No Day But Today

Yesterday was March 3rd. 3/3. The anniversary of my first sober date.

It was quite a few years ago now that I checked into detox at Stonington Institute on the Connecticut/Rhode Island border. I was shuttled around in dirty vans from our old, dilapidated house that we stayed in, back and forth to the program facility where we spent the bulk of our days. It was on one of those vans that I learned from a friend who had just come into the program that my classmate and friend, Ryan, had overdosed and died while I had been in treatment. He was the first loss from my graduating class from an overdose. I was devastated.

That day I decided to take my treatment seriously. I did what I was told. I became the “house rep”, of course, and became a beacon of recovery overnight. I committed to getting the Vivitrol injection before returning home, even though I had not been properly detoxed from Suboxone yet, and suffered through the worst withdrawal of my life in a strange place with no medications, alligator rolling across the squeaky twin mattress in my recently earned private room.

3/3, or as I simplified it to simply 3 or III, became the sign of my life. It became my lucky number. I ordered a silver ring with the serenity prayer engraved on the inside, the number III engraved on the outside. A few years later, I would put that ring on my friend Taryn’s finger at another rehab in South Florida, as she clasped a silver elephant bracelet around my wrist. Symbols are big for many of us in recovery. 3 had become invalid long before I found myself in the beautiful garden housing at the Orchid Recovery Center for Women in Palm Springs, a very long way from Stonington Institute, and not just in terms of miles.

Letting go of that sober date, of the recovery time I had painstakingly earned, was a tremendous challenge for me. I felt that I had lost that time. That I had let it slip through my fingers because my hands were too busy juggling the life I fancied for myself as a “normal person”, letting my recovery fall into the past.

So last night I find myself somewhere that I never would have been when 3 was my sober date, which is an AA meeting. In the early days, I found meetings to be nothing but one giant trigger. I frequently left meetings and drove directly to my dealer in those early attempts at sobriety. I just couldn’t find serenity in those crowded basement rooms. But ten years later, here I am, in the most unlikely of places: The rooms of Alcoholics Anonymous.

Though the vast majority of my current stretch of recovery has been spent keeping the rooms at an arm’s length, recovery can sometimes surprise us. Finding myself in a relationship with another addict was the biggest surprise of all, I thought. Until I agreed to come to her regular meetings and meet her network of women. I found a much more agreeable group, particularly the Saturday night meeting, where open-mindedness flourished and the “old timers” and their rhetoric were quiet, with a few notable exceptions.

As time wears on, I find that despite my unorthodox recovery program, my unique philosophies, my anti-AA attitude, I am not only welcomed but slowly came to be respected in these rooms. I am even asked to speak, despite my story having little to do with alcohol. Though AA knows many of our stories are intersected with substances other than alcohol, the group conscious often asks us that we keep our discussions focused on issues as they relate to alcoholism. Yet here I am, a heroin addict, who only identifies as an alcoholic out of respect for the rooms, being asked to share my story. I made Saturday night my home group that night, two seconds before the meeting opened.

My partner now chairs that meeting and I make the coffee. Last night, the anniversary of my first sober date, my partner wasn’t feeling well and I offered to chair in her place as we sometimes pick up the other’s commitments if one of us is not feeling well or can’t make the meeting for whatever reason. So here I am, chairing a meeting in Alcoholics Anonymous on the anniversary of my first sober date, and I welcome the speaker named S.

S had 16 years of sobriety before she relapsed. She went back out for ten long years before she finally found her way back in. With five years of new, good sobriety under her belt, she talked about the struggles of trying to present as a normal person in the world while being so very far from it.

I instantly identified with her story.

Being sober before your 21st birthday is an interesting phenomenon. It would’ve been quite the story, had it lasted it, however my story today has a few more chapters which I think makes for a better read anyway. But going back out after being truly in, is one of the hardest things for an addict and for those who love them.

Knowing that you had it, you were doing it, and now you are suddenly incapable of what you had done so well for so long, is very difficult to explain to your friends and family. They saw you do it. They know you can do it. But suddenly you can’t do it anymore.

The guilt and shame of that is part of what keeps us out for so long when we have a relapse like that. I was back out for longer than I had previously been in. The expression that it’s a lot easier to stay sober than it is to get sober is one of the truest that we have in recovery. Coming back was the hardest thing I’ve ever done in my life. Adding those chapters to a story I thought was already finished absolutely destroyed me.

I got sober the first time at 19. Relapsed at 22. I didn’t truly make it back in until I was 26. I am at the point now where I have slightly more recovery time than active time. It’s funny though, that depending on the day, it can feel like I’ve lived a whole lifetime in active addiction and it feels like that is who I truly am on the inside. Yet on other days, that part of my life feels so far away that it almost feels like a scene from a movie I’ve watched way too many times. That one movie that feels like it’s your real life, that you know every word, every dramatic pause, every exchange of dialogue.

When I relapsed after those first three years, I was so devastated at the loss of time. I couldn’t stomach telling anyone that 3 was dead and gone, that I had thrown it all away, that the time had been lost. It kept me from coming clean about my relapse, which kept me from getting clean, for much longer than it needed to. It took me a long time to figure out that I didn’t actually lose that time. I still had three beautiful, amazing years of active recovery. I still had a meaningful impact on countless parents, other addicts, and millions of people who saw my features on Good Morning America and Nightline in 2007. I spoke to addicts as far away as Australia, encouraging them to keep fighting. I put down the roots of the advocacy career I’m still building today. If it hadn’t been for those first three years, there are so many lessons I would never have learned. I didn’t lose them. They are just as real, and just as valid today as they were back then.

Today I no longer fear losing time. I no longer worry about sober dates. Today I know that I came back in some time in January of 2015. I picked up a three year coin a few weeks ago, for the second time. I have reclaimed those three years, I have done what I thought I could never repeat, that I could never put those three years back together again. Counting days became something bigger than me, and time, the quantity of my sobriety, became more important than the quality of my sobriety. Today the time doesn’t matter. I finally understand what they mean when they say I only have today.

My favorite musical of all time, Rent, helps me to remember how important today is for my recovery. How important it is that I don’t let the fear of losing time prevent me from moving forward. How important it is that I never have to start counting days again.

“The heart may freeze, or it can burn… The pain will ease, if I can learn… There is no future, there is no past, I live each moment as my last. There’s only us, there’s only this. Forget regret, or life is yours to miss. No other road, no other way… No day, but today.”

Harm Reduction: The Answer to Community Drug Issues

There has been a lot of talk lately about the effects addicts have on the community. Especially when it comes to addicts using in cars parked in neighborhoods, syringes and other paraphernalia being found around our communities, and theft of personal belongings especially from cars. People in the community are up in arms about it. They want it dealt with, they don’t want to see it, they don’t want their children to see it.

The problem here is not that we don’t have solutions to these problems. We absolutely do. Progressive societies, especially the Nordic ones, have come up with some great alternative solutions to these exact problems. So why don’t we implement them? The answer is that people who have absolutely nothing to do with addiction, are not addicts themselves, do not work in the field, but live in the community, feel that they know what’s best for us and are so vocal to town administrations that it prevents these solutions from being utilized.

The issue is that these progressive solutions are not understood by the community at large. Harm reduction strategies seem “soft” or “counterproductive” or “enabling” to people on the outside, and even to some people on the inside. They are not ultimately fixing the problem, they are reducing the harm associated with the problem, which is why we call it harm REDUCTION.

If you don’t want to see active addiction in your community, you have to give it a place to go.

There are three big harm reduction strategies that address the problems our communities are facing.

1. Needle Exchanges

Needle exchanges are the easiest to implement, and the less invasive of all the harm reduction strategies I’ll be addressing. They can be mobile or stationary and there are advantages to both. Mobile exchanges are great because they can go to high traffic areas for drug users and meet them where they are, which makes it easier for many addicts to access their services. This works best in larger cities. In smaller communities, especially those that are more upward socioeconomic areas, a stationary facility can be a good option as well. Being stationary can provide more space for more services, so that the facility can possibly employ other agents who can assist addicts in other ways.

