Addiction Management Blog

Archive for the ‘Resolve’ Category

Addiction and the Perennial Philosophy

Saturday, April 13th, 2013

perennial_philosophy_coverWe have known for a long time that among the most powerful ways to overcome addiction is through spiritual interventions. The essence of such approaches is that addiction is a problem of the ego, of our lower self, of the body. By harnessing the powers and energy from our higher self, from the part of us that is unchangeable and connected to the source (God, Buddha,  Allah, Atman …your choice), we can overcome most anything in life. This philosophy is at the heart of twelve-step programs, but it really goes far beyond recovery. In fact, it is about our ultimate work on this earth – awakening to our true nature.

I will admit I have been slow to all of this. I was not raised religious and the rare times I made it to church were with friends on holidays primarily for the food. Even more, I was raised in a family that valued science, and awakening to our true nature was not something that fit well into randomized clinical trials. So it took many years of wandering before I stumbled upon the Perennial Philosophy, something that made a lot of sense to me.

Perhaps you too have heard about it, or maybe not. Although I am sure there is a more elegant way to describe it,  I understand it like this. If you ventured back in history and gathered up all the wisdom on how to live life from all the great mystics and enlightened beings from all the world’s religions and spiritual traditions, and then boiled down their essential message, they would all speak universal truths, which is the Perennial Philosophy. It is the commonality in all religions, it’s what links them all together no matter how different they may appear on the surface. For me, this is very much like the scientific method. We have a bunch of researchers, who over time, using a variety of techniques, study a phenomena from various perspectives and all arrive at the same conclusion, informing reality as we know it!  Of course science is not perfect because it is conducted by people who can make mistakes, but history has shown that it is pretty darn good at helping us understand the world.

UntetheredSoulMech-#1.inddSo for me, the Perennial Philosophy bridges the gap between science and spirit, and has been a game-changer in life. If awakening to our true nature is our primary purpose on this earth, then it sure simplifies a lot of things! My to-do list is now much, much smaller. And so many things that I believed to be critical to a good life, things that I had to have, now seem not so important. Less really is more! What exactly is the Perennial Philosophy? There are two ways you can discover the answer. You can use your lower self, your ego, and read all about it. A good place to start is Aldous Huxley’s well-known The Perennial Philosophy. Or you can read about it in many of Ken Wilbur’s books, or get a nice summary on Wikipedia. But in all honesty, this method is a bit like reading all about a cool place you want to visit. It will give you some background, the lay of the land, but in the end it is not the cool place, is it? To really experience and understand the cool place you read about, you have to visit the cool place!

If you really want to understand the Perennial Philosophy you have to experience it through your higher self, through contemplative practice. There is no other way. Meditation, in all its forms, is the primary vehicle for developing a contemplative life, although there are other ways. With practice, you will discover the self behind the self. The part of you that has always been there, that does not change with your thoughts and feelings, and is capable of pure awareness. If this all sounds a bit warm and fuzzy, check out the bestselling book The Untethered Soul. I will admit, it has been a very slow journey for me. Perhaps the most important thing I have learned thus far – if you never take trip, if you never go inside and really see what is there – you are missing out on something very cool, beyond cool, actually.

Siddhartha’s path out of addiction

Saturday, June 30th, 2012

I’m not sure how I missed reading Hermann Hesse’s Siddhartha (Hilda Rosner translation) in high school, but I did. It’s one of those enchanting books I wish I would have read earlier! If you are unfamiliar with the story, I encourage you to read it and soak in its many wonderful messages about life. I have no intention of recapping the story here, but instead want to use parts of the story to illustrate one path out of addiction.

Siddhartha is a man on a mission, on a journey to the center of Self, to a place where Self is merged into unity, or the All. On his way to enlightenment he has many interesting adventures, including a period of time where he hangs out with the beautiful Mistress, Kamala. “She played with him, conquered him, rejoiced at her mastery, until he was overcome and lay exhausted at her side.” She enticed him into the world of the ordinary, a life of attachment. “The world had caught him; pleasure, covetousness, idleness, and finally also that vice that he had always despised and scorned as the most foolish – acquisitiveness. Property, possessions and riches had also finally trapped him. They were no longer a game and a toy; they had become a chain and a burden.

I find it interesting that as Siddhartha descends deeper into his attachments, Hesse beautifully describes addiction. “He played the game as a result of a heartfelt need. He derived a passionate pleasure through gambling away and squandering of wretched money….He won thousands, he threw thousands away, lost money, lost jewels, lost a country house, won again, lost again. He loved the anxiety, that terrible and oppressive anxiety which he experienced during the game of dice, during the suspense of high stakes. He loved this feeling and continually sought to renew it, to increase it, to stimulate it, for in the feeling alone did he experience some kind of happiness, some kind of excitement, some heightened living in the midst of his satiated, tepid, insipid existence.

And like so many who suffer from addiction and relapse to numb the pain and despair of an insipid existence, Siddhartha too experiences the consequences of his actions. “And whenever he awakened from this hateful spell, when he saw his face reflected in the mirror on the wall of his bedroom, grown older and uglier, whenever shame and nausea overtook him, he fled again, fled to a new game of chance, fled in confusion to passion, to wine, and from there back again to the urge for acquiring and hoarding wealth. He wore himself out in this senseless cycle, became old and sick.

For those who struggle with addiction, and their family and friends forced to endure a life on the edge, there is an insightful lesson in the story of Siddhartha.

I have had to experience so much stupidity, so many vices, so much error, so much nausea, disillusionment and sorrow, just in order to become a child again and begin anew. But it was right that it should be so; my eyes and heart acclaim it. I had to experience despair, I had to sink to the greatest mental depths, to thoughts of suicide, in order to experience grace, to hear Om again, to sleep deeply again and to awaken refreshed again. I had to become a fool again in order to find Atman in myself. I had to sin in order to live again.

For someone who reaches enlightenment, it’s strange imagining Siddhartha sitting by a river thinking about suicide. But he does. And in the pain of the moment, “he understood it and realized that the inward voice had been right, that no teacher could have brought him salvation. That was why he had to go into the world, to lose himself in power, women and money; that was why he had to be a merchant, a dice player, a drinker and a man of property, until the priest and Samana in him were dead. That was why he had to undergo those horrible years, suffer nausea, learn the lesson of the madness of an empty, futile life till the end, till he reached bitter despair, so that Siddhartha the pleasure-monger and Siddhartha the man of property could die. He had died and a new Siddhartha had awakened from his sleep. He also would grow old and die. Siddhartha was transitory, all forms were transitory, but today he was young, he was a child – the new Siddhartha – and he was happy.”

So often when addiction is the problem we believe heading off to treatment is the answer. No doubt treatment can be helpful and at times life-saving. But this story is a powerful lesson in how change, even the most challenging of changes, are possible when we access what is already inside us. Atman. The All. “To much knowledge had hindered him; too many holy verses, too many sacrificial rites, too much mortification of the flesh, too  much doing and striving.” Too much treatment, too many self-help meetings, too much reliance on evidence-based practices and medications. Too much action. Sometimes, the path of no-action, the path of contemplation – of sitting, listening, and just being is the path out of addiction.


Three critical lessons from neuropsychology

Monday, November 9th, 2009

Years ago I worked as an assistant for two neuropsychologists, essentially doing all the face-to-face testing. Usually, this meant 4 to 6 hours crammed into a small stuffy office conducting various cognitive, memory, and intelligence assessments. Although watching patients attempt to stick square objects in round holes had its moments, the lessons I learned about brain functioning have been very influential in my work with those who struggle with addiction. Here are three of the most important lessons I have learned:

