Marian Webster dictionary defines addiction as "persistant, compulsive use of a substance known by the user to be harmful; a compulsive need for and use of a habit forming substance, characterized by tolerance and by well-defined psychological symptoms of withdrawal." Alcohol, illegal drugs, prescription medication, over-the-counter medication, gambling, sex, cyber-sex, pornography, video gaming, food, shopping, exericise - the list of potentially addictive substances and behaviors has grown as our ease of access and exposure has increased. Few (if any) of us can say we haven't been touched in some way by addiction (professionals in the field of addiction cite 10% as the rate of incidence in a population.) Yet, lack of understanding of addiction, limited access to services for the treatment of addiction, and social stigma continue to be roadblocks to an individual's successful recovery. For those of us fortunate enough to not fit the criteria of an addict, it is often difficult to understand the phenomenon. A common refrain is, "why don't they just stop?" The short answer is, "they can't." The simple interpretation of a complex medical model is that chemical substances either ingested by an individual or triggered behaviorally in the brain have the potential in 10% of our population to result in a compulsive need for the chemical. What often begins as an innocent, pleasurable exposure to a substance (or activity) can result in a lifelong compulsive need by the brain in order for the individual to avoid the painful and potentially life threatening symptoms of withdrawal from the chemical. (A chemically addicted individual will tell you that their continued use of the chemical no longer produces a pleasureable result. They will tell you that continued use of the chemical helps them feel "normal".) Scientist don't have a clear understanding why one individual's brain can experience the results of a chemical and not develop the compulsive need and another individual's brain will. There is data suggesting a genetic link. Yet why are some family members addicts and others not? We do know addiction is a chronic disease of the brain. As with any chronic disease, with appropriate treatment there is opportunity for long-term recovery. As with any chronic disease, there is potential for relapse. Until science solves the mystery that is addiction our options are limited. Education, affordable treatment options, long-term recovery support and empathy are our tools for now.
Thursday, August 25, 2011
Tuesday, August 23, 2011
Change
A framed poster on the office wall of a former colleague was of the comic figure Dilbert with the words "Change is difficult...YOU go first!" Sage expression. Fear of the unknown, of change, can keep an individual in a situation far from satisfactory - sticking with the familiar rather than risking something new. Counseling an individual in an abusive relationship would be the most glaring example of this phenomenon. Though a glimmer of light may shine at the end of a long tunnel to freedom, choosing to stay can seem the only option. Those of us on the outside may easily see the benefits of leaving, from the inside of the relationship leaving seems impossible. Only through the often difficult work of counseling, a workable escape plan, and the state of mind to drive the process, can the individual hope to embrace change. This same model applies to anyone facing the possibility of change. Though the scenario may seem far less dire than the one highlighted above, finding the courage to change any unsatisfactory life situation can feel overwhelming. Exploring options, building a change plan, and finding the courage to get started could be the beginning of something new. The poster could then be "Change is difficult....I'LL go first!"
Monday, August 1, 2011
What are we going to do about Mom and Dad, Part 3
My Mom returned home yesterday from a five day stay in the hospital. The scar tissue in her lungs, the result of chronic bronchitis as a child, coupled with breathing the smoke from a nearby forest fire, resulted in congestion in her lungs which became pneumonia. This is a situation revisted often over the last 10 years. Vigilence and prophylactic measures were not enough to ward off infection. This latest episode gave me and my siblings the opportunity to continue our email conversation about whether or not it was time for our parents to move from their home to an extended care facility (the term my oldest sister uses rather than "nursing home" which carries too many negative connotations.) After much back and forth, my brothers, who live closest to our parents, feel moving them while they are still able to manage on their own would be traumatic and premature. I agree. The question I brought up is how do we define "manage on their own"? Since my brothers are, due to proximity, providing supplemental care, we will have to depend on them to be clear about what they can and cannot (or will or will not) do to help our parents "manage". It's clear we will have to monitor the situation over time, adjusting the situation as needed. Meanwhile, we will continue to explore options for their care both in their home and, should the time come, somewhere else.
