Injecting Some Mindfulness into the Mindlessness of American Recovery Culture
Filling the Void Left by the Failure of Treatment Models Prioritizing Abstinence in Place of Harm Reduction
Addiction Treatment, Desire and Attachment
Wild Geese
by Mary Oliver
You do not have to be good.
You do not have to walk on your knees
For a hundred miles through the desert, repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about your despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting --
over and over announcing your place
in the family of things.
The Recovery Movement’s Selfish Ego
As practiced in America, modern addiction treatment attempts at best to teach and at worst to reprogram drug users. Addiction treatment in the US relies primarily on an abstinence based cognitive behavioral approach to managing addiction. It represents a narrow minded, one size fits all approach to treating behavioral issues related to drug use. Given the privatized and non-professional character of the treatment industry in America, significant client populations are placed in highly inappropriate levels of care. Exposing drug users to inappropriate treatment models causes drug users serious harms making recovery more difficult.
Despite its limitations and flaws, the “abstinence only” model maintains the status qua when it comes to American addiction treatment. Apparently we are too afraid to think outside the box imposed by our prudish Puritanical roots. Those in the recovery industry are complacent with the status qua because it worked for them and they assume it will thus work for everyone else challenged by their relationship to substance use.
Recovery zealots do not understand that their abstinence only approach to treatment does not work for the vast majority of substance user. They cling to their understanding of addiction because it has become a part of how they understand themselves, how they identify with their world, and are unwilling to try open their minds to the possibility that there might be something better when it comes to their understanding of addiction or the efficacy of their treatment model.
Normies and Addicts: A False Dichotomy
America is a nation of addicts. America is not a cesspool of junkie scum, but it is a nation of drug users. Who do you know who never drinks anything with caffeine or eats anything with sugar? These two drugs are the staple habit of America. What separates the intravenous drug user from your neighbor who enjoys a blueberry muffin with his coffee is merely a difference of degree.
When it comes to substance use, normal is only found on a spectrum, with deviance at one end and conformity the other. As one’s relationship to substances develop over time, one’s substance use will move from non-existent to either deviant or conformist. Within the realm of deviance and conformity there is also room for movement.
As with the bell curve, a narrow majority of people occupy a space of so-called normality, but as a location normality is only so definable. You might be able to place normality on a graph, but in life normal is dynamic not static. There is no fixed point or origin of normality. People are not definitively normal (conformity) or abnormal (deviant), they become. Like a dance, the actors are constantly moving, flexible, in flux.
The dynamics that go into substance use represents a form of experiential learning. This is good news because, as with any form of experiential learning, substantive change is possible. Experiential learning implies choice and relates the significance of decision making. Awareness of the causes and conditioning of our behaviors allows agency to develop from more reactive conditioning.
As with any set of behaviors, patterns will emerge when we engage in substance use. No one is born an addict in the literal sense. Just as one must learn how to use substances before meaningful self-medication is possible, addiction is learned. Addiction cannot be unlearned, but recovery can likewise be learned. By gaining an awareness of patterns of self-medication substance users gain insight. When these insights are put to good use and cultivated, patterns of behavior that cause harm invariably change for the better.
Insight into substance use creates a kind of forward momentum well into recovery. The catch is that the insight must be cultivated. The application of insight to decision making must be supported. Insight is cultivated simply by bringing awareness to present moment experience. It is nurtured by turning towards and leaning into one’s experience, not turning away from or avoiding it. Avoidance is antithetical to insight.
Avoidance: The Essence of Addiction and Hindrance to Recovery
Addiction is defined by craving and craving characterizes avoidance. Providing clients with the tools to regulate craving is the priority of the abstinence based treatment model. The most widely used modalities in addiction treatment emphasize the cultivation of avoidance based coping skills.
Even in medically assisted treatment programs like opioid replacement therapy, treatment models rooted in the philosophy of harm reduction, the goal and emphasis of treatment tends to fall on abstinence. When it comes to the classic treatment models in America, residential and outpatient treatment, the emphasis is solely on abstinence, despite the fact that other modalities and paradigms are often more appropriate for certain patient populations (such as opioid users) that are much more successful in their efficacy (such as medicine assisted treatment).
The poor efficacy of abstinence based treatment models can be traced back to their focus on substance user’s addiction instead of their relationship to substances. For treatment to facilitate recovery, the locus of control needs to be the addict’s process in recovery, not their process of addiction. Merely placing the addict in the limelight is not enough.
Little insight is gain in conditioning the addict to believe they are, first and foremost, an addict. The process by which the addict approaches and pursues must be the focus. It must respect and celebrate the multidimensional nature of the addict, empowering the addict with the understanding that they are more than merely the sum of their addiction.
