I empathize with health care professionals who open the door and see me sitting there. I have alcoholism, one of the most puzzling and pernicious addictions to treat. And no consensus exists on what alcoholism or other addictions really are or how to treat them. Add the conundrums that addiction is often accompanied by mental illness, symptoms of trauma, physical illness, emotional and physical pain, and sleep disruption, well, that ranks it with the world’s impossible puzzles. If the smiling health care professional is inwardly groaning, I get it.

Still, to quote Talk Talk, “It’s my life.” As a do-it-yourself addictions recovery practitioner, the first order of business for me is to get myself health care. What can I do to help health care professionals help me?

Let’s follow Stephen Covey’s advice: “Begin with the end in mind.”

What do I want to have happen as a result of consultations with health care professionals who might have help for me with addiction?

1. Greater understanding of my unique story, i.e. my “case conceptualization.”
2. More data a) to refine and deepen my understanding of my case and b) to provide increasingly comprehensive information during subsequent consultations with additional professionals.
3. Treatment recommendations that might foster my stability. The more stable my inner system is and the more stable my living situation is, the more likely I am to progress rather than regress.

This post addresses #1 and #2 in the above list.

1) Case conceptualization

Case conceptualization is a counseling term for a description of what is thought to be going on with a person and why. It’s like a Wikipedia article on a person and his or her problems. What we do know about treating addiction is that it requires helping the whole person. But given the current limited state of knowledge of addiction, limited understanding of addictions treatment, and limited access to treatment, a person with addiction just has to try to puzzle out the “wholeness” for himself or herself.

If I envision my case as a jigsaw puzzle in a new box, I open the box and see a whole bunch of puzzle pieces. I take out a puzzle piece. If I recognize it, I can put it where it goes. If I don’t recognize it, what do I do?

As someone with addiction, I’m likely to have what Maia Szalavitz terms an “outlying temperament” which means that the volume on my inner state spikes or plummets very fast. (More about that in the last third of this post.) I tend to feel overwhelmed immediately when I don’t know what to do or don’t understand, either feeling highly anxious or deeply hopeless. Consciously looking at what’s going on with me is probably going to be distressing. I’ve got to engage my mind to help myself through these shifts in intensity.

If I don’t know where the puzzle piece fits, even what it represents, the piece goes back in the box, perhaps in a corner with other unknown pieces.

This piece and others I can’t identify are the ones with which I need help.

A professional has knowledge, training, expertise, experience and membership in expert networks that I do not. Using the jigsaw puzzle metaphor, a professional can look at a puzzle piece and identify it or, if the professional can’t, knows someone who can. Or the professional may rank the piece as more important or less important than I can. The professional may look in the box and be able to quickly identify pieces I haven’t gotten to. The point is that the professional can help me do what I cannot do for myself.

(The problem with DIY addictions recovery is that it’s actually impossible. I don’t know enough. And I don’t have enough credentials to access needed resources. I simply must work with others.)

While invaluable, a professional will have finite expertise and I will have finite time with that professional. In DIY addictions recovery, my priority during the appointment needs to be getting as many puzzle pieces identified as I can in the time we have. Then my job is to come home and start fitting them into the bigger picture.

2) Data

I need data for two reasons: a) to get more information with which to understand my own case, and b) to have updated information available for the next professional who might help me.

If I walk into an appointment wanting to a) tell my story or b) receive reassurance, I will misuse my time with this precious resource. It’s legitimate to want to be heard and to be comforted. These might well be byproducts of the appointment. But I need to get those needs met in other ways. This is a not-to-be-missed opportunity to have someone look at my box of puzzle pieces and see what they see.

To help the health professional help me, I need to provide as much data as possible – presented as concisely as possible due to short appointment times – to help the professional get up to speed on my case as quickly as possible.

