The Shrink’s Links: Advance Psychiatric Directives

Bringing you the best of mental health every week.

You know what an advance directive is, right? Advance Directives are the legal documents that enable you to state your preferences regarding medical care beforehand and empower someone to make decisions on your behalf when you are unable to do so yourself. They’ll come in handy when you’re in a coma and don’t want to be hooked up to a machine for years. The psychiatric version of an advance directive can also come in handy if you are sometimes hospitalized for mental illness and want to be treated in a certain way.

Let’s just say there’s a hospital you prefer, a medication you can’t tolerate, a doctor who should be involved, or a procedure that should be avoided. You can document this on your psychiatric advance directive. Unless you say so, the hospital will not tell your loved ones where you are, involve them in your care, or even allow them to visit. You might be OK with experimental studies or drug trials, but no one would know it if you didn’t say so in advance. You might want to make provisions for your children or see to it your plants get watered or your cat fed. If you have someone in your life who just drives you nuts, you may not want them around when you’re in the hospital. An advance directive can see to it that they will not visit.

Anyone who has bipolar disorder, schizophrenia, or is prone to being suicidal should prepare an advance psychiatric directive sometime when they are feeling well. I know, you don’t ever want to go to the hospital again, but it’s worthwhile to be ready in case it happens again.

Click here to get the forms you need.

Some Things You May Not Know About Substance Abuse: What keeps you addicted

Chemistry

First there’s the chemical. That calm feeling you get from Percocet is just too good to give up. The sickness you feel when you are in withdrawal is just too bad to bear. Genes get rewritten when you use cocaine often enough, so that nothing but cocaine can make you happy. Your brain cells get pickled with enough alcohol. No wonder your thoughts get soft and mushy. When you use a chemical, you are bringing about a chemical change. Don’t be surprised when that chemical changes you.

Even when you’re not taking a chemical into your body, a chemical is keeping you hooked. Your body makes its own chemicals. The excitement when you gamble, shoplift, or take other insane chances, is adrenalin, pure and simple. They don’t call you an adrenalin junkie for nothing. When you fall in love for the zillionth time, that feeling of irrepressible optimism you get involves a chemical change. Phenethylamine (PEA) is being produced. They bottle a version of that stuff and sell it as an amphetamine, but you’re making your own.

Even the very cells of your body are addicted. Mute mitochondria are screaming for it. It all comes down to chemistry, which all comes down to physics, and you can’t buck chemistry and physics. You might just as well try to turn over the Periodic Table or overthrow the force of gravity. You can’t fight the laws of nature.

Oh, but you can. People do it all the time. All it takes is a few days to get past withdrawal and a few months to revise the genes that had been revised before. There are a few cases of permanent brain damage, persistent LSD flashbacks, a sopping wet brain, but they are rare.

Chemistry got you in this mess and chemistry can help get you out. There are pills for withdrawal, too. It’s possible to control doses and gradually titrate down your dependency. The chemical part of addiction is the least of your concerns.

Chemistry is part of addiction, but it is part of recovery, also. The changes that occur that we call healing are physiological changes, too. Restoration is real.

Habit
The second part of addiction is the habit. Do something long enough and it becomes automatic. Consciousness is a limited resource. The sooner the brain can move a procedure into the unconscious and not have to pay attention, the more efficient it is. If you don’t believe in the unconscious, try walking across the room while ordering each muscle to move right when it should. You can’t do it. You don’t know how to do it, yet, you do it all the time. It’s unconscious.

The woman who unthinkingly lights up a cigarette after each meal, when she gets in the car, or answers the phone is doing it unconsciously. The process of getting her pack of cigarettes, pulling one out, putting it in her mouth, and lighting it up has been repeated so many times it’s as automatic as walking. Not only the behavior, but also the decision to smoke is automatic. Even if she thinks about whether or not to smoke, her rationalizations are also automatic. She never really gets a chance to decide whether to have a cigarette because her body is doing it unconsciously without her.

Habits can seem immutable, but, like chemistry, they, too, can be changed. Simply by putting her pack of cigarettes or lighter in a different place, preferably not close to hand, the spell will be broken when she finds she has to look for them. Change brands of cigs so the package looks different, switch from a litter to matches, sit on the other side of the dining rom table. The more she can switch things up, the more barriers she can place between her and her cigarettes, the more likely she has to think about what she is doing. Then, once a habit is broken, a new, hopefully more healthy, habit is formed. One that goes on just as automatically as the previous one.

