. Remember that
judgmental language is not really used with any other illness or mental illness.
Why do we use judgment with this disorder?
If I feel judged, then I feel hopeless, discouraged and unworthy to even look at the off-ramp. I will avoid and actively resist. This is what is mistaken for denial in my experience and opinion. If I am accepted for who I am in the moment without our social mythologies of addiction used as ammunition to shame me into some sort of abstinence, then I feel safer and even invited to accept my highways (not shortcomings) and my abilities to build new ones.
Counter his using the concepts of denial and choice; the author argues that shame fuels pain. In this, I am in total agreement.
Don't get me wrong, though. Many people find their way to abstinence using very
tough approaches. Shame and guilt are actually adaptive tools for changing
behaviours. Many of those folks do remain abstinent. Many remain bitter. Some
don't. Many may relapse as with any approach. That is the way of substance
illness. Those who let go of the language of judgment may have a more
satisfying experience.
And I recognize that everyone gets there in different ways. I just prefer less
judgmental language and concepts. It works well for me and for many of the
people I have had the privilege of helping in my career. It was much harder for me to drive up a hill
of shame than it was to drive the highway of hope.
If we change the way we say things, we change how we see things. If we change
the way we see things, we change how we say things.
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Author: Ben Goerner – Ben is a retired counsellor and advocates for people with
substance and mental illness
Families Helping Families is an initiative of the Port Alberni Community Action
Team. We regularly send out "Learning Moment" articles to help folks
understand substance illness. Knowledge is vital in understanding the disorder
of our family members. You may copy, distribute or share our articles as long
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Resources:
Miller, W. R., & Rollnick, S.
(1991). Motivational interviewing: Preparing people to change addictive
behavior. The Guilford Press.
Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy: Theory, Research, Practice, Training, 38(4), 443–448. https://doi.org/10.1037/0033-3204.38.4.443
Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) [Table], Figure 2-2: Appropriate Motivational Strategies for Each Stage of Change. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64963/table/A62587/
Mate Gabor MD., 2008 "In The Realm of Hungry Ghosts: Close Encounters with Addiction" Vintage Canada
Hari Johann 2015 "Chasing the Scream: The First and Last Days Of The War On Drugs" Bloomsbury New York.
Alexander, Bruce K 2008 "The Globalization Of Addiction: A Study In Poverty Of The Spirit" Oxford University Press New York.
Lewis Marc,
2015 "The Biology Of Desire: Why Addiction is Not a Disease", Public
Affairs New York.
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