I fucking HATE being honest with myself when it comes to shit that really matters.
That’s how it started; the most difficult email I’ve ever written.
I remember having to squint through endless tears to even see well enough to type out the words. Perhaps the memory is so vivid because it was just two weeks ago that I forced myself to write it. I had spoken to many women about my situation, but knew Julie, the founder of this blog, had experienced something very similar. I wanted to share my realization with her because I knew she would not only understand, but also hold me accountable.
I wrote:
I was really in deep denial about my motives for this custody modification. I truly believed I was only doing this for my daughter, but now can see that was bullshit. It was a decision based in self…
Earlier that day, I’d finally admitted to myself the real reason I had been so terribly consumed with constant feelings of guilt and shame.
The admission was the hardest truth I’ve ever had to face about myself.
My daughter is five and has lived with her father, full-time, since I checked myself into rehab for 28 days in October of 2012. Before that, I was a single mother, “living” in active alcoholism and putting her life and safety at risk daily. After my sister kicked us out because I couldn’t stay sober, I was served with custody papers. I was mortified. I had no clue what to do. I had no job, no home, no money, a DUI on record (with my one-year-old in the backseat), and I was STILL drinking…
I knew I was in no position to win a custody battle.
I consulted with my lawyer, decided to sign over temporary custody, and go to rehab.
If you had asked me then, I would have told you I did it out of a mother’s selfless love for her child. You probably would’ve called me “strong” or “brave,” but the truth is, I was thinking only of myself. I was scared. I wanted to run away and hide—and that’s exactly what I did for 28 days. I didn’t want treatment; I wanted an escape. It was completely and utterly selfish.
I was released from rehab on Halloween, and was drinking daily again by early December while my ex maintained custody. I attended outpatient treatment while still steadily drinking, and in February of 2013, I attempted suicide. That landed me in a mental institution for a week. I got out and carried right on drinking.
I carried around an extreme hatred for my daughter’s father for drastically reducing the time I was allowed to see my daughter. I denied my part completely. I was constantly demanding more visitation time, and truly believed I was entitled to and deserved it.
Did I mention my selfishness?
It took nearly dying on my bathroom floor to reach my bottom with alcohol. My sobriety date is December 23, 2013. In July, 2014, seven months sober, I decided I was ready to regain full physical custody of what was rightfully “mine”. I had earned it! That past October, me and my big-bad ten months of sobriety retained the services of the best family law attorney in town.
And then I went mad.
Recovery took a backseat to my custody case, and I became absolutely obsessed with “getting my child back.” I stopped doing pretty much everything I knew was necessary to stay sober and lost all perspective. I began an awful downward spiral. I became more selfish and self-righteous than ever. The words I spoke and texted to my ex during this period were accusatory, mean, and intrusive. They could have cost me my relationship with my little girl. I could not see any of that. In my mind, I was absolutely justified. I was doing what was right for my daughter.
Thank God for other women in recovery who had the balls to call bullshit, dish out some tough love, and be brutally honest with me. Thank God I reached out. I hated what they were saying, but after enough people said the same thing—after an abundance of prayer for clarity, self-awareness, and strength to be honest with myself—I was finally able to see the harsh reality. They were absolutely right. I was in NO position to have my daughter back. She was much better off where she was.
I knew what I had to do.
That’s not the kind of mother I want to be. And that’s not the kind of “love” my child deserves.
I confessed in the email. And I meant it.
It is difficult to explain how much finally being able to do this means to me. So many times I have told myself to just hold on…just hang in there until December. Maybe it’s sick, but I drew a lot of strength and hope from that…
I finished the email around 10:30 PM, and just sat staring at it. I knew clicking send could quite literally be the only way I’d ever follow through with my decision to do what was right. I knew I would receive the support, encouragement, and reassurance I so desperately needed, and I would be held accountable—to take all necessary action to prevent further harm.
Forty minutes later I committed and sent Julie the email.
This was a first for me. Not only had I been able to finally see the truth about myself, I was actually able to use that knowledge to fix a mistake and prevent harm to others. I was able to take my wants out of the equation and do what was right for my daughter. Not easy, but right.
The next morning I headed to my lawyer’s office as soon as their doors opened to drop the lawsuit. I went to work and forced myself to show up for my regular day. By 7:30 PM, I was curled up in fetal position on my bedroom floor. I was in full-fledged grief over the loss of the fantasy “future” I’d held onto for so long.