Emotion
The third part of addiction is the friendship you have with your drug. It’s more like a love affair. A bad love affair. A really, really bad love affair with a bad boyfriend who was good to you in the beginning, but turned abusive.

People keep on saying you should leave your drug, but they don’t understand. You’ve been through a lot together. It was there for you when no one else was. The mouth of that bottle kissed you when you were at your worst. You hugged it when you were all alone. The bottle understood what you were going through and you didn’t even have to say anything. It didn’t judge. It was there at your darkest times. It put you to bed at night and woke you up in the morning. It came when you met with friends. It joined you in every meal. It never forgot you on holidays. It toasted your every accomplishment. Even if there have been problems, you take the bad with the good. It’s not right to turn your back on a friend without offering forgiveness.

Giving up a drug is like ending an abusive relationship. Even if your feelings have changed, you still fear a bad break up. You know that things can get ugly after rejection. It’s sometimes better to settle, to pretend you’re happy, than it is to go it alone.

This factor, the love affair you have with your drug, I believe is one of the most difficult parts to overcome. You’ve got your emotions caught up in the addiction. Emotions can be very persuasive. Emotions tell us what is important and they’re telling you that your drug is very important. Don’t leave home without it.

What I can say to this? Well, other than the fact that your drug is a thing and not a human being, or even animate.

Friends come and friends go, even inanimate ones. Grief can be painful and there is no grief as painful as losing something you love; even if it’s a drug. But, realize this: in the course of your life you will let go of every single person and every single thing there is, including a drug. You can try to hang on for as long as you can, but eventually all things come to an end, one way or another. You can relinquish it now, on your terms, or some unknown terms that will be imposed later. You can let go in an intentional recovery, surrounded by supports and cheered by many, or you can wait until hospitals, prisons, or death separates you from your drug. If that sounds pretty grim; it is.

Idolatry
You’ve seen what are called idols: little wooden representations of gods, golden calves, Buddhas, as you walk into a Thai restaurant, Shivas as you walk into an Indian one. They probably seem pretty harmless to you. Keep on walking till you get to the bar. There, beyond your reach, cared for by an attendant, mounted on high, in front of bright mirrors and surrounded by lights, are, for some, the true idols: bottles of booze.

Those bottles of booze are not idols for everyone. They may be expensive and potent, but they are just a beverage, like water, soda, or milk. For an alcoholic, though, they are much more significant. If you’re an alcoholic, they’re a power greater than yourself. If you’re too shy to go to parties, the alcohol brings out your boldness. If you can’t get out of a funk without pouring a drink, then it’s the answer to your prayers. If you don’t know how to get through the day without it, then it’s the meaning of your life. If you’re willing to sacrifice everything: your job, your health, your relationships, your freedom; then it’s your god.

Don’t think you’re off the hook for being an idolater if alcohol is not your thing. If you feel the same way about the mall, chocolate, dope, work, sex, or getting on the treadmill, then those are your idols. Wherever your treasure is, there’s your heart.

You may have not intended on making your drug your God. You might think you’re an observant Jew, a submissive Muslim, a practicing Buddhist, an energized Evangelical, or a good Catholic, but if you turn to your drug before you turn to your God, then I know what Moses, Muhammad, Buddha, Paul, or the Pope would say about it. You’re kidding yourself if you think you’re on the straight and narrow. You know what the path is. Get back on it.

You might think you’re non-religious, rational, scientific, agnostic, or atheistic; but if your drug is your answer to everything, it has become your god. Is this the best you can do?

All the Above
There are the four factors that contribute to an addiction. Chemistry, habit, emotion, and idolatry. Any response to addiction that does not take all four into account is going to fail.

You see one dimensional attempts at recovery all the time. The person who only takes a pill for his addiction, or gets through detox and thinks he can go merrily on his way, without changing his behaviors, his feelings, and his spirituality is not going to be very successful. The same goes for the one who treats it just as a habit or an attachment or one who thinks all they have to do is pray. Addiction has a way of hiding wherever you aren’t looking. The thing that keeps you addicted is a lack of thoroughness.