This directly deals with the issue of drug paraphernalia being left in streets, parks, parking lots, and other areas of the community. This is becoming an issue in a lot of towns, so why not confront it head on by creating a safe place to dispose of dirty works? Most towns have no place where people can safely dispose of syringes, even for diabetics! These facilities typically give one syringe for every one that is turned in. Even in the instance that they do provide syringes without exchanging them, people need to understand that syringes are not hard to come by. They can be purchased in bulk on the internet, and can be picked up in quantities under ten at many pharmacies. It’s not that these facilities are giving out contraband that cannot be obtained any other way. Addicts have always, and will always, find what they need when they need it. Needle exchanges are the answer to used and dirty paraphernalia in our communities.

2. Safe Injection Sites

Another big problem we are seeing in our communities is people parked in cars on neighborhood streets, people in public restrooms, parking lots, and other public places using drugs. Many addicts cannot go home to use because they are hiding from their families or the people they live with. I know many addicts who unfortunately have children in the home, whether the children are theirs or a relatives, and they don’t want to bring drugs into the home. Worst of all, many addicts are homeless and don’t have a safe place to use.

Providing these facilities gives addicts that safe place they need to take care of their business. It keeps addicts out of public places where they can be seen by residents, especially children. This also contributes to the work of needle exchanges in that it keeps works off the streets.

The best and most useful part of these facilities is that they virtually eliminate overdose deaths. They are typically staffed with medical professionals who can intervene in the event of an overdose and administer Narcan and life saving measures. Furthermore, they typically have counseling staff on hand to help those who are ready to get clean. They can fast track addicts into treatment and eliminate many of the barriers to getting clean.

Of course, no one wants one of these facilities in their neighborhood.

We have enough trouble opening methadone clinics in our communities. People seem to believe that these facilities bring addicts to the area, not understanding that addicts are ALREADY THERE. These facilities help addicts to stay alive long enough to hopefully get clean when they are ready.

3. Heroin Assisted Treatment

The most controversial of all the harm reduction strategies that exist in the world is heroin maintenance, or Heroin Assisted Treatment (HAT). Many countries utilize this program in a similar way to how the United States utilizes methadone maintenance programs. The clients are provided with a safe, synthetic heroin several times throughout the day and must use it at the facility. These programs are sometimes used in conjunction with methadone.

While this seems contradictory, it has had incredible success in Europe. Statistics show a decrease in illicit drug use overall, a lack of appeal of heroin to young people, and of course a virtual elimination of overdose deaths. Many people reduce their dose over time, just as with methadone, and eventually get their lives together. The idea is to taper addicts off over a long term, while providing counseling and other resources to help them eventually get off the drug all together.

While methadone works perfectly well for millions of people, some do have an aversion to the medication. Many people continue to use heroin in the early stages of methadone therapy, so these programs are basically providing addicts with a safer way to do what they’re already doing anyway. That’s what harm reduction is all about: Making addicts’ lives safer until they are ready to get clean.

Programs like HAT, while controversial, solve the problem of neighborhood crime. Our communities are seeing more and more petty theft such as car break ins, theft of landscaping equipment off trucks in neighborhood streets, and the theft of building materials from construction sites. This petty theft is how many addicts support their habits. HAT programs provide the narcotics that addicts need to prevent dope sickness, and are a reliable alternative to tainted street heroin. These programs keep people alive, period, and that should be enough in and of itself.


People hate the idea of harm reduction strategies because they see it as enabling. However, these strategies exist to help people be safer while engaging in behaviors that they are already going to engage in, regardless of whether the harm reduction strategy is implemented or not.

Something to consider while you’re rolling your eyes at these life saving strategies is that what the United States does and has done to deal with drugs has not and will not ever work. Incarceration doesn’t work. Making an addict a felon will not help them to live in sobriety. Prohibition has never worked. Police crack downs have never worked.

We really need to look at other progressive countries who have the actual science and statistics to back up their policies. Our insistence as a country of doing things our own way, despite plenty of evidence that illustrates that our way is not working, is allowing people to die in record numbers. Eventually, these programs will be proposed in your town. When that time comes, please ask yourself if you want to be part of the problem, or part of the solution. Trust science. Trust statistics. Be willing to open your heart and change your mind.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

Theft In Addiction: We’re ALL Guilty

Theft is a huge piece of the puzzle that is addiction. The vast majority of addicts, especially opiate addicts, have stolen something from someone or somewhere at some point in their active addiction. Whether it’s a few dollars from a parent or spouse’s wallet, a pawned piece of jewelry, or an old laptop, most of us are guilty of stealing at one point or another. When we think about theft in addiction, we typically think about the taking of a physical object that does not belong to us. However, that isn’t the only kind of stealing that we do in our addictions.

I recently had an experience with an addict who felt that she was better than the rest of us because as she put it, “I don’t steal”. Apparently she was independently wealthy, or able to maintain employment during her addiction and somehow was able to support her own habit. This is extremely rare, as even the wealthiest of celebrity addicts have used themselves broke in very short order. So this particular addict felt above those of us who have stolen during our addiction.

My father, who generally doesn’t have much to do with the deep and dirty details of my addiction and recovery, is the one who actually put the true nature of theft during addiction into perspective for me some years ago. Even though I never “stole” any money from my dad, unlike the countless dollar taken from my mother’s wallet and endless amounts of her jewelry that I pawned, my dad still felt violated and that he had been stolen from.

He explained that any money he had given me for spending money, bills, or other expenses that I in turn spent on drugs, was money stolen from him. He gave me that money for a specific purpose, and that purpose was NOT to buy drugs. To him, every dollar that I spent on drugs that came from his wallet, even though he had willingly given it to me, was money stolen.

But what about the things that money cannot buy? What about the time that is lost while using? I bet my mom would say that I stole what adds up to years worth of time that we could’ve spent together. She would say that I stole many nights of peaceful sleep from her. I stole her peace of mind. I stole her sanity.

These are all intangible things, things that can’t be measured in dollars and cents, but they are just as real and just as valuable, if not more, than any amount of money that I stole.

Worse still, I stole something more valuable than all of that from not only my mom and dad, but my brother, my aunts and uncles, my cousins, my friends, and anyone who knew me. I stole their TRUST. Trust can be easy to gain, and even implied among family members. However, once it is gone, it can be impossible to regain it.

I was banned from the homes of family members for years, because I stole that trust from them. I was not allowed to carry cash by my parents for years, because I stole that trust from them. Everywhere I went, everything I did, every word I said, had to be questioned. Even months into sobriety, I couldn’t be trusted to do something as simple as drive to pick up the Chinese food from around the corner. The theft of that trust is the most valuable thing I ever stole, and I took it from more people than I can count.

We steal so much in our addictions that can’t be measured.

Time, friendship, relationships, and trust are just a few of the non-monetary things we steal during our addictions. Money, electronics, cars, jewelry, all of those physical things can be replaced, and in some cases quite easily. The real theft is the emotional toll we put on those around us. There isn’t a single one of us who lived through an addiction that didn’t steal some sanity from the people who love and care about us.

So to any addict out there who feels “better than” because they’ve never been in a pawn shop or lifted a few bills from someone else’s wallet, just remember that the things you stole are just as real, and just as valuable. And until you understand and own that, you’ll never be able to repair the damage and you’ll never truly live life in recovery.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

Unpopular Opinions: Marijuana For Good

When it comes to the fight against substance abuse, especially geared towards students and young people, many communities are still wasting precious time and resources trying to fight against the inevitable legalization of medical, and eventually recreational, marijuana. While hundreds of people die every day due to heroin and other opioid related overdoses, we know that no one has ever, in the history of the world, died from an overdose of marijuana.