The following week was pure hell. Thank God for sober alcoholics; people willing to love me through darkness, until I can see the light.
Julie’s response to my email that night included, “Surrender doesn’t have to mean giving up. It can mean the difference between acceptance and change, and a lifetime of bashing our heads against a wall trying to move it. I love you so much. You are stronger than you know.”
Truer words have never been spoken.
I’ve heard that pain is the touchstone of spiritual progress, and that emotional turmoil must come before serenity. Today, I believe these claims to be 100% true. This experience has allowed me freedom, relief, and the unshakable faith that, no matter what, everything will be ok. I finally know in my heart and soul what the selfless love of a mother for her child feels like.
And it’s absolutely beautiful.
Thank you, God—for the blessings that follow pain- for hearing my pleas—and for placing amazing sober alcoholics in my life.
This post was submitted by Raegan.
The term ‘recovery’ has come under a harsh microscope recently in academic and clinical settings. It has been interrogated, scrutinised, criticised, bloated and dissected. Reconstructed like Frankenstein’s monster, recovery is now seen to be a floating signifier, made of disparate bits that don’t necessarily fit comfortably together – a stumbling, lumbering construct. Is recovery becoming of little use to anyone and, quite possibly becoming a stigmatising and dangerous term?
Like Mary Shelley’s monster, you might expect recovery to be sitting bruised and battered now in the corner, bolted head in sutured hands, saying, ‘I shall collect my funeral pile and consume to ashes this miserable frame’.
But that’s not what’s going on. Recovery is not dead. It’s not pushing up the daisies. If we think that, we’re looking in the wrong direction. Turning our gaze away, the black and white flicker of horror movie fades and is replaced by widescreen, Technicolor certainty. It turns out that recovery remains real, resilient and very relevant.
Glorious Gatherings
Today and tonight in thousands of mutual aid groups, in person and online, in 12-step mutual aid fellowships, in SMART and LifeRing, Women for Sobriety meetings and other gatherings, people who value recovery as part of their identity will gather to support each other and bolster their chances of success. There is convincing evidence that, in terms of positive outcomes, their shared efforts do at least as well as, or better than, other professional established psychological interventions.
Many thousands more will connect in a host of ways with lived experience recovery organisations (LEROs) outside of mutual aid. Even in a wee country like Scotland we have scores of these, where individual and group recovery identity are not only core to meaning and purpose, but drivers of action. Fuelled by passion and altruism, members want to identify with others and support their peers to make gains across a range of life domains. Oddly, there is a dearth of academic interest in this remarkable phenomenon.
Recovery advocacy
Aside from these self-supporting communities of recovery, something else is happening. Those with lived experience of addiction and recovery who have not had their needs and goals met in our wider treatment and support systems are finding their voices and calling for change. A new recovery advocacy movement is emerging. Reacting to the patriarchal and out of kilter power relationships endured in some treatment settings, activists strive for something better. Recovery in this domain is visible, underpins the urgency of advocates and is a powerful catalyst for reform.
The proof of the pudding
Despite the criticisms of recovery, having a recovery identity has been consistently associated with improved outcomes in the scientific literature. Frings, Wood and Albery say in their paper published last month, ‘Recently, social identities associated with recovery have been linked with better recovery related outcomes such as treatment retention, abstinence and confidence in one’s ability to maintain treatment goals such as abstinence and harm reduction’.
In general, higher levels of recovery related identity, or increased differentiation between addiction and recovery related identities, are associated with positive outcomes.
Frings et al, 2021
Say Frings and colleagues, ‘Alongside AA, these effects have been observed amongst varied populations, including other group-based treatments such as SMART, and in both in-patient, out-patient and peer support settings.’
Helping or meddling?
Partly because of these effects, efforts to reconstruct the concept of recovery need to be carefully monitored. There are risks. Recovery is already a broad church, but in widening the doors further and further, we risk making the term meaningless. In addition, while dialogue is welcome, the motivations for the debate are not always clear or good. Some of us working in addiction treatment or research are threatened by people recovering in ‘non-medical’ ways.
At a conference I attended, a presenting medical colleague said, ‘If my patient goes from using crack cocaine seven days a week to six days a week, that’s recovery’. I’d say that’s progress, but recovery is not primarily about the removal of harms, it’s about the accrual of positives.