If I can provide even a single one of these documents, ideally contained in a binder in this order, I offer invaluable help to someone who wants to help me:

1. One-page list of current and past treatments, including current and past medications.
2. Results of blood work.
3. Timeline (for more on the timeline, scroll down to “Contribute to my loved one’s documentation” in this post.)
4. Copies of previous medical records organized in reverse chronological order, i.e. most recent first, including hospitalizations, stays in treatment centers, reports from labs, scans and x-rays.
5. My “case conceptualization,” i.e. my typed or handwritten narrative of what I think is up with me and why. (If writing is difficult for me, perhaps I can find someone to listen and type as I speak.)

It’s a lot, isn’t it?

The challenge with documenting one’s own case is that most people with addictions don’t feel very good and just aren’t up to the task. In addition, they may have cognitive limitations due to substance use, as well as due to the very impairments the illness of addiction itself makes to executive systems in the brain. Fitting puzzle pieces together can simply be impossible. Plus we have that outlying temperament that makes looking at each piece feel epic. We’re not wrong or bad for having challenges. We have a brain condition, a grave and serious illness. Of course we’re going to have challenges.

This is why if someone with addiction can find someone to help them document themselves, or serve as advocates as they navigate the system, it’s hugely helpful. Perhaps a trustworthy parent, partner, daughter or son, minister, friend, even neighbor could help! Recovering from addiction is hard enough. The barriers to treatment make it almost impossible. It is not weak to ask for or to accept help.

If you can’t do anything else, just keep receipts and printouts – of appointments, medications, any document related to your health care. You might feel better soon and can perhaps put them in reverse chronological order. Or someone might come along who can help you piece together your story.

Image: iStock

Last updated 10/01/16

. . . . .

A table of contents for the entire DIY Addictions Recovery series of posts is here.

New posts refer to subsequent posts and I’m doing my best to link them up in an understandable way. I update posts as I learn more.

This post is part of a series contained on this blog in the DIY Addictions Recovery category.

If you have suggestions or feedback, I welcome them. Feel free to contact me.

Disclosure and disclaimer: I am a counselor at a community services agency. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends. 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.

While faces get redder and voices get angrier as people debate what addiction is and what to do about it, the first order of business for do-it-yourselfers in addictions recovery is to take action on the evidence that addiction is a health condition and to arrange for health care for ourselves.

The health problem of addiction is often accompanied by mental illness, symptoms of trauma, physical illness, emotional and physical pain, and sleep disruption. Issues of temperament and personality may need assessment. Blood work needs to be done to test for the presence of function and dysfunction, to diagnose illnesses, and to assess suitability for medications. All of these factors need to be provided by, and considered and evaluated by, health care professionals. Ideally, these assessments would be coordinated by one specialist or a team of specialists but you will likely have to cobble together data for a comprehensive evaluation from multiple sources. From all the data, an individualized treatment plan can be devised.

So, the goals for getting medical care are to:

1. get immediate care for immediate problems
2. get assessed for medications to address addiction or co-occurring mental or physical conditions that exacerbate it
3. begin to try to stabilize all conditions
4. get referrals for more specialized care
5. begin to create and collect data about your health conditions.

In my experience, people with addiction fall somewhere on a continuum of being in an emergency state, an urgent state, or in chronic distress.

Emergency State

If you’re in a state of emergency, call 911.

Urgent State

If you’re in an urgent state, still consider calling 911.

If you are in an urgent state and not calling 911, consider these options in priority order.

Consider the ER. Know that it is through the emergency room (E.R.) that many people with addiction make first contact with the local health care system. E.R.s help stabilize patients briefly, but are limited in the length of care they can provide, sometimes under 24 hours. Hospitals in my locale do not provide addiction treatment, medication-assisted treatment, or prescriptions for detox or pain medications.

Depending upon the system in which the E.R. operates,  referrals will be made to additional treatment through emergency evaluation services like these in our locale. Referrals from those services are to local treatment providers (here’s a list of our 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 you are considered a threat to yourself or others, a stay at a mental hospital will be required. An E.R. visit may result in a range of outcomes, including release into another’s care, time at a detox facility, or a stay at a mental hospital, possibly far from home.

If you’re released from an E.R. without a plan for immediate follow-up care, a return to use is probable.

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 makes it routine to provide a printout of services provided for record-keeping. If you’re in state of  of physical or mental emergency, however, they will refer you to the E.R. and the visit will waste precious time. However, E.R. wait times are long and an urgent care center might be worth a try if you’re stable enough for it.

Consider walk-in “after hours” care. If you’re in an urgent state during your clinic’s walk-in hours, try to get in there. The clinic will know your case, have access to your records, and may be able to offer more individualized care than an urgent care facility or emergency room.

Consider seeing if a primary care physician (PCP) or nurse practitioner (NP) has an opening today. This is probably the least likely way to get care because most PCPs and NPs are booked solid, but sometimes you can find an opening due to a cancellation.

Chronic Distress

While I appreciate learning that most people “age-out” of addiction, I didn’t get a chance to because I had late onset at age 50, and the people I know with addiction didn’t, so most of us are in an acute state of addiction from having it long-term and/or having it under-treated or maltreated. We’re either actively using, practicing some kind of harm reduction by using less often or using less harmful substances or, like I am, miserably holding on to abstinence.

And hardly a one of us was told to go to a doctor.

It’s not too late.

While we don’t exactly know what directly cures addiction – although buprenorphine for opioid use disorder can seem pretty darn close – conditions that often co-occur with addiction, i.e. mental illness, chronic pain, and sleep disorders, can be directly addressed medically.

Lessening the suffering caused by other conditions can potentially reduce the intensity with which addiction is experienced. Return to use or increased use is correlated with increased stress. Getting treatment for untreated medical conditions can reduce stress.

If you’re semi-stable, you can use the list above for accessing medical care in reverse order. Start with your PCP to begin the laborious process of being set up for appointments with specialists – start first with making an appointment to see a psychiatrist because that can require a lengthy wait – and then continue to see specialists for other problems.

[Personal anecdote: It took me 3 years of pouring over the literature to find this 2009 report citing two studies, one from 1992 and one from 2000, about medication for alcoholism. It states, “[P]atients who achieve abstinence may benefit from taking naltrexone at times when they are at higher risk of relapse, such as on vacations, on holidays, or during a personal tragedy.” I was able to muscle through the 6-month wait time to see a psychiatrist, ran this report by her, and have an arrangement with her that if another of the intermittent bouts of abject longing to return to drinking occurs for me, she’ll prescribe me 3 months of naltrexone. This is a radical approach: less than 9% of people with alcoholism receive medications to treat it.]

If addictions medicine practices, or psychiatrists or psychologists who specialize in addictions are available via self-pay, I would avail myself of them. Clients pay directly for services and the provider does not bill insurance. This is simply too grave of a condition with too dire of consequences for penny-pinching. In my locale, TASL offers direct payment for addictions medicine care. 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 you don’t have money and you don’t have health insurance, then you’re going to have to work the system and get some. Scroll down  in this post to section 3 entitled “Make appointments” for my explanation on how to do that.

Ignore Naysayers

The evidence is in that the earth is round, although it was believed for a long time to be flat.

The evidence is in that addiction is a health problem although it’s been believed to be a personal, behavioral, and moral problem for a long time.

Addiction is a treatable, chronic disease that can be managed successfully. Research shows that combining behavioral therapy with medications, where available, is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric, and social problems.
– National Institute on Drug Abuse, NIDA

Some of the most resolve-strengthening advice I’ve ever been given as a person in recovery was given to me by another person in recovery and I’ll share it with you:

Trudge, baby, trudge.

However you can – run if you can, trudge if you have to – get yourself to a doctor.

. . . . .

Last updated 9/16/16

This post is part of a series contained on this blog in the DIY Addictions Recovery category.

A table of contents for the DIY Addictions Recovery series of posts is here.

Disclosure and disclaimer: I am a counselor at a community services agency. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends. 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.