That doesn’t mean like with every single drug and/or medication out there that there are not risks. True that driving under the influence of any substance, marijuana included, is dangerous and can cause serious injury and death to not only the driver and passengers, but other innocent people on the road. It is true that we don’t fully understand the impact marijuana has on the growing and developing brain and body, so keeping individuals under the age of 18 from using this substance isn’t a bad idea. I certainly don’t object to efforts to keep kids from experimenting with marijuana until they are of legal age, just like we do with alcohol.

Fighting to keep marijuana illegal, whether it’s medical or recreational, is a complete waste of resources and it is a fight that will not be won by opponents of legalization.

Marijuana is one of the oldest, if not the oldest, mood and mind altering substances in the world. It has been used by humans for thousands of years for both medical and recreational purposes. We know that it is not a drug that causes fatalities. We know that less than ten percent of users develop an addiction to the drug, which is characterized not by regular use but by any negative consequences associated with that use. Smoking weed everyday, just like drinking a glass of wine everyday, does not make one an addict. Being unable to go to work or school because of the consumption of the substance, or financial issues resulting from money spent on the substance, or the ability to live a functional life due to the substance would indicate a possible addiction. This is extremely rare when we talk about marijuana, just like with alcoholic beverages. Many people consume alcohol on a regular basis, with about 70% of Americans reporting drinking within the past year.

However, just like with marijuana, less than 10% of individuals who drink have a problem with alcohol consumption.

So why is marijuana illegal while alcohol is not? Many people believe that it goes back to industries that lobbied to make hemp illegal because it would be a more cost effective alternative to their products. Hemp is an incredible resource that can be made into paper, textiles, and hundreds of other everyday products, so other industries vilified the drug itself to prevent it from harming their business and bottom lines. Other reasons trace back to early immigrants who used the drug, so just as we do today, the white people vilified the drug because it was linked to brown immigrants who they considered dirty, lazy, and undesirable. We are all familiar with the prohibition of alcohol, and the propaganda used against it. It has been much the same with the prohibition of marijuana.

Many people in the treatment industry believe that if one is sober, that they need to abstain from every mind altering substance out there. This is the way promoted by Twelve Step fellowships, and consequentially this is the philosophy held by the majority of those who work or live in recovery. Just like each person gets recovery in their own way, the parameters of what recovery means can be different for different people. Many people in recovery from drug use are able to drink alcohol without consequence, and the same is true of casual use of marijuana. It is up to each of us as individuals to decide what recovery means to us.

When it comes to opiates, marijuana has been used for decades, probably even longer, to help with the withdrawal effects. Historically, people who couldn’t afford to get on methadone or receive other kinds of treatment have turned to marijuana to help with both acute and post acute withdrawal. Many people use it just like methadone or Suboxone, as an unofficial maintenance program to help them cope with the long, years long process, of staying off opiates. If we can treat opiate dependence with marijuana instead of other opiates, then why shouldn’t we? Isn’t it a better alternative than staying dependent on methadone or Suboxone for years on end? Some states get this, and are trying to move forward with “marijuana maintenance” programs for those addicted to opiates.

In the same vein, isn’t it better to prescribe marijuana for various medical conditions than the alternative of prescribing dangerous opiates and benzodiazepines? The dependence and side effects of these drugs are so dangerous and even deadly, while the alternative of using marijuana is much safer. I’d rather see a chronic pain patient smoking weed or using CBD’s to treat their condition that spending their life dependent on an ever increasing dose of oxycodone.

We’ve all seen the videos online of people having seizures, or episodes of indescribable pain, and using marijuana almost instantly reverses the symptoms. It is inhumane to allow people, especially children, to suffer from pain, discomfort, or crippling anxiety when we have a drug that can be used to treat it with little to no side effects. There are countless strains of marijuana that can be used for all kinds of issues. Each strain has a unique set of traits that can be applied to almost any illness or condition.

Legalization would provide an incredible amount of tax revenue to our communities. It could solve a great deal of budget issues. Furthermore, it would drastically reduce the number of people that are incarcerated for possession or sale of marijuana. It would put a significant dent in our prison overcrowding problems. It would significantly lessen the traffic through our courts and drastically reduce the number of people who participate in diversion programs and who are on probation. It would lower the number of children who are placed into foster care, and parents who are trapped in DCF programs, simply because they use marijuana. This is basically the equivalent of taking the children of parents who drink alcohol, and since most adults in this country drink, everyone should be able to see how ridiculous this policy is.

When opponents of marijuana are asked to explain their argument, they have nothing but junk science and skewed studies to support their position. Marijuana is no more dangerous than alcohol, and in all honestly probably less so. We are spending copious amounts of money to keep this drug illegal. We have to pay police, prosecutors, public defenders, advocates, court employees, treatment centers who run diversion programs, and an endless list of people and agencies. It costs a lot of money to keep this drug illegal, while legalizing it would actually GENERATE money. Dispensaries could bring jobs to our communities. Imagine the research that could get done on so many different diseases and medical conditions once we work to eliminate the stigma associated with marijuana.

Marijuana is just as valid of a medication as pain killing opioids, with a fraction of the risks associated with them. It is also just as safe of a recreational drug as alcohol, if not more so. The health risks are really in the ingestion method, which is typically smoking. However, using cannabinoids and marijuana itself in other ingestion methods would eliminate this one potential danger. We can do better when it comes to the ways we treat many different diseases and conditions, including the terrible issue we have with opioid dependent individuals. We need to focus our energies on the prevention of dangerous drug use, like that of opiates, and stop wasting our time and other resources fighting something that just isn’t worth the battle.

Rather than a danger to those in recovery, marijuana could be, and to many people already is and has always been, a blessing.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

I’m Still Here: Treatment for Long Term Sobriety

I often talk about changes on this blog. Changes that are happening, and changes that need to happen. There is an endless list of things wrong in the sphere of addiction. From the problems with the way the police and justice system deal with addicts, to the stigma we deal with in the general population, and even on the front lines in the treatment world.

There are many different kinds of treatment out there. There is a lot of treatment available to someone who is in the very beginning stages of sobriety. We have the highest levels of care in detoxes, which then typically lead to an inpatient or Partial Hospitalization Program (referred to as PHPs). The level of care after that is generally Intensive Outpatient Programs (referred to as IOPs). There are no rules to the order in which someone engages in treatment, except that most programs do require someone who is actively using to have completed a supervised medical detox before enrolling them in treatment. Some people jump right into an IOP without having gone through an inpatient program.

The problem with any kind of outpatient treatment is that is allows the client to still engage in addict behavior while enrolled in treatment. Whether it is actively using, or other shady behaviors, it can be challenging to break those habits and that lifestyle while only engaged in treatment a few hours a week.

This is a problem that not only outpatient treatment programs deal with, but that is common in the rooms of twelve step programs as well. Everyone who has ever been in treatment or in the rooms has been told to “stick with the winners”, meaning that you shouldn’t hang around with people who are struggling to live a clean and sober life.

This philosophy can be difficult to adhere to, however, when those with good clean time are mixed into a group session at the treatment center with those who are still struggling to stay clean.

This issue basically stems from the major problem with treatment in general, which is that there is little treatment available for those in long term sobriety.

Once you have over a year of good clean time, your life generally changes in very significant ways. For most of us, our legal problems have been resolved. We are no longer on probation, and if we are on a long term probation that has extended multiple years, we are no longer worried about violating our probation in our daily lives. We don’t worry about giving dirty urines. We don’t have open cases with DCF and we don’t worry about losing custody of our children. If we have lost custody in the past, we have regained it or are in the process of regaining it. We don’t associate with people who are actively using, even if it’s only occasional slipping. We no longer frequent places like pawn shops, or spend time hanging out in the streets. We have realized major changes in the three areas I talk about that indicate true recovery: Behavior, Mindset, and Intent.

For these reasons, I generally avoid attending groups or twelve step meetings. I don’t want to spend time talking about those early recovery issues, because for me personally, it puts me in a negative mindset.

It is extremely triggering for me, personally, to be put back into a room full of people who have a totally different set of behaviors, a completely different mindset, and a dangerous intent.