The Shrink’s Links: CrowdMed

Bringing you the best of mental health every week.
Do you have frustratingly complex medical symptoms that have you and your doctors baffled?

Pay $199, submit your medical history anonymously to CrowdMed, and dozens, or even hundreds, of “medical detectives” will chime in. You get a list of suggestions, based on these detective’s rankings, to share with your doctor.

Do you have medical knowledge and want to sharpen your diagnostic skills?

Look over the cases submitted. Share your assessment. As feedback comes in from patients, your reputation rises, or falls, you learn more about medicine, and may even make some money.

Why should you trust a group of anonymous people, some of whom may have never gone to med school? I know, it sounds scary. However, you should be scared when you trust just one, who may have gone to med school decades ago and may have never seen your particular problem in all his years of practice.

Click here to find out more.

Some Things You May Not Know About Substance Abuse: You can’t stop cravings from knocking at the door, but you don’t have to answer

You could stop using whatever it is that is destroying you and you will still think about it from time to time. You’ll have dreams of using. A beer truck might roll by and you’ll feel thirsty. That old life will seem good every now and then. You could have some very good reasons to stop using, but you will forget them if the craving is strong enough. Thoughts of using are just that: thoughts; but they can be very powerful if fed. They can bring down the most secure sobriety.

When people enter recovery and find they cannot stop the thoughts of use, they get discouraged and figure nothing can help; but recovery is a process. You can’t reduce the incidence of thoughts of use without first reducing their duration.

You know those people who walk through your neighborhood in pairs and knock on your door asking you to join their church? I get them in my neighborhood, too. One day, I invited them in for coffee. I gave them donuts. We had a good talk about the Bible, but I couldn’t get them to leave. They next day they were back. I didn’t want to be rude, so we had coffee again, and again, and again, and again. They were good people, but I wasn’t going to join their church, I was already set in that regard. I was wasting their time and mine also. I couldn’t make them stop. It was madness.

Then, one day when they knocked, I made an excuse that I was painting the kitchen, so we couldn’t have coffee. They were back a few minutes later in old clothes and offered to help me paint. Since I wasn’t really painting anything, I had to tell them the truth. Please don’t knock on my door anymore. Goodbye.

The next day, they were back.

Eventually, I learned that even engaging with them in the doorway was a mistake. Whenever I would hear the doorbell, I had to peer out a window. If it was them, I’d make like I was not home. Finally, they stopped coming.
Your cravings to use drugs are like that. So are your anxieties, your negative thoughts, your unwarranted feelings, your paranoia, and any of your impulses to do things that you’ll regret. You can’t stop these thoughts from knocking at the door, but you don’t have to let them in.

When you notice you’re engaging in these thoughts, that’s the time to stop them. Say to yourself, “Stop the Madness”, and those thoughts will stop for the moment you say it. Seriously. All you have to do is identify your thing as madness for you to end the power it has over you for that moment. It’s as simple as that.

Oh, the thoughts of use will come back in, like, two seconds; so soon it’ll seem like you never stopped. It’s simple, but often it’s not easy.

Sometimes thoughts of use have already moved in, are sleeping on the couch, or even kicked you out of your own bed, or are holding you hostage. They’ll dig in their heels, argue, threaten, lie, hornswoggle you into believing you need to use. Getting rid of them will be like when a woodchuck chews his own leg off to get out of a trap, but it all starts with you identifying the madness.

So, do it again. Say, “Stop the Madness”, and those thoughts stops once more. Do this as many times as it takes. You will reduce the duration of thoughts of use. Time spent in thoughts of use will get shorter and shorter. You’ll get better at doing this. It’ll get easier for you to stop. Eventually, you’ll learn to see the thoughts of use coming and, like me, pretend you’re not home.

I was complicit with the people knocking on my door, but I didn’t know it. I had a choice. I didn’t need to let them in. I entertained them. I fed them. I sat with them and had coffee.

When you stop answering the door every time your thoughts of use knock, you’ll see you have a choice, too. You’ve been complicit. The sooner you terminate your engagement with thoughts of use, the sooner they lose their power over you. They wither away, malnourished. You’ll see.