To the best of my ability to make some kind of sense of this – and I’m going to do my best to explain this in jargon-free, simple terms, risking inaccuracy, but in an emergency, we’ve got to be quick and direct – here’s what I understand is up with people with addictions:

First, here’s how I’ll use the terms “brain” and “mind.” The physical organ of the “brain” is experienced by the individual as the “mind.” While the mind is influenced by the organ of the brain and the mind can do much more than this, for the purposes of addictions recovery, my working definition of “mind” is the individual’s ability 1) to become aware of what he or she is feeling, thinking, saying, and doing and, 2) to decide what would be helpful or effective to do with feelings and thoughts prior to speaking or doing something.

Now about addiction and the brain. As a result of addiction, an abnormality in the organ of the brain has occurred. The organ of the brain is also likely to have been influenced by the substance itself, pre-existing trauma, pre-existing mental illness, and other factors.

In sum, I can’t control what’s happened to my brain. Some theories say my brain can heal, even to the point of reversal, but I struggle with addiction to alcohol and I want a drink right now. I don’t have time for theories.

What I can control is my mind. Yes, my control of my mind is limited and the severity of what’s happened to my brain can limit my control, even limit the reliability of my perception. However, in this Stone Age of addictions treatment, it’s the only tool I have of my own to carve out a new way for myself.

Right here, right now, whether I am alone or present with others, I am confined to my brain, my body, this place and this situation.

I am it.

. . . . .

After nearly 3.75 years without a drink of alcohol, I cannot say whether or not these helped or hurt, but I see no cause-and-effect relationship between these factors and my abstinence: willpower, resolve, determination, readiness for change, wanting or asking for help, my choices, character, or morals. Those are all components of my mind. Addiction is a disorder of the organ of the brain. Brain and mind are interrelated, sure. But no amount of the intense use of my mind can change my brain fast enough to prevent me from taking a drink right now.

Nearly every concept and “principle” I’ve been taught about addictions recovery is based on unspoken, covert, psychologically-undermining judgment. I have been told to judge myself constantly: how right, how wrong, how good, how bad, not enough, too much?

And I was taught that the antidote to judgment is compassion. But if things aren’t going well for me or in my relationships? I’m not measuring up as compassionate enough…

Using the club of judgment has resulted in my unrelenting suffering. I have beaten my whole self bloody – my one and only body, my tender heart, my willing mind – with “What’s the matter with you?!” for having a brain disorder. Horrendous. Tragic.

Enough.

“See what is without judgment.”
– Kristen Lenz

I’m going to put down the club of judgment and place it nearby – it is of inestimable value when used wisely – and pick up the stone tool of my mind and begin to learn to use it – not in a good or bad, right or wrong way – but helpfully and effectively.

. . . . .

In the brain, the set-up of pre-existing conditions predicting development of addiction, trauma, mental illness, and addiction all seem to have in common the brain experiencing everything acutely. In addition, that acuteness stays acute for a long time and is hard to return to a stable level. (Maia Szalavitz terms this an “outlying temperament” and covers it thoroughly in her book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction.)

Lights are bright, sounds are loud, the touch of a fingertip is an assault or a promise of forever devotion, hunger is danger of starvation, careless words are mortal wounds, feelings of anger spike to rage, feelings of sorrow descend to despair, thoughts about the unchangeable past and the unknown future must be thought over and over again to find a way to change and know!

This acute state of physical sensations, emotions and thoughts can get so acute that it’s experienced as unbearable pain. Drinking alcohol or using other drugs is experienced as humanity and mercy.

So my primary job as a person with addiction is to acknowledge this acuteness, become aware of when it’s happening, and use my mind to ease it, to prevent it from becoming unbearable.

Become aware. Use the mind.

Become aware. Use the mind. 

That’s the simplest way to state the only reliable addictions treatment I know.

. . . . .

This post is part of a series contained on this blog in the DIY Addictions Recovery category.

A table of contents for the DIY Addictions Recovery series of posts is here.

Photo: Nancy Brauer

Disclosure and disclaimer: I am a counselor at a community services agency. The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends.  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.