Keep in mind, AS ALWAYS, we are all unique in our experience. For some people, they call it “keeping it green”, which means being reminded of those bad times so that they remember not to fall back into those old routines. For those people who find that kind of group experience to be beneficial, they should continue to utilize it as part of their program of recovery. However, for myself and many others, we prefer to stay moving forwards.

Yesterday I made the mistake of attending a group at my treatment center. I typically only attend one group, which is an aftercare group for those of us who have completed IOP and are succeeding in recovery. There is only one of these groups available, and all the rest are open to everyone, regardless of their level of recovery. Don’t get me wrong, these people need groups, and they should be welcome to attend them. The problem for someone like me, with multiple years, is that we need a different level of group care.

This group was completely out of control from the minute it started, which was ten minutes late. The topics of discussion were all things that are typical problems for people who are still using. Custody issues, probation violations, arrests from pawning stolen items, you name it. The individuals who were talking dominated the entire group, and became agitated every time the counselor tried to reign them in. The topic of the group was supposed to be “Coping Skills”, which is something we all need to work on. No one on this earth has perfect coping skills. However, there is a big difference between coping with the early days of sobriety and coping with the problems that arise for us later on.

The treatment industry needs to take steps to address the needs of those who are living in recovery long term. I am proud that my treatment center does offer the one aftercare group that I truly benefit from, but we need more. We need to make it a common practice in treatment centers to offer groups to those who have a history of clean urines and whose counselors can approve them to attend based on their time in recovery and what they have accomplished during that time.

The problems that generally arise stem from trying to ascertain what qualifies someone to attend what we might call an “advanced” group. For me it always comes down to the three qualifiers of Behavior, Mindset, and Intent. Is this person engaging in any negative behavior? Is their mindset focused on living life in recovery? What are their intentions in their daily life? These are observations that a counselor should be able to make regarding each of their clients, and determine who has come to a point in their recovery where their daily challenges have changed from those faced by someone who has less progress.

My daily challenges have drastically changed from the ones I dealt with three years ago, or even one year ago. This is why I struggle to sit through a group with people who are still navigating those early struggles.

We need to break down the recovery process further than simply clean vs. dirty.

Progressive treatment centers need to find ways to cater to clients in every stage of recovery. Someone who has been in recovery for ten years probably has much different challenges from someone who has been clean for three years. Someone who has been clean for six months is in a totally different place for someone who is still counting their first thirty days.

Everyone who desires a life in recovery deserves to have their unique needs addressed by their treatment center. When we talk about opiate withdrawal, the Post Acute Withdrawal process can last up to two years, but the average treatment center provides no more than eight weeks of care to clients enrolled in an IOP. What happens after that? Where is the follow up care? We need to do a better job with the follow through process when it comes to continued care.

A diabetic doesn’t get prescribed insulin, spend a few weeks getting monitored, and then get sent on their way. They continue to report to their doctor and talk about what is working and what is not working for as long as necessary to keep their condition under control. A cancer patient doesn’t go into remission and then never see their doctor again. They go back for testing for years to ensure that the cancer doesn’t return, and if it does, it is caught early BECAUSE of the continued regular monitoring.

Addiction is an all consuming disease that totally alters every single facet of our lives, and it typically goes on for months or years. When we talk about weight loss, we always hear that it took so long to put the weight on, so it’s going to take just as long to lose it. We need to treat addiction and recovery the same way. Changing your behavior, mindset, and intent amounts to changing your entire perspective on life. These changes cannot be made overnight. We spent years building these negative habits, and it can take years to fully break them and replace them with our new way of life.

This is just one of many changes we need to see moving forward in the treatment of addiction. The list of steps towards progress is endless, and it’s going to take time to implement new strategies of care as we change the way we look at and treat this deadly disease. The good news is that there ARE progressive treatment centers who are looking beyond the twelve step model to see what else is out there and what other ways people can get into and stay in recovery. What changes would you like to see in the treatment of addiction? Let me know in the comments!

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

Liar, Liar: When You’re High Functioning & Mentally Ill

There are few people out there as open about their addiction and mental health as I am. Anybody who knows me knows that I have some long term issues that I have been dealing with my entire life. The problem is that actions speak louder than words. Even though I am very vocal about my problems, people don’t often see them in action, so they believe they aren’t really there, or are not as severe as they are.

When someone is more high functioning in their mental illness, the way I am, people often think that we’re making up our symptoms or that our diagnosis isn’t real. Because we present as articulate, educated, or in any way “normal”, people think that our mental illness is made up or in some way not serious.

There have been times that I’ve explained to people that I am disabled, and receive disability assistance. I cannot tell you how many times the person has said some form of “You’re so lucky! I wish I was disabled!” No one would ever dream of saying that to a person who had lost a limb, or someone suffering from a serious physical illness. What possess a person to think that being mentally disabled is something to be desired?

What people don’t see is what happens in private. Classmates notice that I miss a lot of school, but when I’m there, it doesn’t seem like anything is wrong. I have always done an excellent job of blending in, acting normal, and keeping the crazy to myself. Even close friends who I have known for years don’t know the extent of my mental illness. I have been able to work a variety of jobs during certain points in my life, and have even owned my own business. On the outside, it seems like I’m just a normal person, maybe with just a few quirks.

The first thing to understand is that I am very medication compliant. I have grown out of the phase where being manic on purpose sounds like fun, so I generally always take the medication that is prescribed to me. However, sometimes the disorder outsmarts the medication. I do suffer from break out episodes from time to time, including some that are very severe and others that are less so.

Bipolar I is the most severe form of Bipolar disorder. It is characterized by extreme highs and lows, which isn’t a very illustrative way to describe the symptoms. People often mistakenly believe that the bipolar high just means a person is very happy. This is simply not the case. The manic high can be just as risky and dangerous as the depressive lows.

Mania is characterized by rapid speech, sometimes so fast that people cannot even understand what I’m saying. Additionally, the thoughts being expressed flow so quickly that people cannot keep up with what I’m trying to say. In my brain, thoughts are cycling a mile a minute. It is difficult to stay on task, because I am prone to jump from one thing to the next without completing any of the tasks at hand. People who are in a manic episode are also prone to risky behaviors outside of their regular character. Common behaviors are shoplifting, wild spending and buying things that you do not need, including multiples of items you already own, excessive drinking or drug use, promiscuity and risky sexual activity, and risky or dangerous activity in general.

During a manic episode, people are prone to grandiose thoughts and behaviors. They believe they are capable of things that they normally would not consider possible. The paranoia is also very real. It’s easy to start believing that people are talking about you, ignoring you, or conspiring against you.

You start to get in arguments and debates inside your own head.

Irritability is another common symptom of mania. Snapping at people, losing your patience very quickly, and having a low tolerance for anything that isn’t going exactly your way are all common attributes of someone dealing with a manic episode. It’s very contrary to the mistaken idea that a manic person is happy. A lot of irritability for me in mania comes from people not keeping up with my crazy train of thoughts and ideas. I start to feel like everyone around me is a complete moron for not being able to make sense of my delusional thought process. It can feel so frustrating, and make me feel so powerless, that often times I dissolve into tears and the whole episode of frustration and irritability to the point of break down happens so fast that people around me are just completely confused as to what in the hell is going on.

Mania can turn into psychosis in some people, myself included. This can be as simple as hearing things that aren’t there, or thinking you saw something that wasn’t real. It can progress into losing track of time and space, being unsure about how you got somewhere or not knowing where you are. It can be very frightening and disorienting.

On the other end, individuals suffering from Bipolar I can suffer from depression that is just as crippling as those with typical clinical depression. It starts with being withdrawn, pulling away from people and things you care about. You feel overwhelmed by life in general, and simple daily tasks become too difficult to even consider.

There are times when I don’t shower, brush my teeth, or even eat, for days at a time.

