Stats… STAT!

Our children relapse. We are warned “relapse is part of recovery.” But I don’t think most of us believe it. By the time your child has a few years under their belt you get comfortable. You see a person emerge that you haven’t seen in years. Someone who is genuinely happy. Focused. Funny. Confident. Surely this person is here to stay.

But the fact remains. A mom I know confessed to returning to the days of sending canteen money to her son after his recent relapse landed him back in jail. She ended her dark missive with “why, why, why?”

It’s a rhetorical question I suppose. We know why. Giving up anything for a lifetime is a pretty monumental task. Giving up something you once loved more than life itself must be harder. Then throw in the added bonus of having an addictive personality or a mood disorder. Those are some pretty good whys. Sometimes I am amazed at the fortitude required to obtain 2-3-4 years of complete sobriety. It feels like a miracle. But I don’t want to think this way. I don’t want my daughter’s future to be dependent on a miracle.

Last week my daughter called me from detox. It was her third attempt in ten days. Her voice was hopeless as she numbly reported “only 1% of addicts ever make it mom.” I also have heard this number quoted. And I don’t like it.

We know statistics are manipulated to present a particular point of view. Is this one in existence because historically we haven’t cared enough to get the math right? Or has it been cultivated to justify poor spending on treatment?

This number was ringing in my head when I sat on an opioid forum last week. Beside me sat the head of a Massachusetts hospital emergency room department. He confidently stated that “involuntarily committing addicts to treatment is not recommended because we are setting them up for a higher rate of overdose death.” I am presuming his reasoning was based on the premise that this population is not interested in quitting drugs and therefore would return to using. I don’t question that deaths are higher among the involuntarily incarcerated vs. the voluntarily committed when treatment ends. It makes logical sense. But the data is flawed. The data is flawed because of “patient selection bias.” The doctor failed to include those who were NOT included in the data: those not forcibly committed to treatment. I venture to say that most of them are dead – or will be dead. Look at it this way: it’s like playing Russian Roulette with people who don’t want to quit the game. If you take away the gun some may eventually go back to playing with the gun. But if you DON’T take away the gun… well everyone is going to die. It’s that simple.

Are there better stats regarding relapse? Unfortunately there is a dearth of long term data. One of the few long term NIH funded studies followed 1,162 addicts for eight straight years. Published in the Journal of Alcohol and Drug Abuse it revealed that as the length of time in sobriety increases, so do the odds of continued sobriety. Those with less than a year have a 33% success rate. Those with over a year increase their odds to 50%. And those who achieve five years can expect an 85% future sobriety success rate. Data just doesn’t exist for those with 20 or 30 years of recovery time; but those who work in residential centers find their reappearance rare.

So we know clean time breeds more clean time. I remember joking a few years back with a local officer.  I asked him to handcuff my daughter to her bedroom radiator to prevent her from scoring. He smiled, but then seriously replied “yeah, I can’t do that…and neither can you.”

Since that day I have been searching for a legal means to success.  That searching even led to attendance at a spiritually based reading group (disclaimer: it is an act of desperation for me to turn toward faith for any sort of answer.)  What I found was that many of those in attendance were living a life of successful sobriety.  History, science, and society have not been kind to those suffering from the disease of addiction so we can not blame them for remaining in the shadows.  AA and NA use “anonymous” for a reason.  But by sharing their status this group become a living example of hope and, even better, a room full of positive odds!

It is still going to take a lot of unbiased research to get us solid numbers to stand upon.  Faulty statistical analysis, unfunded federal research, a lack of evidence-based treatment, and social stigma have led us to this unsettling place. To live within the world of addiction is to stand on shaky ground.

For now I will tell you what I can do. I can share a whole new set of facts with my daughter when I visit her at the hospital. I can tell her with confidence that the 1% success rate is inaccurate. And I will tell her with even more confidence that she matters 100% to me.

These are the only true numbers at my disposal and, for today, we are relying upon them.

Triggers Are Not Real.

“TRIGGERS ARE NOT REAL.”

My daughter stated this, firmly, when I tried to stop her from taking a bus through a neighborhood full of triggers. Addicts are supposed to avoid triggers….just like someone on a diet should avoid a bakery, and someone thinking about a new dog should avoid a pet shop. It’s good common sense.

This particular neighborhood, for three years straight, had replaced days meant to be spent at school. It was where she met her first, of many, older, opiate-addicted boyfriends. The neighborhood where she drank with her girlfriends until they couldn’t stand up. The neighborhood she went missing in for nights on end. The neighborhood she partied in to the point of hospital intervention, repeatedly. The neighborhood with the drug store street corner. All of this would be within memorable reach.

“I don’t want you to take the bus. I can get you in the car.  I would be happy to come get you… “

“No.”

Trigger has to be the perfect colloquialism for “classical conditioning.” I appreciate the way it brings to mind the image of a loaded gun to the head. When you are the parent of an addict it becomes that clear. That person, that bent spoon, that ball of singed tinfoil, that street corner…. all become sensorial reminders capable of triggering relapse. And relapse is nothing short of a game of Russian roulette.