When it comes to any process of recovery from addiction, the addict is the most important player. The struggle of the addict is characterized by challenges of unskillful desire, otherwise known as craving. The aim of any effective treatment model is training clients to regulate craving.
Successful treatment outcomes are defined by addicts developing the ability to self-regulate. Self-regulation is not the kind of conditioning used by the vast majority of treatment models. The more common abstinence based conditioning you see in treatment focuses on a kind of psychological tough love, on teaching the addict that they are, at their core, an addict.
Although things are shifting, there is still a nearly insurmountable stigma attached to lay understandings of addiction. Forcing addicts in early recovery to self-identify as addicts is like asking them to think of themselves as degenerate junkie scum. The tendency to cultivate self-hatred here should be obvious. Effectively educating addicts in early recovery as to the dynamics of addiction is therefore crucial.
Locating the problem of addiction in drug use itself is the mistake often made educating drug users on addiction. The harms associated with substance use should not be the sole focus of educating addicts. Its locus must be wider, on the nature of desire.
Craving affects the body’s neurobiology and serves to regulate the mood. Yet craving is nothing more than desire turned on its head. Craving also reinforces itself, a form of self-regulation. It is also entirely experiential. Drug users experience craving firsthand themselves, often many times each day. The intellectual experience of craving is not necessarily the same as one’s experience of it in the body. When it comes to the push and pull of powerful desires, craving can make things very confusing for the drug users. Craving can make very complex things seem simple. That is how it regulates one’s mood.
In addiction, the desire to use drugs or engage in certain behaviors to regulate one’s mood easily become conflated with the otherwise healthy desire to live, succeed and overcome life’s challanges. When the desire to thrive becomes associated with the desire to use, the sense of self is craving. Craving becomes wrapped up in the addict’s very identity.
Both drug users and non-drug users alike have definable relationships to substances, such as heroin and sugar, and behaviors, such as shopping and sex, that affect our neurobiology. In craving however, the drug user has a particularly challenging relationship to desire. Drug users have it hard enough out in every day society. Whether one is a regular drinker of alcohol, caffeine junkie, cigarette smoker, cannabis aficionado or opiophile, drug users are shamed because of their relationship with substances in traditional recovery culture. While the vast majority of drug use involves the use of drugs that are perfectly legal, those drawn to using illicit substances are demonized on all fronts. We are literally criminalized.
Just as the war on drugs scapegoats drug users, traditional treatment models scapegoat craving. Just as scapegoating drug users leads to demonizing drug users, vilifying craving leads to alienation for any self respecting drug user. Drug users don’t just wake up one day and decide to use drugs. There are good, logical, compelling reasons why using makes sense to the user. Anything that has a noticable affect on our neurobiology is useful in affecting our mood state. Drug users use drug because they feel discomfort and dissatisfaction, and substances can alleviate such dis-ease.
There is nothing special or unique about this kind of process. Non-drug users do it all the time, when they self regulate by themselves or co-regulate with others. Herein lays the essential difference between drug users and non-drug users. Non-drug users do not need to self medicate in order self regulate or co-regulate. Their caregivers provided them with positive role models of how to self-regulate. Non-drug users learned how to co-regulate from their care givers in healthy ways. Drug users simply were not provided with positive role models, caregivers who were capable of self regulating their mood state in healthy ways. Drug users were not able to learn from their care gives how to co-regulate their mood state in healthy ways.
Non-drug users learned early on that they could rely on their caregivers to regulate their mood state. They learned to trust others to help meet their emotional needs, because others did so consistently. There was no need for substances to fill when it came to regulating their mood for such people. Drug users use drugs developed their relationship with substances because drugs filled such a need. This need developed because drug users learned that their others were unable to consistently meet their emotional needs. Drugs on the other hand can always be relied upon to affect our neurobiology. Drugs can always be trusted to regulate one’s mood simply by using them! It is much easier for drug users to trust drugs to affect their mood state than other people.
Enforced Abstinence Reinforces an Unhealthy Relationship with Substances
However broadly understood it is in theory, abstinence is defined narrowly as avoidance within the our nation’s recovery industry. In traditional treatment models, craving is understood as the mechanism defining the addict’s relationship to drug user or compulsive behavior. Craving is managed according to such models through periods of enforced abstinence. There is nothing wrong with abstinence in and of itself. It is not inherently good or bad, right or wrong. A period of abstinence, at the very least, is often necessary in most cases to help stabilize patients.