When you are incapable of basic grooming, the thought of going to school or work is simply out of the question. It feels like the world is coming down around you, like you’re drowning in your own despair. It also manifests physically, making it something that you can’t just snap out of. I get a lot of headaches that make me so dizzy I am unable to drive, or even sit up in a chair. I have no choice but to lay down until it passes. Muscles and joints become sore, so much so that even if I could motivate myself to shower it is physically impossible to hold the blow dryer to dry my hair.

Deep depression is also very disorienting. You become confused about time and dates, losing track of where you’re supposed to be and when. You can become extremely forgetful, and even the most intelligent and capable person can start to feel, and act, like an idiot. You can forget how to do basic tasks that you’ve done a thousand times before.

There are also episodes that we refer to as a “mixed state”, where elements of both mania and depression manifest at the same time. There are some theories out there that Bipolar patterns will change after the introduction of psychiatric medications. I personally think there may be some truth in this. When I was young, my patterns were very easy to detect and follow. Now, after fifteen years of treatment with medications, I experience many more mixed episodes and a much less discernable pattern to the highs and lows. This can also be attributed to the disease changing as I get older.

Living with Bipolar I is a lot harder than people think, because so many of us who struggle with it are very good at hiding its symptoms. Many brilliant people in history are suspected to have been Bipolar, because so much creativity can flow from the episodes. This makes it even harder for people to understand that just because I may seem smart, or put together, does not mean that I am not mentally ill at the same time.

For those of us who have substance abuse issues as well, it is even harder for us to get and stay sober.

When our mental illness takes us from our ability to make rational and logical decisions, we are prone to relapse even when we have been enjoying long term sobriety. Many of us suffer from extreme episodes during early recovery, when all the chemicals are going crazy in our brains. It makes it very challenging to let go of the safety net of regular drug use.

Anyone who knows anything about SSI and SSDI (the two government programs for disability insurance), knows how challenging it is to get accepted. People apply over and over, some with very serious disabilities, and are denied time and again. Getting approved on your first application is almost unheard of. When I presented my history to Social Security, not only was I approved on my first application but in record time. I did not have an attorney or someone to help me navigate the system. I did not have any advantages in any way. All I had was a fifteen year history of severe mental illness, complete with multiple hospitalizations. Not even the government could deny the reality of my situation, even while people around me routinely do.

Despite the severity of my mental illness, no one really knows the true depths of the insanity besides my mother. Even my father, who has been around this entire time, does not fully understand the severity of my condition. He thinks disability is a temporary situation, and that I will finish school and get a full time job. The likelihood of this happening is slim to none. I have never done anything for 40 hours a week with any kind of regularity. I have not been able to complete a full 30 hour school week yet, up to this point. Every time I try to take on more than about 20 hours of commitment, whether to a job or school, I wind up dissolving into a complete break down. Forget school or work, I find myself unable to take care of my basic human needs. I just cannot handle it.

Just like with my father, people who have known me for many years still don’t get it. Whether it’s friends or family, they just don’t understand how severe and far reaching my mental illness truly is. They don’t realize that what they have seen is just the tip of the ice berg.

They have never seen the true extent of my issues, and because of that they have expectations for me that are beyond unrealistic.

The government awards disability to people on the assumption that their situation is permanent, or very long term. I have been dealing with this disorder for over fifteen years. My track record is pretty solid. What gives anyone the idea that I’m suddenly going to morph into this healthy, “normal” person is beyond me.

If it wasn’t for my family and the support they have given me, I would likely be living in some kind of home for disabled adults. I have been working very hard to shift the financial responsibilities of my life and well being off of my parents and on to the programs that are available to me. My parents won’t be able to support me forever, and it’s important that I find a way to survive in this world without their constant attention, supervision, and finances.

The point of this blog is not to garner sympathy. It’s to bring awareness to the fact that none of us know what the people around us are going through in private. Even when someone is as open as I am, the people around us still don’t know the true depths of our issues.

I want people to understand what living with a severe mental illness is really like, the way it affects our daily lives, and to know that what they see on the outside may not be a true reflection of what’s going on inside.

Even those of us who share a diagnosis do not share the same level of disorder. Some of us are more functional than others. Some of us are very good at hiding our dysfunction. Bipolar Disorder is characterized by episodes that come and go, leaving us somewhat “normal” in between. That’s why people think we are better off than we really are, because they aren’t seeing the extent of the illness at its worst.

As an advocate, it’s my job to draw attention to the issues that addicts and mentally ill people face every day. I choose to be honest about my own struggles because I firmly believe the only way to reduce stigma is for those of us who are dealing with these issues to be honest about what we face and what our struggles are.

If I wasn’t honest with school administrators, I would’ve never graduated high school. I needed accommodations then, and continue to need them now. I’ve needed them at every job I’ve ever had. The point is that the help is out there for those of us dealing with mental illness to still succeed in life. If we advocate for ourselves and the assistance we need, we can still do things that “normal” people do like go to school or hold a job. We need to illustrate that many of us do present as “normal” people sometimes, so that those around us understand that it is possible to be crippled by symptoms one week and be highly functioning the next. We need to help people around us understand our strengths and our limitations, so they can be more sensitive to our needs the way they would be with a physically disabled person.

It is also important to remember that mental illness can be fatal. When untreated, and even sometimes when it is treated, those of us suffering from mental illness can become suicidal. We are also at risk of injury or death from risky or dangerous behavior during episodes. The times in my life when I have felt this way have been largely from feeling misunderstood and incapable of keeping up with the world around me. Feeling like a failure at life, a failure at doing the most basic things that “normal” people do, like working a normal 40 hour work week or graduating from high school, can make someone suffering from a mental illness feel completely invalidated and useless. I have often felt like a burden on my parents, and have at times convinced myself their lives would be easier and better if I wasn’t around.

When we are honest with ourselves, and in turn honest with those around us, we can set ourselves up for a more successful life. We can seek special accommodations from school or work, to help us succeed when we otherwise might not be able to. I have tried a lot of things, and have had many failures along the way. Sometimes special accommodations can make an impossible thing possible. Sometimes we still fail, and that’s okay too. It can be very difficult to not feel as though people are looking at you like a faker. Part of that is paranoia from the disorder, and part of that is factual. I just try to remember that the people who matter most know the truth. My doctors know the truth, the government knows the truth, and my mother knows the truth. If people think I’m fabricating something or exaggerating, that’s on them. Luckily, the government protects me and others dealing with mental illness from discrimination under the ADA (Americans with Disabilities Act). But that doesn’t mean we don’t have to continue to advocate for ourselves.

Many people are dealing with mental illness in secret, due to the shame and stigma that surrounds the topic. I encourage you to be honest with yourself, and get honest with at least one person in your life who doesn’t know or understand your situation. Challenge yourself to be honest, and challenge them to learn about your disorder and stand by you despite it. You never know, that person may be dealing with their own issues and you could start a dialogue. You’ll never know until you take that leap, and get honest, about who you really are and what you’re really capable of.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

Three Strikes: You’re Out (of Treatment)

There are a lot of changes happening in the treatment industry these days. One of the best things that can possibly happen to this antiquated system is that is makes a sweeping change in one area that has been rock solid since the treatment industry began: “Zero Tolerance” and “Three Strike” rules when it comes to positive urine screens in treatment centers.

Whether we’re talking about complete black out zero tolerance, or a three strikes type of rule, treatment centers have long had this area of recovery so dead wrong that it’s actually laughable when you break it down. Laughable, until you consider how many addicts have probably died after being thrown out of treatment when they wern’t ready.

The average American can’t even stick to a healthy diet when they’re trying to lose weight. The average American can’t even resist a hamburger. We have companies like Jenny Craig, and Weight Watchers, that are like the treatment centers for obesity. These companies act very much like treatment centers for addiction, with one sweeping difference: They don’t throw you out on your ass when you make a bad choice and eat a cookie.