The Shrink’s Links: The New Year’s Clean Sweep

Bringing you the best of mental health and relationship advice on the internet.

Today’s link from the shrink is:

The Clean Sweep Program

I’ve posted it before, but this is a link that’s worth repeating in this season of setting goals and making resolutions.

The Clean Sweep Program is a checklist of 100 items which, when completed, give you complete personal freedom. Left undone, they are 100 things that will someday bite you in the ass. You are basically taking inventory of four areas of your life: Physical Environment, Well-Being, Money and Relationships so that you can see where you fall short and set goals to square things away.

One warning, though. If you already know that your life is majorly messed up, you may not want to go through the checklist and get an abysmally low score. It may be just too discouraging. In your case, you probably already know what you need to do. Stop using drugs, restore relationships, take care of yourself, get a job. The Clean Sweep Program is best used after you overcome the most serious hurdles and you want to keep on going and not fall into complacency.

Happy New Year!

Keith

Click here to go to the Clean Sweep Program

Related articles
Enhanced by Zemanta

The Shrink’s Links: Bright Ideas for Treating the Winter Blues

Bringing you the best of mental health every week.

Christmas time is a busy time of the year for malls, elves, and postal workers, but, despite the myth, it is not a busy time for us shrinks. Actually, it’s April.

Nonetheless, there is something about this time of year that makes it hard, especially in the Rochester area, to kick it into gear. It’s the time when clients complain more and more about loneliness, family conflicts, and dashed expectations. Alcoholics have more temptations to drink, overeaters to eat, and drug addicts remember the time they once hocked the kids’ Christmas to score, get guilty, and hock Christmas again just to feel better. There is something about Christmas that makes people miserable.
Why is this so? Christmas is supposed to be a happy time of the year.

Have you looked outside lately? Go ahead and do it now. What do you see?
Chances are, you can see nothing because it is dark. It’s mostly dark this time of year. Can that have anything to do with it?
It does. A lot of of heartache could be prevented by turning on a few lights.
Read this article from the Wall Street Journal to learn more.

Some Things You May Not Know About Substance Abuse, Part 20: Those who care the most about you will be the last to believe in your recovery

If you’re an addict in recovery, you may have already noticed this. Those who are closest to you are the last to believe you’re changing. Your wife, your husband, mother, father, children, close friends, don’t get as excited as you do when you celebrate one week clean, one month clean, or one year clean. They’ve heard it before. They don’t want to hear it again.

You feel offended. You wish they trusted you, believed in you.

Well, it isn’t just you. This is a universal phenomena. Your loved one is acting as your lookout. This is a good thing.

Your addiction was custom-made just for you or you would not be subject to it. It sneaks up in your blind spots. If you could see it coming, it never would’ve gotten you. It fits you like a glove. When anyone is tricked by your addiction, it tricks you first.

If you’re in a close relationship, you have a resource that others don’t have. You have a lookout. Your addiction was not custom made just for her (or him). It doesn’t sneak up in her blind spots. She spots it coming before you do. She can see through the deceptions more easily. She has a vested interest in keeping you safe from relapse. She could warn you that it’s approaching, if only you will listen.

It takes hard work to cover from addiction and eternal vigilance to keep from using again. Relapse can be expected. It takes an average of seven real attempts before recovery feels solid and, even then, you won’t know if you’re going to need eight. Moreover, addiction of all kinds will often go into hiding when it feels threatened, so that what appears to be recovery is really a more pernicious hidden phase of the same madness that troubled you before.

Paid professionals can help, they have the knowledge, they have the objectivity, but they don’t have the access your partner has. They don’t see you on the weekends and at night when triggers often strike. They do not have as much at stake.

Far too many people fail to use their lookout. The lookout sees the relapse coming and they argue with her, deny it’s happening, get defensive. This is a mistake. It’s as if a lookout on a ship, up in the crow’s nest, saw an iceberg up ahead, and the captain yelled, “You’re crazy, I’m not going to hit an iceberg. You never trust me. I’m going to do what I want. Get off my back.” It would not be good if a captain did that.

To be sure, many lookouts don’t execute their role too well. When they see relapse coming, they often make accusations, rather than observations. It’s as if the lookout, up in the crow’s nest, called out, “You’re hitting an iceberg again! Don’t you care about me?” They should just warn you that there’s an iceberg. You might be tempted to dismiss their warnings as crazed paranoia. It would not be good if you, or any captain, did that.