I suspect that the debates that are currently happening over what recovery means seem of little relevance to wider recovery communities. Their members are not in a state of angst over the definition; they hold the identity and use it to further their own recovery and that of others. They have used the term for decades and are fluent in what it means in personal, functional and social realms. They know what it means. They are living it.
Recovery curators and crusaders
Recovering people are held up by hope, not distracted by definitions, yet their lived experience and credentials as experts by experience must surely be systematically included in this discussion. Recovering people do not own recovery, but for a very long time they have been recovery’s progenitors, curators, caretakers and crusaders. That hasn’t changed. It absolutely does need to be recognised.
Academic reframing of recovery based on data and sundered from lived and living experience risks creating a creature that everyone ends up unhappy with, and ultimately is unhappy in itself. Recovery is not dead. It’s alive, it’s alive! Not only is it alive, it is thriving and spreading with healing in its wake. Let’s acknowledge, value, and build on that and have people with a recovery identity included at the heart of the debate.
Continue the discussion on Twitter: @DocDavidM
Picture credit: Shutterstock PatriciaPix under license
Recently in medical and behavioral circles I am hearing discussions of what is termed “occupational moral injury.” This article from 2020 in the British Medical Journal describes occupational moral injury as “arising during work such as armed combat or emergency response when people carry out, fail to prevent, or become aware of, human actions that violate deep moral commitments. Occupational moral injury is often associated with psychological distress, and moral responses including guilt, anger and disgust.” The article goes on to say “a moral wound can be experienced by anyone. It arises from sources that include injustice, cruelty, status degradation and profound breaches of moral expectations. The moral-philosophical version of moral injury associates it with moral and psychological anguish, and feelings such as bewilderment, humiliation and resentment. According to this formulation of moral injury, it could affect patients, service users, families and loved ones as well as care staff.” Mic drop.
Truth be told there is significant occupational moral injury associated with SUD care work. Looking through the literature on the topic, I am seeing that people often confuse it with burnout. Reflecting back on conversations with colleagues out in the world. I am hearing of more than a few who are leaving. I hear about people who lost colleagues to COVID-19 and could not get personal protective equipment or ended up at lower status on vaccination protocols. For many, it goes in the mix, for others it was the last straw. I lost count of how many people I treated who died because I could not get them into the proper care because of barriers that emanate from our systems of care, each one a human who should have been valued enough to properly help. We need to honor them by accounting for these moral failings of our care systems. We owe them that much.
According to this WebMD Article, moral injury occurs when health care providers are “repeatedly expected, in the course of providing care, to make choices that transgress their long-standing, deeply held commitment to healing. The moral injury happens because they’re frustrated and can’t provide the care they trained for and promised to give.” This type of triage care has been the norm for me over several decades of work in the SUD care field. I know I am not alone, it is the norm. This week a colleague confided in me that thoughts of suicide have entered her thinking process because of these very dynamics. She is not alone, she simply has the courage to talk about it.
I have joked that every month, unfunded mandates and new administrative burdens added 2% of effort to justify or document the work rather than actually do the work of helping people. I think it was a reasonable figure. Over a year, it means roughly a quarter of “extra” time to these areas of focus over three decades, it is 720%. Every minute of this takes away from the actual work of helping people. In 2013, PRO-A, my organization conducted interviews and examined the SUD workforce in the state of Pennsylvania, the counselor version titled Systems Under Stress found all kinds of barriers to actually doing the work and a workforce who were leaving because they were spending less time actually helping people. The trends of increased administrative burdens has continued unabated, one might argue it has accelerated. More time spent justifying the work, less time doing it as death rates from addiction, including alcohol, stimulants and opioids or combinations of all of these substances dramatically increase. This is the very definition of “occupational moral injury.” It starts to feel like being in the trenches fighting the good fight as our own officers pick us off from their bunkers to the rear of our own lines.
This post is probably more self-reflective than most, but I also know that my experiences are similar to what others experience. Being in recovery makes many of us “those people” who end up getting disparate care. Every time I see it, I recognize it could be me getting disparate care and insurmountable barriers to accessing help. I could have ended up in a body bag instead of having a life. Every single day this very long week I have spent time on the phone with people describing care denials of life sustaining medical interventions under the lens of seeing addiction as a moral failing by licensed medical professionals, persons in long term recovery who are being denied employment for decades old legal charges and more. It is a normal week. It also hurts my soul.