Imagine that you’re trying to lose some weight, and you go in to your weekly meeting at whatever program you’re involved in. You’re having a rough time, you’re really struggling with keeping to that diet. When it’s your turn to share, you admit that you cheated on your diet program. What happens next? You receive support from the weight loss leader. Maybe they give you the “We’ve all been there before” speech. They tell you that what’s done is done, now get back on track. The group rallies around you, maybe you get a little sticker for your honesty, and you don’t feel so bad about it by the end of the meeting. You resolve to get back on track and you’re feeling confidant, lifted up by your group, and your feelings of guilt and shame have been put to rest. The next day you get back on track.

How many of us, especially us women, have been through this before? There are no weight loss programs out there that shame us when we fall off, because if they did, no one would subscribe to that program. Because nobody wants to feel shamed. Nobody wants to pay someone to help them and then have them make you feel like garbage when you inevitably struggle with such a significant life change.

Now take that diet that you’ve struggled with over the years, and amplify it by a thousand times. Heroin addiction is much harder to kick than a hankering for chocolate, but the sensation is somewhat similar as it affects the same part of the brain. So amplify your worst food craving, your biggest diet weakness, and imagine it ruling your life. Imagine that if you didn’t eat that chocolate, that you would start to feel sick. You would start to sweat, your muscles would ache until it felt like your actual bones were cracking from your insides. Your bowels empty into the toilet like an explosion, but you also have to vomit and you can’t get off the toilet so you contort your body to try and reach the sink, or the tub, but only half of it makes it and your vomit gets all over your bathroom. All you have to do to stop it is eat the chocolate, but that would mean cheating on your diet.

Treatment centers for addiction could take a cue from weight loss programs. Instead of meeting slip ups with guilt and shame, they could try the “build you up” approach. Unfortunately, this is an industry that vilifies the shame placed on us from the outside while manufacturing shame on the inside. When someone slips up in recovery, they need to talk about it. Burying it only escalates the problem, just like with dieting. But often times, addicts keep it close to the vest because of the repercussions they’ll face in treatment and in the recovery community.

The shame from peers and professionals is bad enough, but getting thrown out of treatment is the usual consequence addicts are trying to avoid. This idea that you have to want to be in treatment, and if you wanted to be there then you wouldn’t screw up, is asanine. At our core, many of us want to be sober, but we need help. That’s why we are in treatment, because we need help.

No treatment center on this earth, no matter what their alleged success rate is or how good they think they are, is good enough to get someone sober on their first day of treatment. Or their first week of treatment. Or even their first MONTH of treatment. It takes time to relearn these habits, to relearn how to do everything from go to work to cook dinner to bathe yourself without using. Treatment centers expect you to enroll on Monday and never use again, even though you are still IN TREATMENT, it’s not like you learn everything you need to know on that Monday and you are set for life. You are learning every day, and you NEVER become an expert. There is always something new to learn in recovery.

Therefore, it stands to reason, that it might take some time in treatment before you get the hang of not using every day.

Maybe you’ve cut it down to just the weekends, and are progressing towards using less and less. Maybe you’ve been sober for the whole month, but then have a slip up. This is exactly when you SHOULD be talking about it with your counselor and your group, but we so often don’t because we’re afraid to get thrown out of treatment. Even if we don’t get thrown out, maybe that’s one of our “three strikes” and we can’t afford to waste one if we haven’t actually gotten caught with a dirty urine, so we bury it and pretend it never happened.

Any treatment center that gives an addict an incentive to lie is failing in my book.

If an addict feels the need to cheat or dodge a urine test while in treatment, that treatment center is doing something wrong. You preach honesty as a pillar of recovery but encourage clients to lie and hide their truth for fear that they aren’t getting recovery fast enough for your thirty day program.

When you think about it, it literally makes no sense. Imagine going to the doctor and you’re told you have high cholesterol. They tell you that you need to improve your diet, maybe they put you on some medication, and when you go back next they expect to see an improvement. That’s what they are looking for: AN IMPROVEMENT. Not that you’ll be cured by your next appointment!

Addiction is the only disease where we expect the patient to cure themselves BEFORE they finish treatment.

We expect addicts to become abstinent from their first day of enrollment in treatment and stay that way for the rest of their lives, before we’ve even taught them anything! It’s actually insane, when you think about it.

So what is the alternative? Obviously not a free for all, use all you want while you’re in treatment philosophy. The idea is that we should be improving, and working towards total abstinence, so that by the end of treatment we’ve gotten the hang of living life without our substance of choice. For some, that may mean giving it up on day one and never looking back. For most of us, it doesn’t work that way. We struggle, we falter, we are imperfect.

Treatment centers need to keep their doors open to clients well beyond the three dirty urines most will tolerate. If someone wants to be there, but they are struggling to get sober, who is to say they don’t deserve to keep trying? It takes many of us multiple treatments, multiple relapses, to get there. Maybe this wouldn’t be the case if we could go through this process of success and failure WHILE in treatment, rather than in between treatments.

I have NEVER gone through a treatment and stayed sober from day one. I have had many long term stretches of sobriety, but every single time I have had slip ups along the way, including this time. That’s why I don’t count sober time and sober dates. I have been living in recovery for a few years now, and if I had to “start over” every time I slipped up during the early days, I would’ve gone off and running each time to make the restart worth my while. Having a philosophy that separates “clean time” from “recovery time” makes it easier to get back on the wagon after a slip up. Just like when you’re on a diet, and you eat a cookie, you don’t start the diet all over from day one. You made a mistake, but you’re still on a diet. One cookie doesn’t negate all the kale and grilled chicken you’ve been eating for months.

As we learn more about the science of addiction, some treatment centers are becoming more progressive and embracing this crazy idea that you don’t get sober overnight. Unfortunately for these amazing facilities, they are bearing the burden and overflow from all the treatment centers who throw out clients that actually want to be there, but are still struggling to “get it”. We need to continue to advocate for more research, and more understanding, in the treatment of addiction. If we fail to do so, more and more people will be pushed out of treatment for “relapsing” before they’re even given the chance to get in recovery. I encourage those who advocate for zero tolerance and limited “chances” to think about this the next time they’re on a diet.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

No Stigma, Know More

Those of us who have lived through an addiction, or are currently dealing with one, know what our biggest enemy is, and that is stigma. We talk about it all the time. We complain about the way people judge us, the way those on the outside don’t understand addiction, and the lack of support from everyone from our families and friends to the government. We are angered by the perceptions people have about us and our family members who are in active addiction or recovery. They don’t know who we really are, that we are good people from good families and that this can happen to anyone. But then we feed it.

We feed it by whispering among ourselves. We feed it by hiding our status or our loved one’s status as an addict once we get established in recovery. We don’t tell people about our history, like it never happened. Parents don’t talk to other parents, unless their kids are also affected. We stay isolated among ourselves and we feed this stigma that we then complain about.

We cannot wait for others to one day wake up and change their minds about how they perceive addicts. The only way people’s perceptions change is when they come into contact with someone who alters their reality surrounding addiction. We have to be those people.

It’s our job to advocate for a change in the way the world views us. When someone loses their battle, and succumbs to a fatal overdose, it is their family’s job to honor their battle by being honest about how they died. When we say a 23 year old with a known drug problem “died suddenly” with no explanation, the world knows what happened and they know you are hiding. That tells people that you are ashamed of your child and how they died, whether that is true or not. That is the message you are sending. That is the perception you give people when you fail to tell the truth. If they died of any other disease, you would acknowledge it. Obituaries are a way for us to acknowledge the fight, and how powerful addiction is when we lose that fight. They are also a way for us to draw attention and donations to organizations that may have served us during our struggle.

Once you or your child gets established in long term recovery, this is an ideal time to wave your addict flag. Because this is the time where you are showcasing an addict at their best. You are showing what can happen when recovery is realized. You are showing people that there is hope, and that this disease can be treated and can be overcome. When you decide the bury the struggle you and your family have just conquered, how are you helping the next family? How are you reducing the stigma that you are so upset about?