  • It’s not intelligence that matters so much as the level of emotional development. I will never forget a couple who were in the process of divorce and both required by the court to submit to neuropsychological evaluations -something to do with custody issues of their children. The husband went first and scored so high I believe he was in the range of genius -it was the highest IQ score I had ever seen in my two years of doing testing. The next day his wife came in and I was unprepared for her IQ score being half of his! In fact, it was clear she had some learning and developmental disabilities. I eq-vs-iq1immediately began to wonder how these two people with drastically different levels of intellect could remain married for over a dozen years. Upon further reflection, I realized that intellect is not the glue that attracts or holds people together, it’s their level of emotional development. I have wrote about this in other blog posts, but continue to bring it up because it points to the absolute necessity of helping those who struggle with addiction developmentally catch-up from the emotional age at which they are stuck. There are some really smart people that get caught up in addiction, and often they can be among the hardest to treat because they believe they can think their way out of the problem. But you cannot “think” your way to a higher level of emotional functioning.
  •  The brain needs time following detoxification to heal before it can absorb, process, and benefit from information discussed in treatment. Advances in neuroimaging have helped establish addiction as a brain disease. The slide on the right shows that 10 days post cocaine use, an abuser’s brain is still very far off from normal baseline functioning (top). Even more illuminating is the cocaine-brain1degree to which brain functioning is still imparied 100 days post last use! We see similar profiles for other drugs of abuse including alcohol, and behavioral addictions. Because neuropsych testing can provide a window into brain functioning, we can use such testing to help us understand how long it takes for the brain to heal to a point at which it is capable of learning, processing, and remembering new information – information such as how to manage addiction over time. Researchers are now doing a battery of neuropsych tests on patients following detox to determine optimal times to begin treatment. What is clear, is that our current system is set-up to have a person who has completed detoxification immediately enter a residential program. About 1-2 months later – about the time they are being discharged from treatment – is really the time when their brain is ready to benefit from treatment. I find it sad that significant sums of money are invested in residential programs when science is helping us understand that for treatment to be beneficial a person must not only detox, but also wait a month or two (or even longer, depending on the drug and time used) before engaging in any significant treatment. This of course brings us the messy question of what should a person do between detox and treatment?  I welcome your suggestions…
  • Neuropsychological assessments can be critical for understanding how to proceed with addiction treatment. While working as a counselor at a community-based addiction treatment program, I encountered a number of patients who suffered from Traumatic Brain Injury (TBI). Usually, the TBI would come up in the evaluation, or it would become apparent when I did a mini-mental status exam. Today, over 5 million people live with a disability caused from a brain injury, and approximately 70 percent of those in rehabilitation have a current or past diagnosis of substance abuse. When I first began encountering addicted TBI patients as an intern, I treated them similar to other patients. I did individual therapy, put them in groups, and proceeded to educate them about ways to deal with their addiction. But over traumatic-brain1time I realized my outcomes were very poor. Many dropped out of treatment,  others continued but were incapable of remembering what they had learned or how to apply it to their life. Relapse rates were significant. Then I discovered our medical psychology department at the hospital and began refering addicted TBI patients for neuropsychological exams. The reports I got back were invaluable in helping me completely restructure treatment. Like children, the trick was understanding what they could comprehend and how best to teach them what they needed to learn. I got a blackboard for my office and begin drawing pictures to represent ideas I wanted to get across. I went slow, paid attention to patients different learning styles, and adapted my treatment approach to the diverse ways in which their brain processed information. And as you might suspect, my outcomes improved. Utilizing the knowledge from neuropsych assessments, I believe, can make all the difference in the world when working with patients with TBI.

Autism expert can help those who struggle with addiction

Tuesday, July 21st, 2009

In the late 1990s I begin attending workshops on trauma therapy because I realized many of those who struggle with addiction also wrestled with untreated underlying trauma – sexual, physical, and emotional. It was at one of the workshops that I first heard the name Stanley Greenspan. Today he is known as one of the foremost experts on autism having published over 35 books and many scientific publications since graduating from medical school in 1966. But for me, he has become an instrumental figure in understanding the foundation of long-term successful addiction management - which in a nutshell is healthy relationships.

In an earlier post I described how addictions are about relationships, and that long-term success in dealing with addiction necessitates replacing unhealthy relationships with objects with healthy relationships with people. The key to doing this is realizing that to initiate, develop, and maintain healthy relationships requires developmental skills that become constricted, or in some cases, never develop due to trauma or time spent in addictions. These skills are critical to relating to others in many contexts: intimate relationships, child rearing, work environments, marriage. Yet most treatment programs and self-help groups are unaware of the critical need to assess and treat emotional developmental problems. When they go unaddressed, many continue to relapse and struggle in life without the benefit of knowing what is missing in recovery.

Based on his extensive clinical and research experience, Stanley Greenspan created a developmental framework that I believe is among the very best at helping us understand the essence of what it takes to succeed in relationships, but even more, how to optimize our mental health. The framework, in brief, suggests that emotional development occurs in six sequential steps. This overview paper focuses on infants and toddlers, but in the book The Growth of the Mind, Greenspan details how many adults become stuck at early developmental levels and require developmentally based therapy to catch-up. Unfortunately, many treatment programs and therapists will intervene in ways that never advance emotional development, resulting in a lot of hacking at the leaves instead of getting to the root. In all fairness, I spent plenty of time hacking at the leaves with patients because assessing emotional development and knowing how to do developmentally based therapy is not so easy. In fact, it requires a therapist to be attuned to their own emotional development and have some fairly advanced therapuetic skills. But therapy is not the only way to increase developmental capacities. By doing things out of your comfort zone, joining diverse types of groups, engaging with people in many contexts, and journaling about your emotional world can help. In future posts I will be more explicit about specific things that lead to developmental growth.

To get a flavor of the genius of Dr. Greenspan, here is a very short clip from the documentary film “Autistic-Like: Graham’s Story.” Although he is talking about the early development of his DIR model of intervention for autism, such insights are very appliable to those who struggle with addiction. Because “emotions serve as the orchestra leader for getting the mind and brain working together” it is absolutely critical to long-term successful addiction management that significant energy is invested in understanding, managing, expressing, and acting on the vast array of emotions we experience every day.