This 2006 article from Journal of Social Work Research Personal and Occupational Factors in Burnout Among Practicing Social Workers found that within the helping professions there is a lifetime burnout rate of 75%. They suggest we examine individual factors that can influence resiliency. One way to do this is to address the moral wounds of systematic barriers to recovery. I have said often that we have built a system of care that provides less than what people need to get better because of implicit bias against persons with addiction. As a society we have low expectations of persons with SUDs and this influences care design. We don’t have care that offers the minimum effective dose of care. Marginalized communities get even less than the dominate culture. I didn’t get arrested, I got treatment as a white kid. I don’t have a legal history tattooed to my forehead for life. I could go on.
In 2019, it was the honor of a lifetime to receive the Vernon Johnson Award for individual advocacy at the America Honors Recovery Diner. The speech I gave is HERE. In the speech, I reference the moral injury of this work. The death of a childhood friend who was as close as a brother because a mental health nurse in a hospital emergency department did not want to be bothered with actually helping him. A person being denied life insurance for purchasing naloxone (related story in the Philadelphia Inquirer here). The denial of a cardiac procedure needed to sustain a young woman’s life “because she did this to herself.” In reflection for me, the moral wounds of our system have thus far propelled me to hold systems accountable and work for change. It is not often welcomed, but the body count continues to escalate and under even slightly different circumstances, I could be in that static. What alternative is there but to carry on. As Camus so famously said, we must imagine Sisyphus as happy. But that rock is heavy and the new day dawns, again.
According to this article by the Moral Injury Project at Syracuse University, “moral injury, then, is a burden carried by very few, until the “outsiders” become aware of, and interested in sharing it. Listening and witnessing to moral injury outside the confines can be a way to break the silence that so often surrounds moral injury.” They are recommending public dialogue and deepened understanding of the burdens carried by the few on behalf of society. Even within social services, there are few fields of work with the level of implicit bias and systemic barriers as the substance use care system. We should have such a process across our SUD care system. I suspect we will keep have unending workforce shortages without such an accounting. If we can address such dynamics here, we can fix a lot of things.
Of course, the first step is acknowledging we have a problem and then we must do something about it.
There’s a lot of academic and advocacy energy around harm reduction, legalization, and assertions that drugs and drug use carry relatively few innate harms–the real problems are puritanical and often racist attempts at social control.
These discussions give the impression that people with addiction and society would be ok if we assured a legal, unadulterated supply, safe and unfettered spaces to use and live, sterile equipment, along with access to first aid and treatment meds.
I’ve said many times, since the beginning of this blog, there is no ideal or problem-free drug policy. The real questions are: What problems are intolerable? What problems are we most willing to tolerate? How do we minimize/eliminate what’s intolerable and mitigate the harm from the problems we’re willing to tolerate?
That we’re deciding mass incarceration is intolerable is a good thing. Same for the role of racism and disparate and heavy-handed impact experienced by communities of color.
Those should be deemed intolerable. And, drug policy, like many other things, involves trade-offs.
Our failure to acknowledge these trade-offs and attempt to earnestly mitigate the harms associated with the priorities we choose to enshrine in policy/practice has resulted in immeasurable damage and prevented us from changing course in a responsible manner.
The current focus on individual liberties and harms, along with the conflation of addiction with lower severity substance problems often gives the impression that the only serious harms associated with substance use disorders are results of legal status and adulterated drug supply, obscuring many harms experienced by people with addiction and those close to them.
A recent Keith Humphreys tweet speaks to this and touches upon the amends process associated with 12 step recovery.
The Washington Post has a paywall that might prevent you from accessing the story, but a friend shared this video, which the story is based upon.
Humphreys refers to a cringe factor in this story. I also sense considerable hesitancy to acknowledge and create space for the harm experienced by people around the addict. Note Humphreys’ nuance. He says, “Addiction typically inflicts harm on others.” … addiction inflicts harm.
Preslee’s description of her dad (Casey) threads an important needle too. She alludes to him as two different people — a sober-self and an addicted-self.
“For as long as I can remember, my dad has been an alcoholic… I knew how my dad would be one person when we showed up to the party, and a completely different person when we left.”
“Seeing him in rehab, he was so different from before,”
I sense that this hesitancy emanates from destigmatization efforts. There’s an effort to frame them as non-threatening, which aligns with framing them as victims of social failures and harmful policies. It also aligns with impulses to downplay impaired control and the risk that presents to others. (
So… this gets complicated. Are people with addiction frequently victims of bad policy? Yes. Definitely. But there’s much more to it than that.