To be clear, my fear of triggers isn’t a case of playing probabilities or trusting in a predictable pattern of personal weakness. Classical conditioning is scientifically proven. Most of us are familiar with Pavlov and his bell salivating dogs. This early study in classical conditioning proved that a learned process can change a previously neutral stimulus into a potent stimulus. This potent stimulus in turn creates real biological change in the body. Biological change where none existed before. Replace Pavlov’s bell with a street corner and excessive saliva with irrepressible craving and the problem becomes all too real.

“I want to take the bus. Triggers are not real. Like, everything is a trigger. A song. A boy. The bathroom. The sunshine. A nice day. A bad day. Even the breeze. You have to deal with your stuff, mom. If taking a bus makes me relapse then I haven’t dealt with my stuff. You just don’t understand.”

I am trying to. Classical conditioning is not equivalent to the loss of free will. Biological stimulus does not have to be a siren call to action. We are a little more complicated than a bell drooling hound. But how difficult must it be to retrain our rewired and tired brains to see each situation clearly and non-reactively? Can we be our own psychologists, neurosurgeons, life style coaches and cautiously present Buddhas?

In the end, she took that bus. And you know what?
She made it safely home.

Modern Love

There is a program on National Public Radio that does a spectacularly good job at deconstructing a word most of us feel we can confidently define: love.

In one episode Jason Alexander narrates his love for the family goldfish. The loss of someone close to him has forged his affection for this swimmingly simple little golden fish. Its presence represents an escape, and an embracing, of the crumbling reality of existence.

Can love be tempered by unpleasant realities? The program would say yes. Most of us, especially those of us with decades of life behind us, would agree.

We all have our own “modern love” story. Mine would be about my daughter, who many might describe as hard to love.  They would be wrong.

Admittedly, she was hard to snuggle.  She preferred the plastic embrace of her car seat. The car seat could be parked far from me: she was happy with any room, any corner. She tracked me with her eyes, but she tracked other things with equal interest. I took to forcibly putting her in a snuggly and walking up and down the street with her.

Glowering was also a specialty. She was a beautiful blonde baby with fat pink cheeks, green eyes, and a perma-scowl. Her mouth, right from the get-go, had a natural down turn to it. Glowering with the addition of defiantly crossed arms came later. When asked to give her name during her kindergarten interview she stood up, turned her chair backward to the teacher, crossed her arms, and sat down. She remained that way for the entire interview.

My husband and I remained enamored. (Why should she perform tricks like a trained seal? Maybe we have the next Hillary!) We affectionately nicknamed her “little black cloud.” We would mimic her mood in a dreary Eeyore voice – desperately trying to add some EB White levity to our situation. Sometimes we would just mime a “brewing storm”  by circling our fluttering hand over our weary heads.

But of course at this young age it isn’t about them loving you. It’s about you loving them.

Loving her could be exhausting. It wasn’t easy for my daughter to accept love. She appeared to weigh it, to quantify it – to find it lacking. She was often displeased. I came to see it as her natural default button. She screamed about sitting in the cart at the grocery store. She screamed at her older sister to claim the best barbie. She screamed if she could hear you chewing during dinner. She screamed for the last cookie, to hold mommy’s hand, to find the most Easter eggs. She screamed over minor transitions. It was relentless. Her ability to express love was buried under an itchy blanket of sensory issues, fear, jealousy, and an unshakeable sadness.

But she loved us too. It was apparent in the way she would fit herself to your side when watching a Disney movie. And in the occasional half smile with tilted head. In the way she kissed her dog’s bearded face. And the gifts of found flowers or crayoned pictures.

So, yeah, love is not only tempered by unpleasant realities… in can grow in them. It may even grow hardier. We are living proof.  We are the dandelions of love.

Broken Things Have Value.

I have a set of flawless china. It is Lenox and it has a silver rim like a lucky cloud.

I also have a morning coffee cup. It’s crazed from being microwaved just a little bit too much.  There is a chip that serves as a reminder to not sip on that side. When the handle breaks I will, most likely, glue it back on.

Sentimental? Not really.

I have been thinking about broken things a lot lately. How my daughter’s journey has introduced me to the fractured and hidden members of our society. I have been inside too many psychiatric hospitals, too many jails, too many police stations, too many emergency rooms and too many detox centers. I have seen too many people cry.

But now I can hold these experiences in the palm of my hand like an old coffee cup. They are no longer things that happen to other people. And I can see that they have added value to my previously flawless life.

Three years ago I noted in my journal the incongruities that were becoming our norm:

“I had to pick my daughter up from an in-patient psych ward this morning. She looked just beautiful in a black tee shirt and old jeans. Her blonde hair hung in a long braid over one shoulder. I could barely see the bruise on her cheekbone. As she gathered her things to go she insisted on saying goodbye to Carl. She knocked on his door on her tippy toes, and said, “Carl come out.” “Carl, come out and say goodbye to me.” And she waited patiently. I was expecting a young boy…. but an old man came out. Wizened, beaten down, shuffling. She gave him a big, big hug. And I just didn’t know what to do with the feeling.”

Somedays I still don’t know what to do with all the feeling.  But I know I am the better for it.