Prioritizing abstinence over a more inclusive understanding of recovery is inherently problematic. Imagine the coercion, manipulation and brainwashing that it would take to restructure one’s life around forcing people to refrain from behaviors they have learned are in their self interest? This is exactly what happens when you take drug users, who have learned to trust in substance to regulate their mood state, and tell them they are no longer allowed to self medicate without consequences.
The harsh consequences externally imposed upon those who are not able to abstain from drug use in treatment settings and recovery culture, like getting ejected from treatments programs or to becoming ostracized from recovery communities, is extremely harmful. It leaves the drug user feeling even more isolated and alienated, reinforcing the earlier experiences of how they cannot reliably trust others to help them grow and heal. Ironically enough, enforced abstinence can easily end up reinforcing an unhealthy relationship with drug use, emphasizing that substances can always be relied upon to do what they do when other people cannot.
For many people who misuse substances, people who would undoubtably benefit from exposure to effective treatment, programs of enforced abstinence represent nothing less than the denial of individual agency. Using can be a very effective way to change one’s mood and manage uncomfortable mood states. Removing the possibility of using thus becomes tantamount to preventing the drug user from caring for themselves. It represents nothing less than suppression of self determination. To many actively self medicating users, this angst feels like nothing less than paternalistic control. Standing in the way of individual agency, enforced abstinence feels like one is being prevent from becoming the person one feels one truly is or would like to be.
To what lengths should you be force to go in hopes of restraining the desire to use or engage in comforting behaviors? What would it look like to structure your life around avoiding desire and temptation, around avoiding those experiences you up until recently found so pleasurable and desirable? Doesn't sounds like fun. It sounds like a lot of work, a lot of very distasteful effort if you ask me. Lets be honest, I love dugs. I love how they make me feel. Why else would I have organized my life around acquiring and using them during my days of active addiction? I love the excitement of procuring them and getting off on them. The thrill involved in having to hide that part of my life from the powers that be has itself consistently gotten me off. Considering that drug use has become such a significant part of my identity, to deny myself a relationship with drug use is to deny my own self. Ironically enough, exactly such a denial of the self is precisely what treatment modalities narrowly focused on abstinence tend to produce.
Modern treatment in the US emphasizes cultivating skills and tools focused on avoidance based coping strategies in addict client populations. Abstinence and personal values, as opposed to ethics and personal health, is the primary emphasis of treatment in my country. It understands a healthy lifestyle as one centered on avoiding drug use and related addictive or harmful behaviors. Paradigms of addiction prioritizing an abstinence only narrative tend to emphasize abstinence from drug use and questionable behavior above all other goals when it comes to understanding or addressing addiction. This stands in rather stark contrast more nuanced paradigms promoted by harm reduction communities, where the focus is on reducing harms associated with drug use and questionable behavior, as opposed to merely reducing the drug use and questionable behavior itself. An abstinence only paradigm, as currently practiced in the US, makes avoidance the primary focus and overarching priority of treatment, promoting a culture of being highly critical, shaming and judging any drug use or potentially addictive (read: pleasurable) behavior.
Narrowly prioritizing abstinence denies individuals new to recovery any chance of beginning to build the foundations of a meaningful life for themselves. This kind of tunnel vision also denies such persons a chance to learn how to create new, healthier relationships to their past trauma, drug use and any other addictive behaviors. Considering how significant one's history of trauma, drug use and the like is to one's present sense of self and identity when one enters recovery, a single minded focus on abstinence prevents the individual from developing a healthier relationship with themselves or cultivating the skills necessary to becoming the healthier, more successful person we all wish to become.
What about why I began using drugs? Putting the emphasis on abstinence and focusing on avoidance based coping strategies does not address all the mass of often jumbled underlying issues that made my addiction possible and shaped its development. I find that a narrow focus on abstinence, and thus a focus and need for avoiding drugs and drug using behavior, does not incorporate or explore any meaningful narrative on the nature of desire.
Putting the primary emphasis on abstinence and avoidance tends to lump all desire together as bad and shameful. It misrepresents desire as craving, even when it might be an otherwise healthy, constructive influence. A narrow emphasis on avoidance and abstinence makes moving forward in recovery both very confusing and very unpleasant.
Unlike CBT with a focus on abstinence, mindfulness trains you to recognize, allow, investigate and then move beyond your problems instead of training you to avoid or attempt to ignore your problems. Becoming more aware of our recovery entails we become mindful of our desires, passions, urges, impulses and cravings. It asks us to gentle investigate difficult emotions like restlessness, torpor, craving, fantasizing, and doubt. A mindfulness practice cultivates an ability to become aware of the present moment such that skillful action become possible.