However, you’ve got to realize that you’ve hit a few icebergs in your day, already, and your lookout should be excused if she gets excited when she sees another one.

There’s a few things you can expect from a good lookout. Don’t be surprised when you see them.

· A good lookout doesn’t resign.

If your partner comes down from the crow’s nest and tells you that you’ve got to look out for your own addiction, you can figure that next she’ll be going off in a lifeboat. True partners do not resign as lookouts, unless they’re about to leave the relationship, or they’re a damn fool. She has to be a lookout, if only to guard her own interests.

· A good lookout stays awake.

She doesn’t watch like a hawk in the beginning and then forget about it later on. If it’s months or years since madness last struck, don’t be surprised if she still on the lookout. She has to be. That’s her job.

· A good lookout scans the horizon.

She doesn’t keep looking in the same place. The main thing to look out for is the way the madness arrived in the past. It is likely to come that way again. If, for instance, Christmas is a difficult time, then she should be especially on the lookout at Christmas time. But understand, the same difficulty can come wherever there is busy-ness, family contact, alcohol use, overeating, darkness, or an imperative to be merry.

· A good lookout is not deceived.

Addiction arrives in disguise. No one starts off drinking three six packs a day just to feel normal. No, they start off with a glass of wine at dinner, a beer during the game, or doing a shot with a friend. These things are all good things, there is nothing wrong with any of them in themselves. They are only evil because of where they lead. A good lookout sees through the disguises. She knows the masks that your addiction wears.

· A good lookout is jumpy.

She’s got to be vigilant. If you keep driving by that place where you used to score drugs, she should be seeing red flags. This may very well be the way relapse creeps up innocently.

· A good lookout raises the alarm.

If she sees relapse coming, she should say something, not keep that information to herself. You need to know it. She may not want to do it, no one wants to be the bearer of bad news, but this is what lookouts are for. If the addiction has given the two of you a lot of trouble in the past, she might not want to believe it’s back. If the addiction has already taken you over, she might get an argument.

· A good lookout keeps her eye on the hazard.

If your lookout spots a relapse approaching, she should keep her eye on it, even if you say it’s nothing. Don’t be surprised if she looks for confirmation in the form of a home drug or alcohol testing kit to eliminate suspicions. She may want to get a second opinion from a professional; sort of like calling in another lookout and asking what he sees.

· A good lookout keeps herself safe.

She shouldn’t be so busy being a lookout, watching out for your relapse that she gets overcome by her own kind of madness. Yes, everyone, even your partner, has her own kind of madness.

· A good lookout has someone looking out for her.

Be your partner’s lookout, just as she is yours. Watch each others’ backs. You can see her madness more clearly than she can her own. If your partner has been dealing with your addiction for a long time, she’s probably worked very hard to keep herself strong. Someone in the house had to function. The laundry, the cooking, the kids, the relatives, the shopping, and going to work don’t get done by themselves. She may not be accustomed to relying on you for anything; you just haven’t been reliable. That’s going to have to change. She needs a lookout, too.

If you’ve ever complained that your partner doesn’t trust you, let her be your lookout. This is how she learns to trust you again.

Some Things You May Not Know About Substance Abuse, Part 18: You don’t know what you can do

You could learn a lot about addiction and recovery by watching the Wizard of Oz.

I’m not referring to the scene where Dorothy and her friends pass out in a field of poppies. That’s the only outright drug reference I can recall. I’m talking about the way Dorothy and her friends are traipsing all over Oz, trying to find the Wizard who can give them what they need. You remember. Dorothy wants to go back home. The Tin Man wants a heart, the Scarecrow a brain, the Lion, some courage. They’ve all been told the Wonderful Wizard of Oz can get them what they want.

Dorothy and her friends go through quite a lot of trouble for the Wizard. Together, they confront the Wicked Witch of the West and her posse of terrifying flying monkeys. Dorothy gets captured, the Scarecrow, Tin Man, and Lion demonstrate considerable ingenuity, loyalty, and bravery to sneak into the castle, and Dorothy unexpectedly murders the witch with a bucket of water.

I hope I’m not spoiling it for you.