When your child is out there in their addiction, and people ask you about them, tell the truth. When you are embarrassed of your child and their truth, what does that say to your child? That you are ashamed. That you are hiding them and their addiction. If they had cancer, how different would the situation be? You would be seeking the best treatment you could find, you would be asking everyone you knew for their thoughts and prayers, and the people in your life would rally around you with concern and support.

People don’t know how to act in these situations because when we are hiding, we are sending the message to the people in our life that we are ashamed and we don’t want to acknowledge what is going on. It can be scary to come out with the truth, because people don’t know how to act or respond. It’s our job to teach them. Then they can teach others. Eventually, we begin to change how people regard addiction and we begin to reduce the stigma. If the people in your life are too caught up in their own ideas about addiction, and they can’t bring themselves to support you, then you should seriously consider their role in your family’s life. It may take some time, and some education, to help bring them around, and that is okay. Don’t complain that they don’t understand, because it is our job to teach them and educate them so that they can come to at least appreciate what you’re going through, even if they never truly “understand”.

We need to be vocal about our struggles and proud of our accomplishments.

We need to teach the world around us about this disease, and how to support us while we’re going through it. When we ask an addict not to talk about their disease, especially when they are in early recovery, we are invalidating them as a person because their disease becomes their entire life at that stage. If they have just come from treatment, if they are fresh in recovery, their recovery is their WHOLE LIFE right now. For some of us, even years later, it remains a significant part of our lives. When we are asked not to acknowledge it, we are being asked to hide. No one would ever ask a cancer patient not to talk about their disease, their treatment, and their recovery. The disease of addiction is just as pervasive, just as all consuming, and just as fatal as cancer.

When a classmate of mine was battling cancer a few years ago, he told me something I will never forget. He said that he wouldn’t trade places with me, because he couldn’t imagine being blamed for the disease that was trying to kill him.

When it comes to the stigma surrounding addiction, those of us who are affected are on the front lines. We need to be proud of who we are, and what we deal with. If we want there to be a change in the public perception, then we need to get loud and get proud about our circumstances. You are your best advocate. If you want to see a change, BE that change. If you want there to be no stigma, then we need to teach people to know more about us and the war we are fighting each and every day.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

No Harm, No Foul: Harm Reduction Saves Lives

When we talk about addiction, everyone is always in a hurry to point fingers and say that nothing is being done to address the issue. The problem is that so much of treating addiction comes down to harm reduction, rather than harm elimination, and the average person on the outside of the issue does not understand this concept and because they do not understand it, they therefore do not support it.

Harm reduction is simply offering a safer option to a dangerous idea or activity as it relates to addiction. Unfortunately, the solutions offered are themselves still risky or dangerous. Because of this fact, the general community often balks at the ideas presented to help protect addicts. People are quick to call harm reduction strategies “enabling” or “switching addictions”, not recognizing that the addiction already exists and the objective is to provide a better option in the effort to save lives.

We see examples of harm reduction in our daily lives all the time. Sunscreen, seat belts, condoms, and nicotine patches/vaping are all examples of harm reduction strategies that we believe in and practice as a society. These strategies take a dangerous activity and seek to make it safer, as an alternative to not engaging in the activity at all. Laying out in the sun is dangerous due to the risk of skin cancer. We all know that we shouldn’t do it. However, wearing sunscreen makes this dangerous activity a little bit safer for those who are going to do it anyway. The same theory applies when we talk about addiction and substance abuse.

The reason we try to implement harm reduction strategies is because people cannot get treatment and maintain any kind of sobriety if they are dead. In order for someone to eventually succeed in recovery, they need to remain alive long enough to receive the message of recovery and get to the place in their disease where they are ready and able to achieve it.

Medical Maintenance for the long term treatment of opioid dependence is the most basic example of harm reduction. Options like Suboxone and Methadone are not free from consequence. They are both still forms of opiates, whether partial or full agonists, and still effect the brain long term. They have side effects and can be inconvenient as far as time spent at the doctor or clinic. Ideally, addicts would get sober and stay sober through abstinence alone. However, because addiction is a brain disease that affects the pathways in the limbic system of the brain, in many cases they are just unable to control their cravings and urges to continue using. Utilizing these medications is exactly what harm reduction is about: It’s less dangerous, less risky, and a step in the right direction. It is better than the alternative of actively using opiates to get high, though it may not be the ideal solution.

Narcan is another great example of harm reduction. Narcan (naloxone) is the medication carried by paramedics and used by doctors to reverse the symptoms of an opioid overdose. Common objections to the push to make this drug more widely available sound a lot like conservative arguments against birth control. There is an insane idea out there that if addicts know that their overdose could be reversed, that they are more likely to take the risks that lead to overdose. There is even a rumor going around that addicts get together and have “Narcan parties”, intentionally overdosing themselves so a partner can administer Narcan and revive them.

The reasons that this is false and extremely unlikely are many, starting with the excruciating pain of instant withdrawal that follows the administration of Narcan. This medication is a method of harm reduction because it allows addicts to have another chance, another day on this earth, to hopefully work towards recovery. Making it widely available increases the chances of more overdoses being reversed and more lives being saved.

Another example of harm reduction strategies are needle exchanges. These facilities are available to known addicts who must present their used syringes in order to receive new, sterile ones in their place. Objections are of course raised anytime an addict is provided the means to use. The issue here that you need to keep in mind is that these addicts are already using. They have to prove that by presenting their used needles to the facility in order to receive the new ones.

The risks of sharing needles are not only obvious but extremely dangerous. The spread of potentially fatal diseases such as HIV/AIDS and other blood borne illnesses such as hepatitis are extremely common among needle users and completely unnecessary. The proliferation of these illnesses creates even more problems for the medical community to solve at the expense of taxpayers due to the large number of uninsured addicts in this country.

This is and has always been a tremendous problem in the community and could easily be solved by making clean needles readily available to anyone who requests one.

Aside from sharing needles among multiple users, there is also the issue of individuals reusing syringes time and time again because they do not have access to new ones or cannot afford to purchase them. Reusing a syringe can lead to serious infections and permanent tissue damage from abscesses at injection sites. In Connecticut, the law currently allows pharmacists to dispense up to ten syringes to an individual without a prescription at the discretion of the pharmacist. This is problematic because it allows pharmacists to deny citizens their legal right to possess those syringes. It is important that we increase the availability of clean syringes to those who use them if we want to stop the unnecessary spread of disease and the instances of dangerous abscesses and infections among needle users.

More extreme instances of harm reduction come in the form of safe injection sites. These facilities are staffed by nurses, doctors, EMTs, and other medical professionals. Addicts can come to the facility and are offered a safe, semi-private place to prepare and administer their drugs. They are provided with clean syringes, cotton, cookers, tourniquets and other supplies to help keep them as safe as possible while using. This is easy to mistake for enabling, but what you need to remember is that these are known addicts who are already planning on using their drug of choice.

The only difference is that instead of shooting up in a public bathroom or park, where your kids might be washing their hands or playing on the swings, these people are removed from the general public into a private location where the community doesn’t have to watch them, and they don’t have to worry about being watched. Most importantly, the medical staff is available in case of an overdose or other issue that arises related to using. Often these facilities are staffed with counselors and people who can provide intervention should an individual be seeking help or treatment.

In communities where these facilities have been implemented, fatal overdoses have dropped and in some cases been eliminated all together.

Once the general public becomes more understanding of the nature of the disease of addiction, it will be easier for harm reduction strategies to be implemented across the country. Unfortunately, the communities we are in tend to dictate what they will tolerate in terms of advances in harm reduction strategies. This can be a deadly situation, when people with no actual knowledge of the disease of addiction can dictate what kind of options will be available to those suffering in their communities. Even the seemingly helpful possibility of a treatment center being established in a community leaves residents up in arms. Everyone wants something to be done about the problem, but they don’t want to see it or hear about it. They want a magical solution where the problem just goes away, and unfortunately, that just isn’t how epidemics like this work. The more we fight for methods of harm reduction to be made available in our communities, the more lives we save, and the more people have a chance to access treatment.