Abstinence based approaches cultivate a judging mind when it comes to addictive behaviors and drug use, essentially training the mind to label and put certain things into categories of good and bad. Mindfulness removes this moralization, putting the emphasis on how to cultivate an awareness of the same behaviors, but specifically
without judging or criticizing them.
Addiction is best thought of as a kind of trap, one we often find ourselves stuck in as drug users with real life struggles. What is the best way to free one's self from a trap? First one must see the trap for what it is. One must understand the mechanics of the trap before one can formulate or implement a strategy to disassemble it. The first step in liberating one's self from the despair of addictioniction is in understanding its nature.
This understanding begins with a paradigm shift. It begins with removing any moralizing tendencies, in understanding that where we find ourselves today is not entirely our own doing. Many things outside ourselves have influenced where were are today, our parents, culture, society, friends, etc. That is not to say we are not responsible for our actions or our choices - actually that is to put the emphasis on the fact that
we are the only one responsible for making healthy choices in our lives. Of course, we need skillful teachers and guides to show us the way, but when push comes to shove it is up to us.
It was a truly amazing day when I realized that I had genuinely begun to look at my problems and failures in a new light. Instead of just reeling against discomfort and trying to cling on to pleasure, through a mindful awareness practice we teach our minds to meet them head on skillfully instead of reactively as the challenges and opportunities our pains and pleasures were all along.
The question invariably become then, how do we facilitate this paradigm shift, sea change of the mind? It all begins with grounding. This is the essence of any true mindfulness practice. In mindfulness you cultivate skills such as concentration and relaxation, to bring one into the here and now. In most of our days the focus is on planning what we are going to do next or reflecting on what we just accomplished (or were unable to accomplish).
Practicing mindfulness conditions us to reign our focus on what is going in the present. The goal of mindfulness is largely gaining insight into what is going on right now in our body, our unique and particular sensory and emotional experience of the moment. It might sounds like it is easy and truth be told, anyone can do it, but given our sentient nature it presents many challenges as a practice.
Normally we get lost in our intellectual experience, the thinking mind. Think of a wheeled cart atop a gentle hill. It takes a nudge to get it going, but once it starts moving down the hill momentum carries it along. Similarly, as the wheels of the cart turn round and round, once we engage in an interesting or stimulating thought the thinking mind gains a certain momentum. Anxiety, rumination, lust, obsession, the similarly strong emotional states can easily thus develop around our thought patterns.
A common misconception is that the goal of meditation is to turn off the mind or somehow get the mind to stop thinking. Let me tell you up front that this is not a reasonable expectation. It just isn't going to happen. In fact, the opposite is going to happen, especially at first. When you begin your mindfulness practice, one of the most striking things you may notice is just how much you think, just how intrusive and distracting your thoughts can be.
This is the meat and potatoes of a healthy mindfulness practice. It is an exercise in letting go of stressful and tantalizing feelings, desirable and undesirable sensations, anxiety provoking as well as pleasurable thoughts alike AND bringing the attention back to the experience of the present moment. Only in letting go of this present moment can one allow the movement of the present into our lives. We make room for what is to come by making space in our hearts and mind. And then doing it all over again.
This is the meaning of equanimity. Without being able to tolerate our present feeling state we will always be attempting to escape into some other less tangible but infinitely more tantalizing feeling state. And is not this what we are attempting to correct for and overcome when it comes to our drug use and self medication? Are not we attempting to escape the dis-ease of any discomfort we experience in our perception of the present moment when we self medicate?
I feel it is important here to distinguish between drug use and misuse. Please jettison the term "drug abuse," it is too morally charged to be helpful to any meaningful discussion of behavior or habit. What I will say here is that something isn't inherently good or bad, right or wrong, merely because it promotes pleasant or unpleasant feelings. Pleasure is not inherently good or bad, just as pain is neither good nor bad. Both pleasure and pain, comfort and discomfort are nothing more but signals, alerting us to something significant we'd be best off giving our attention to.
When you experience something as that feels really good, or makes you feel really uncomfortable, what you are really experiencing is what they call a "bell of mindfulness." Your experience it trying to wake you up, saying to you, "Hey! You. Pay attention to me. This is important!" Perhaps now you may understand the significance of awareness without judgement or criticism of your experience of the present moment, because it allows you to pay attention to these signals.
When we are judging and being overly critical, it is very difficult for us to hear the background noise, or see the fine details of our lives. Mindfulness practices train us to let go of judgement and self hate such that we may allow understanding and self compassion into our hearts and minds. Considering the stigma, the highly moralized charge attached to the concept of addiction in our culture, what could be more important and more necessary if we want to become something more than a degenerate, thieving junkbox?