They return to the Wizard and demand an audience. There they find the man behind the curtain. They discover the Wizard is a fraud.

Things couldn’t get worse for Dorothy and her friends at this point, it seems. Here they are, Dorothy, stuck in Oz, the Scarecrow, brainless, the Tin Man, heartless, the Lion, without his courage, and the Wizard, with no power to help. They went through all that for nothing. It couldn’t get much worse than that.

The Wizard certifies the intelligence of the Scarecrow by presenting him with a diploma. He confirms the Tin Man’s humanity by giving him a ticking heart-shaped watch. He awards a medal to the Lion for his courage. By this point, you know that these characters had these qualities all along. They just needed someone to say so.

The thing that saves the day for Dorothy is that, unbeknownst to her, she had possessed, the whole time, the very means by which she could return to Kansas: the Ruby Slippers. A few clicks of the heels and she’s back in the loving care of Auntie Em.

I think you can see the parallels between the plot of this story and addiction. The object of addiction, the drug, is the Wizard. The addicts confer wondrous powers onto the drug. They’ll do anything for it because they believe it’s the very thing they need. They run grievous risks and commit horrendous crimes for its sake. Then, at some point, they discover the drug is a fraud. It does not have the powers they thought it had. It does not, cannot, give them what they want. This moment of awareness is an awful one. People do not want to feel that way, so they’ll engage in denial and hold out hopes in the power of the drug long after it’s reasonable to do so. However, becoming aware that the drug is a fraud is a necessary step in the process of recovery.

If that was all recovery consisted of, it would not be such a good thing. If all that you experienced in recovery was that the drug is a fraud and you have been wasting your time, then you might think you might as well slit your wrists. Fortunately, there’s more to learn. You can learn that all the qualities you looked for in the drug, you already possess. Indeed, you may have even demonstrated these qualities as you sought the drug.

The man who wakes up every morning, sick, homeless, and broke and, somehow, finds a way to raise money for smack should be teaching MBAs at Harvard. The crack whore, who, against all reason, braves the hazards of the street for a moment of pleasure, Medal of Honor winners should be saluting her. The sex addict who deceives and eludes the person closest to him; who knows him best, should get an Oscar for his performance. If addicts could recognize the qualities they have, they wouldn’t need the drug. If they could use those qualities towards an objective other than obtaining drugs, they could go far in life.

This is why you might not realize you already possess great powers. You started off life as child, utterly ineffectual and enthralled by the capabilities of the big people around you. You got used to being helpless. You may have even liked it and preferred depending on someone or something else, rather than taking responsibility for yourself.

Another reason you might not know you have great powers, is that you have not had a reason to use them.

This is how self discovery works: A boy, when he is growing up, is always getting beaten by his big brother in basketball. He believes he’s just not that much of an athlete, so be becomes a bookworm, instead. He gets good grades and is accepted into Harvard. There, on the Harvard Yard, he begins playing Ultimate Frisbee with the other bookworms. He discovers, out of the shadow of his big brother, that he’s more athletic than he thought.

As life goes on, he discovers more things about himself. Having spent so much time in school, he doesn’t believe he can succeed in the real world, until get gets a job and does just that. He dates lots of people and believes he is incapable of commitment, until he meets the right girl and cannot think of anyone else. His first child is born and he is overwhelmed by the terror of having to raise another human being, but he goes on to be a good father. The point is that we never know what we can do until we try.

Of course, trying something requires a key ingredient: courage.

What makes a king out of a slave? 
    
Courage! 
    
What makes the flag on the mast to wave? 
    
Courage! 
    
What makes the elephant charge his tusk in the misty mist, or the dusky dusk?
What makes the muskrat guard his musk? 
    
Courage! 
    
What makes the sphinx the seventh wonder? 
    
Courage! 
    
What makes the dawn come up like thunder? 
    
Courage! 
    
What makes the Hottentot so hot?
What puts the “ape” in apricot?
What have they got that I ain’t got?
    
Courage.
(Sung by the Lion in The Wizard of Oz, Movie, 1939)

The Lion was right to desire courage. Without the courage to use them, no other qualities count for anything. Here’s the thing, though. You don’t possess courage before you use it, you develop it while in the act of using it. You create it while facing your fears.