Note that while there might be a lot wrong with alcohol policy, it’s not criminalized and it causes plenty of harm.
I think it’s important to note that people with addiction are often harmed by bad policy, but they are also harmed by the illness of addiction, and they are often perpetrators of harm to others around them.
A former colleague who worked in juvenile justice said, “People see my kids as victims or perpetrators. When they reduce them to a victim or a perpetrator, it makes it hard to see them as a resource.”
Note the importance of looking beyond his victimization in healing the relationship with his daughter:
“One day, we were all sitting in the living room for a family meeting,” wrote Preslee. “My dad said, ‘I’ve been through alot and gone through it, kids, and we will be okay.’ This made me angry and I responded with, ‘Really, Dad? You think you’re the only one who had a hard time throughout this?’ ”
The questions around moral responsibility in active addiction are complex and difficult to answer and will inevitably involve acknowledging seeming incompatible truths. Similarly, finding the best policies (which, if we’re honest, might more accurately be described as the least bad policies) requires acknowledging the tradeoffs involved and the harms we’re choosing to tolerate.
- How do our alcohol policies protect, neglect, or harm Casey?
- How do they protect, neglect, or harm Preslee?
- How do they protect, neglect, or harm others?
- Who do these policies place responsibility upon? For what?
- If Casey’s problem was heroin rather than alcohol, how would that change?
- If Casey’s social/environmental circumstances were different, how would our answers change?
Whether we’re talking about policy or moral responsibility, the answers are not easy, but we can’t find them by avoiding, ignoring, minimizing, or obfuscating inconvenient truths.
Take 5 Spotlight is a series of brief articles that introduce you to members of our National Office team, and many other SMART-types, in a short & sweet way. Sometimes hearing about a company from someone on the inside makes for a great job connection. That’s what happened for SMART’s Office Assistant Jas Hilbert. A SMART […]
Take 5 Spotlight is a series of brief articles that introduce you to members of our National Office team, and many other SMART-types, in a short & sweet way. If you want to talk about longevity at SMART Recovery, the conversation starts and stops with Jodi Dayton. Jodi started working at SMART in 2003 (rumor has […]
Take 5 Spotlight is a series of brief articles that introduce you to members of our National Office team, and many other SMART-types, in a short & sweet way. If you called Office Assistant Leah McSween’s journey to SMART employment quick, then you might just be understating it. As Leah points out, “I think from application […]
Switching from doctor to patient was not an easy transition for me. My first attempt at recovery was medically assisted, but only got me so far. What I needed was something more profound: hope, healing and connection to other recovering people. In this podcast for the National Wellbeing Hub, Dr Claire Fyvie interviews me about my own experience of addiction and recovery – warts, wonder and all.
Join me on Twitter @DocDavidM
I keep hearing anecdotal reports of people being prescribed naloxone, filling the prescription, and later experiencing discrimination (refusing to write a policy) from an insurance company, typically a life insurance company.
I have not been able to have direct contact with anyone who experienced this or get the name of an insurance company engaging in this kind of practice.
I’m involved in a couple of Michigan advocacy groups that would be interested in taking action if specifics could be identified. We’ve got lines of communication with legislators and state departments.
If you are able to provide any information on this type of discrimination in Michigan, please comment below or email me at jfschwartz(at)gmail.com.
I decided to try something a little different and record an interview with Derek Wolfe, a new medical school graduate and future psychiatrist with a special interest in addiction. (Maybe interviews will be a recurring thing.)
One of the outcomes of the opioid crisis is that physicians have been centered in addiction treatment and drug policy discussions.
As this shift gathers momentum, there’s been a push to eliminate the X-Waiver that requires physicians to receive 8 hours of training (nurse practitioners and physician assistants must receive 24 hours) to treat addiction patients with buprenorphine. This concerns many of us who have worked in the field for decades and voiced concern about the lack of attention to addiction in medical school curriculums. There is also a simultaneous effort to replace the X-Waiver with an SUD training requirement that is less opioid-centric.
We discuss all of this and how Derek’s experience working in a social detox and crisis residential program have influenced his learning and will influence his practice.
Discussed in this episode
The Healing Forest Project – Derek’s 8 part series about Ann Arbor, Michigan as an example of a healing forest.
Vital Discussions – Derek’s podcast focusing on issues of interest to medical students and professionals.