It's been a month since I wrote the above. A trip home and a meeting with my two brothers and my oldest sister was not the smooth operation I anticipated. The feelings expressed in previous emails set me up (I believe) to be slammed by their true feelings about the burden they feel caring for our parents has become. My sister and I walked away a bit shaken and knowing we would have to come up with a new plan of action. We spent several days coordinating our parents doctor appointments, getting releases of information signed so that we can speak directly with their doctors, getting a clear understanding of the medications they currently take, and making sure we had all appointment dates on not only their kitchen calendar, but also on our own individual calendars so that we can monitor and manage their doctor appointments from a distance. It was decided that Daddy is still okay to drive to appointments, etc. in their hometown. Any distance driving would be handled by one of the visiting daughters or, if necessary, by one of our brothers. It's clear that aspect of care has become too burdensome for them. Weekly housekeeping was arranged (until now they have been managing on their own with occasional help.) Daddy has agreed to having someone help him with the yardwork - something he has fought long and hard. The one area yet to be addressed - we're still investigating options - is preparing meals. Mom, for the first time, has voiced the difficulty this detail entails. Most social services that provide meals require - understandably so - financial need to be established. Not an option for them. For now, the "girls" will stock the kitchen when we're in town. We'll explore the possibility of the housekeeper assisting with meals.
My sister and I drove Mom and Dad, taking days in between for rest, first to Georgia (my home), then to Tennessee where my Father has siblings living, then to Virginia and my sisters house. Here they visited an assisted living facility my sister is familiar with. My mother was ready to move in - her usual response. Daddy, while pleasant and appreciative, was adamant it's not for him. Atleast they've seen the option and, if push should come to shove, they would have an idea of their destination.
So, Plan C is Mom and Dad back home at the river with regular housekeeping help and occasional yardwork help, the "girls" coming for extended visits every month, with our help managing doctor appointments, etc. Everyone seems happy with this arrangement. Everyone also realizes it is a stop-gap arrangement sure to be ammended over time.
This process has left me with a greater appreciation of just what it takes to "live forever". It brings to question all the magazine articles and television programs about aging and how to extend our "stay". There's a great line from a song by Loudon Wainwright III, "...if you're not a millionaire, you better be." Understanding just what it takes to "live forever", not only the dollar amount, but also the physical and mental cost of not only the individual, but also those attached by blood or the legal system, it begs to question whether "living forever" is all it's cracked up to be.
It's been a month since I wrote the above. A trip home and a meeting with my two brothers and my oldest sister was not the smooth operation I anticipated. The feelings expressed in previous emails set me up (I believe) to be slammed by their true feelings about the burden they feel caring for our parents has become. My sister and I walked away a bit shaken and knowing we would have to come up with a new plan of action. We spent several days coordinating our parents doctor appointments, getting releases of information signed so that we can speak directly with their doctors, getting a clear understanding of the medications they currently take, and making sure we had all appointment dates on not only their kitchen calendar, but also on our own individual calendars so that we can monitor and manage their doctor appointments from a distance. It was decided that Daddy is still okay to drive to appointments, etc. in their hometown. Any distance driving would be handled by one of the visiting daughters or, if necessary, by one of our brothers. It's clear that aspect of care has become too burdensome for them. Weekly housekeeping was arranged (until now they have been managing on their own with occasional help.) Daddy has agreed to having someone help him with the yardwork - something he has fought long and hard. The one area yet to be addressed - we're still investigating options - is preparing meals. Mom, for the first time, has voiced the difficulty this detail entails. Most social services that provide meals require - understandably so - financial need to be established. Not an option for them. For now, the "girls" will stock the kitchen when we're in town. We'll explore the possibility of the housekeeper assisting with meals.
My sister and I drove Mom and Dad, taking days in between for rest, first to Georgia (my home), then to Tennessee where my Father has siblings living, then to Virginia and my sisters house. Here they visited an assisted living facility my sister is familiar with. My mother was ready to move in - her usual response. Daddy, while pleasant and appreciative, was adamant it's not for him. Atleast they've seen the option and, if push should come to shove, they would have an idea of their destination.
So, Plan C is Mom and Dad back home at the river with regular housekeeping help and occasional yardwork help, the "girls" coming for extended visits every month, with our help managing doctor appointments, etc. Everyone seems happy with this arrangement. Everyone also realizes it is a stop-gap arrangement sure to be ammended over time.
This process has left me with a greater appreciation of just what it takes to "live forever". It brings to question all the magazine articles and television programs about aging and how to extend our "stay". There's a great line from a song by Loudon Wainwright III, "...if you're not a millionaire, you better be." Understanding just what it takes to "live forever", not only the dollar amount, but also the physical and mental cost of not only the individual, but also those attached by blood or the legal system, it begs to question whether "living forever" is all it's cracked up to be.
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