So I ask you, on behalf of the progressive addiction advocacy community, please be open minded when you hear about harm reduction strategies being proposed in your community. Please remember that addicts cannot get into recovery if they’re dead. It’s our prerogative to keep them alive long enough to get and stay sober. Harm reduction strategies help keep addicts alive, giving them better and safer options in active addiction, until they are ready and able to stay sober.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

Great Expectations: The Risk of Pregnancy In Early Recovery

There are a lot of hot button issues that get talked about in the recovery community. We talk about medical maintenance, we talk about Twelve Step programs. We discuss the pros and cons of psychiatric medications. We debate the differences between enabling and helping an addict. We talk about the dangers of romantic relationships in early recovery. As far as I’m concerned, there’s a huge elephant in the room that we are not talking about that we desperately need to be, and that is pregnancy in early recovery.

I have met countless women in treatment who are absolutely convinced that they cannot get pregnant because there is something wrong with their bodies. They will tell you up and down how they have been having unprotected sex with their significant other for years now and they just don’t get pregnant. Then in the first few months of recovery, they find themselves with child.

These women are right, there is something wrong with their bodies, and in many cases the bodies of their partner. What’s wrong is that they are literally dying from their drug addiction.

The human body is a marvel of biology and is an amazingly intelligent machine. The human body wants to procreate by nature. However, when someone is sick and dying, they are much less likely to conceive a child. How often does someone dying of cancer get pregnant? Yes, it happens, but not very often. People with chronic diseases often struggle to conceive. Women who are overweight, even slightly, are typically told to lose weight in order to increase their chances of getting pregnant. That goes for women who smoke cigarettes as well. When the body is being damaged, it is not a hospitable place to grow another human being.

When a woman is using, her cycle can become irregular, infrequent, and she often loses her period all together. If a woman is not ovulating, she cannot become pregnant. Furthermore, women who do get pregnant often miscarry very early on. They sometimes don’t even realize it’s happening because they attribute the symptoms of the miscarriage to being just another odd period issue. Babies need a healthy body to grow, and that is why women who are addicted to drugs often believe they have fertility issues.

On the male side of the equation, it’s all about sperm count and strength. A dying man is not producing the best quality sperm. Do sick men impregnate women? Of course. It happens. But once again, it is a challenge that many couples deal with when they are trying to conceive on purpose. When a man gets clean, his body also wants to get back to its intended purpose of procreating.

When people get clean, some systems in the body get well faster than others. One of the first things that happens to many women is their period comes back or becomes more regular again. The human body’s main purpose in life is to reproduce more humans. It wants to get back to work on that as soon as possible.

Even though methadone is an opiate, the body gets much healthier once someone becomes established on methadone maintenance. Women in methadone clinics get pregnant very early on in their treatment because their body is becoming healthier and is ready to get back to its purpose of reproduction. The reason this is bad is not because methadone is bad for the baby. While it is certainly not ideal, many women on methadone give birth to perfectly healthy babies. Depending on the dose the mother is on, some babies go through little to no withdrawal symptoms at all. Those who do are treated medically and often remain very comfortable until the issue is resolved. Pregnancy on methadone is a topic for another blog. The reason I’m addressing it here is in the interest of a woman getting pregnant in early sobriety and the issues that brings.

When I talk about early sobriety I’m typically talking about the first year or so. When you are working to overcome an opiate addiction, the first year is no joke. You go through many huge changes and challenges while getting sober. The body goes through tremendous changes. The brain is turned upside down and inside out while it tries to recover. Those with mental health issues are typically getting back on psychiatric medications and dealing with the ups and downs of that, which can take up to a year to get right. Those who choose to utilize methadone spend the first six months or so getting stabilized on the right dose.

Lots of undiagnosed health problems can rise to the surface in the first year. People realize they have liver or kidney issues. Some people find out that they are diabetic. All kinds of health problems that were ignored during the person’s using career can come to light once the body starts getting back to its normal state of being. These issues need to be dealt with and can make an unplanned pregnancy that much more difficult or even dangerous.

There are also the social issues we encounter in the first year. Many people are homeless, living in sober houses, or shelters. People struggle to find a job, and often the first job they get is some kind of “starter job”, just to get them back in the swing of working again. Many people don’t have a car, and if they do, it isn’t very reliable. There’s also the issue of health insurance, which many addicts do not have.

Many of us have a great deal of debt to deal with in early recovery. If we’re not in debt, most of us are dead broke. Raising a child costs a lot of money, and most of us can’t even pay our own bills in the first year.

The first year is not the right time for 99% of addicts in recovery to be starting a family. It is a tumultuous, unpredictable, and erratic time in our lives. We don’t know who we are in sobriety, and we are trying to figure that out. Our lives are unstable, and we often don’t know what our plans are for our futures right away. Our support systems are busy trying to help us stay sober, if we are fortunate enough to even have a support system. It’s not fair to them to have to help us support and raise a baby because we aren’t in a position to support one ourselves.

Many addicts are not even stable enough in their life to even get a job right away, or live on their own, or simply exist as an independent human being. The first year is all about figuring out who you are in sobriety, and who you want to be. You should be able to support yourself, both emotionally and financially, before you take the step to start a family.

The idea that having a baby will help you to stay sober is just as much of a myth as the idea that having a baby will save a relationship or marriage.

Babies don’t fix problems, they exacerbate them. If babies kept people sober, then thousands of grandparents wouldn’t be raising their grandchildren and millions of kids would not be caught up in the foster system. A baby is not going to fix you, and it will not fix your partner.

It truly blows my mind that no one ever talks about this extremely important topic in the addiction and recovery field. Many addicts have never ever heard of this issue of increased chance of conception in early recovery, even those who it has happened to don’t realize the reason behind it. People are extremely fertile in early recovery and it is the worst possible time for that to be happening! I encourage all of my clients to pay close attention to this issue and not only to use birth control, but to double up on your methods.

This goes for the partners of addicts as well. I recently spoke with a woman who herself is not an addict, and whose husband got sober, they got pregnant, and within a month he was out using again. Now she is raising her beautiful daughter on her own. Would she give up her daughter for anything is this world? Of course not. But is the situation ideal? Far from it.

Two women I know have similar stories where they got pregnant in the first month of recovery, not once, but TWICE. No one ever explained to them that they are so fertile in early recovery, and even after it happened the first time they didn’t make the connection. They thought it was a fluke. It’s not a fluke!

There are so many children out there who are growing up without their parents because they can’t stay sober. There are children who are watching their parents die in front of them, and those who have had to bury their parents before they are even old enough to understand what death is. This is not the life you want for your child. There are more stories than I care to remember of terrible situations related to women getting pregnant in early recovery and not being able to stay sober in the long term. Everyone thinks that it won’t happen to them, that they are different, that they can do it, that they can change. I’m telling you that it can happen to you, you are not different, and it will not help you stay sober. Just trust me on this one. In rare circumstances, it probably has helped some people. In rare circumstances, it may have changed some people’s lives for the better. These are not the norm, they are the literal unicorns of the addiction world. No one wants to admit that they wish their child hadn’t been born. It’s a terrible thing to think. But I assure you, I have met MANY women who feel that way. I have met MANY women who are out on the streets, with their child growing up without them, because they got pregnant during a short stretch of sobriety by accident.

Please take this warning and share it with those you know in early recovery. Please understand how real the risk of pregnancy in early recovery is, whether it is the man or women or both partners who are getting sober. It just doesn’t matter. Your past history doesn’t matter. This happens every single day and it’s a source of stress you just don’t need in early recovery. Focus on you and your recovery. Focus on your mental and physical health. Build yourself a life you love and become the person you are proud of. Get your finances in order and pay your debts.

If you need help getting on birth control, please contact your local Planned Parenthood. If you want to help women in recovery prevent unplanned pregnancies, consider donating to our fundraiser. It is part of our mission to educate and advocate on this issue and to scholarship birth control for women in early recovery who cannot afford it on their own.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin