to acknowledge relapse

I work with a young woman who identifies herself as a “problem drinker.” Very long story short and for the sake of confidentiality purposes, she experienced a highly-traumatic childhood and lives with a mentally-unstable mother. Alcoholism runs through her family, as it frequently does with addictive disorders. She drinks to self-medicate; she drinks to avoid feeling; to avoid the constant reminders of her broken past.

She’s been sober since I began working with her several months ago. We’ve worked on depression, anxiety, exploration of childhood pain, recent relationships. She’s a motivated client, and we have built very strong rapport (which I consider the single most important therapeutic skill).

Recently, she relapsed. I astutely observed as she told me this in session. The cowardly look. Eyes gazed down at the ground. Embarrassment. Shame. Lowered voice. I’ve started drinking again.

If shame had an emoji, it would have been the expression on her face. At one point, it would have been mine too.

It’s a painful truth to admit, and I know how much shame arises in just telling your therapist you’ve, in your opinion, fucked up. I hated doing it with my own therapist. So much transference occurs: so much fear of letting your therapist down, so much resentment and pain at letting yourself down. All people with addiction struggle in recovery, but it is far more important to examine how they acknowledge relapse.

I know this is true for me. Every time my therapist told me relapse is part of recovery with that smiling, you-can’t-possibly-disappoint-me expression, I wanted to knock that grin right off her face and yell at her for instilling doubt rather than hope. I obviously understand her intentions now, but back then…hell no. I thought I was the only one screwing up; I thought I was the terrible client; I thought I was somehow responsible for wasting her time and ruining all her hard work. I wanted to always be the exception; I wanted recovery. Perfect, black-and-white recovery…clean, concise, and predictable.

A good therapist, however, never works harder than his or her clients. Thus, when the therapist keeps that mentality in check, it is impossible to be disappointed by any content the individual can bring into the room. Am I concerned about my client’s relapse? Yes, absolutely. But…I recognize this is part of her process. She’s not a bad person for using a “bad” behavior. She made a mistake, as all of us humans do. Alcoholism is a mufti-facted, complex disease that isn’t as easy as stone-cold sobriety. I understand that.

I’m so fucking proud of her for being able to tell me. For being able to own up to that shitty part of herself that she hates, that she believes nobody can accept. Because…I can accept it. I can hold it. I can give her the love and validation she deserves to give herself, but, for obvious reasons, cannot do right now.

My therapist used to do that for me. And it felt good. It is something I always promised I would give to my clients, and it’s something I try and transcend in every single session with every single session. Validation. Support. Constant hope and reassurance that things can and will get better, that they are good enough regardless of what they do or do not do.

Some people never get told that by anyone. My aim is to tell that to anyone who needs to hear it.

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the fantasies of eating

Dear Bee,

I’m home alone at my boyfriend’s apartment, and I’m finishing some writing for that novel I’ve been working on. I’m supposed to complete 50,000 words by December 1st. I just hit my 22,000 mark. The characters are taking own their own paths; the plot is shaping into its own story. I feel like I am just the puppet master overseeing the show. I do not feel as if I have control over what happens. That’s the beauty of writing. When you are immersed in it, the creativity just flows. The words cannot come out fast enough.

It’s a peaceful late afternoon. We’ve been working on homework, enjoying a leisurely Sunday. He’ll be back in about an hour. I’ve just been doing my best to relax.

Over the past few days, I’ve had  fantasies of bingeing, and I’m not sure what void they are filling. Sometimes, before I go to sleep, I’ll start thinking about cramming myself with food. The thoughts are seductive and fierce. It’s intensely realistic, almost in a fervent sexual manner. They terrify me. I haven’t been acting on these urges, and they feel nearly subconscious rather than immediately triggering, but it weirds me out. I feel silly for having such thoughts, because I know NOTHING makes me unhappier in life than acting on my eating disorder. There are a lot of terrible things in this world that I cannot control, but how I treat my body and soul IS in my control. I know this is a part of recovery. I remember when I used to binge in my dreams and wake up discombobulated and confused between reality and fantasy. It always felt so relieving to know it was just a dream.

I’ve been missing my “safe food” repertoire and feeling guilty for eating with less inhibitions and more intuition. I’ve been eating out a lot, which can be a struggle in recovery. Still, I’m pushing. I’m acknowledging my thoughts and feelings, but I’m choosing to act against them.Everyday, it gets easier to veer away from those low-calorie, bland foods and allow in what I really want without bingeing on it. I do not have to succumb to restriction or deprivation to avoid bingeing. Like I said yesterday, living in the gray is healthy. When living in the gray, anything is possible. It’s when we only want to look at the black-and-white, everything is impossible. 

Yesterday, I found out one of my close colleagues is in recovery from alcoholism. She regularly works the Twelve Steps and maintains her sobriety in the best ways she knows how. Like me, she is also studying to be a therapist. Initially, something about her bothered me. She complained frequently, projected her anxiety onto others, and seemed to stem her insecurities in all the inappropriate ways, but for some reason, I feel so much more connected to her now that I know the battles she’s undergone. On some level, no matter how different we are and how different are vices might have been, we have fought the same demons. We deal with the same emotional roller coasters and triggering situations. We know our poisons, we know our disordered voices, and we know how delicious the sober life tastes compared to the sick life. And yet, we both probably flirt with our sick selves more than we’d like to. That’s part of recovery. That’s part of healing.

I’m glad that I have therapy tomorrow. It’s been three weeks. And after running dozens of sessions in that timeframe, it will be refreshing to have my own selfish hour. 

Now, I’m going back to my novel writing. Going back to my creative flow. I love this blog, but I want to get lost in my own fantasies right now. Fantasies that don’t involve my sickness, but rather, ones that involve the uniqueness of my soul. 

The woes of treating addiction in eating disorder recovery.

Dear Bee,

I am just so glad that it’s the weekend. My Monday-Thursday are such a blur between classes, paperwork, supervision, and clients.

I basically spend the weekend at the boyfriend’s house, which is such an amazing way to transition out of the therapist life. I like being able to unwind with him. It feels like a mini-vacation at the end of the week! He’s my greatest supporter. Okay, this is not a time to gush on and on about him, even though we all know I very well could.

So, I have my first addiction on my hands. Alcoholism. This client and I are close in age, but that’s where the similarities concerning our backgrounds end. She’s in that contemplation stage of addiction, that awful in-between in knowing that she has a clear problem, but not sure what to do about it just yet. Her support system is shit. Her living arrangement is shit. She has experienced significant trauma and represents a classic textbook case of life is against her. I understand why she drinks to numb out her feelings. She needs that blanket of intoxication to cope with the chaos that is her life. Like so many of us, escape is all she wants. We don’t fall into addictions to escape the pain and demons outside of us. We fall into them to escape whatever lies within us. When we cannot tolerate our own selves, our own genetic makeup and uniqueness, our own peaks and valleys of emotions and experiences, we must alter consciousness in order to keep going.

Obviously, I have an urge to help her. She reminds me of a friend, one I wrote about in a previous post (http://loveletterstobee.com/2013/03/21/the-day-i-broke-up-with-my-alcoholic-best-friend). Originally, I went into this field with the intention to specialize in substance abuse. Naturally, I wanted to save the world, which is such a novice, idealistic goal for young, fresh-faced therapists. In reality, working with addicts embodies hard, exhaustive work, and the recovery rates hover around 5%. Out of 100 people with chemical addiction, approximately 95 will relapse. Of course, I see it as, Let me be the one who guides those remaining 5.

I am not an alcoholic, but I know what it is like to feel dependent and compulsive. I know what cravings feel like. I know when the thing you want the most is the very thing that is destroying you the most. I know secrecy and deceit, hiding around from others, shame and lying, minimizing and saving face. I know what it’s like to feel like you have absolutely no control. Addiction is just a name and the drug of choice is just the band-aid poorly covering our deep wounds. Food, drugs, gambling, sex, alcohol, it’s all the same. We are in pain, and we cannot tolerate it. The addiction voice has tremendous hold and impeccable logic. There is nothing easy about recovery or sobriety. There is nothing easy about going against every single thing you believe you want or have or must do. Addiction may not be a choice, but letting go of it is. And for many of us, it will be the hardest choice and journey we ever take. Although it may sound contradictory, for those in recovery or sobriety, nothing is harder than letting go of torture and surrendering to freedom.

Alcoholism, just like any other addiction, including eating disorders, is progressive. It just gets worse. You start out with a drink or two a night just to relax and take the edge off, and soon enough, you’re blacking out daily. This is a stereotypical example, but not an uncommon one. The worse the addiction gets, the more the addiction voice justifies it. Our addiction voice protects us because it wants us to remain close and friendly. The addiction is the parasite, and you are its host. It will latch on you, rent-free, and never leave on its own. Only you can remove it.

I don’t know what will happen with this client. My agency does not allow us to work with active drug or alcohol addicts, simply because it hinders therapeutic treatment. She needs to commit to attempting sobriety, and I don’t know if she can do that at this point. I want her to, just as I want any addict to, but that change lies in her, not in me. Therapy is for her, not for me, and I have to continually remind myself that. I cannot change anyone; I can just metaphorically hold their hands as they decide to venture on a new path.

Recovery comes first.

Dear Bee,

There is only one real question that one has to ask- about everything: does this threaten my sobriety? If it does, we addicts cannot do it. It is as simple as that.

I am reading this therapy book and skimming through most of it (because I find the author arrogant and somewhat misinformed), but I stopped at the addiction and codependency chapter, and this quote jumped out.

 In the Twelve Steps philosophy, sobriety holds precedence above everything else. Above family, above friends, above work…because if one is not sober, one is not in the correct capacity to be the person he or she needs to be. I use the words sobriety, abstinence, and recovery synonymously. I prefer recovery, so, in my case, I have to put my recovery first. But what does that mean?

Putting recovery first means acting in ways that I once considered selfish. This includes putting my own needs first, recognizing uncomfortable situations, practicing assertiveness, and doing my best to eliminate negative energy. It also means putting in hard work: going to therapy, reaching out for support, writing as often as I can, talking about my issues, identifying triggers, doing reality testing/thought records/pros and cons lists with myself, and eating in a way that is healthy for my mind, body, and soul.

Full recovery entails the transformation of thoughts, feelings, and behaviors. When I was only eating “normally” in the first few months, I felt miserable. My thoughts were still rigid, my emotions were still rampant, and all I could think about was food, exercise, food, therapy, and food. I was running too fast on a treadmill that was taking me nowhere. Or so I thought. But I kept going.

Putting recovery first is shitty in the beginning. I won’t lie. It’s messy. It’s painful. The days drag, and the alleged light at the end of the tunnel is dim to nonexistent. The lapses hit you, and they hit you hard. You wonder, is this even worth it? You wonder, how do people actually do this? You wonder, will it ever get better? Or am I just a lost cause? Am I doomed to live like this forever?

I think about my recovery every single day. But, I don’t live perfect recovery every single day. That would be impossible. Such unrealistic expectations increase the likelihood of failure, quitting, and self-loathing. I have to be easy on myself, but, at the same time, I need to be aware of the cunning and destructive nature of eating disorders. They don’t just disappear, and relapse rates remain stubbornly high. I’ve only been in real recovery for a year. Before that, my attempts were well-intentioned, but unsuccessful because they still focused on vanity (ex: I need recovery, because it will help me lose weight) and not vitality and overall well-being. 

When you recover from an eating disorder, you recover from the idea that chaos is comfort. You learn to accept that you aren’t special or entitled just because you meet criteria for a diagnosis. You realize that nothing else in life changes just because you lost or gained ten pounds except, of course, your own attitude and perspective. You realize that food is JUST food, and the only thing that is negative or positive about it are your thoughts regarding what it does to your body and mindset. You distinguish eating disordered logic from reality and realize that, at one time, most of your thinking about yourself was irrational, distorted, and destructive.

Recovery is a long process and miracles do not happen overnight. But progress does. Chip at it, day by day, moment by moment, meal by meal. If you slip, you slip. You learn and you grow and you toughen up from it. If you cry, you’re releasing the inner pain and torment. That’s normal. If you feel lost and alone, welcome to the club. I am blessed to have some recovery under my belt; I am fortunate enough to get a second chance at life and all of its virtues; I am grateful- ever so grateful.

Today, if the eating disorder comes out to play, I will ask myself, what do I have to do to put my recovery first?

Having a relationship with an eating disorder.

Dear Bee,

So there is a very real possibility that things are going to be moving quickly with this guy. I just have a feeling. And normally, this is not how I roll. Because this isn’t part of some “plan.” Because this isn’t on some kind of safe timeline. I’m not that kind of girl who falls all over a guy she just met. Like at all. But, who am I to fight this conquering beast we call life?

Having always believed my emotions were wrong or inferior, I followed the all-knowing logic that existed in my head. Who cared what my heart felt? Feelings didn’t matter, but practicality and convenience did. This explains why I stayed in relationships with men I didn’t love. This is why I followed those dating rules almost religiously. Play the nice girl, dumb myself down if needed, give him what he wants, don’t fall too hard, etc.

But, I am also not native. Dating and relationships represent dangerous territories in early stages of recovery. Professionals typically advise recovering addicts to maintain sobriety for at least a year before considering a relationship. What about individuals with eating disorders? There does not seem to be a general rule of thumb for this. Do we need one? Obviously, the dynamic of a recovering drug addict may be different than someone recovering from an eating disorder, but is it? In fact, with an eating disorder, the recovery is less black-and-white. Individuals with codependency issues may find themselves prioritizing the other person’s needs over their own. I am aware that I am still fragile and vulnerable; while i have been making remarkable progress, I need to continue pushing forward. 

At this point, my recovery is the most sacred part of my life. I will sacrifice and change virtually anything to accommodate those needs. And yet, it seems like he can fit into this equation. For one, he already knows what I’m going through (because this what two aspiring therapists talk about all day). And for two, I didn’t feel any sense of shame in telling him. I didn’t plan on disclosing something so personal so soon, but our conversation somehow led us in a direction that opened the door for me to talk about it.  He was genuinely curious and said he admired my strength and willingness. So, there you go. 

You triangulated yourself in my past relationships, and it was extremely painful. You let me be in love, but never with myself. You let me be close to someone, but never to the point where I was fully able to let go and fall into my primal emotions. You always, always kept me grounded and orderly; structured and controlled. Because that’s where you liked me. That’s where you thrived the most. You needed to be the first priority in my life, and you did everything in your seductive powers to make that happen. When I think of past anniversaries, do I remember the feelings i experienced or the food I ate? When I think of vacations, do I remember all the laughs we shared or do I remember feeling self-conscious in my skin? When I think of holding someone in my arms, was I thinking about how much I loved him or how much I weighed that morning? It didn’t matter how many times he told me I was beautiful. It didn’t matter how much I knew that number on the scale didn’t really matter or the food I ate wasn’t really going to make me incredibly fat.

The eating disorder pathology isn’t about logic and reason. If it was, it wouldn’t exist. 

I would never wish for that history to repeat itself, but I just don’t think it will. You may still linger from time to time, but I no longer need you for protection. I no longer need you to keep me safe or in control. I can trust myself and the universe now. I know a world that is so much more beautiful than your reality. 

The day I broke up with my alcoholic best friend

Dear Bee,

One of my best friends is an alcoholic. She admits she has a problem, but she has not accepted that she needs to change. Today, after six years of growing, learning, and leaning on each other, I ended our friendship.

I didn’t want to, not at first. I resented anyone who said she had a “problem” and resisted any advice to reconsider what our friendship meant to me. She worked the AA program once and maintained a brief sobriety, but once she stopped attending meetings (after deciding that everyone there was just trading one addiction for another one and that her problem was just a matter of “sheer willpower), she relapsed.

I truly believed we could maintain a perfectly balanced relationship outside of her own addiction, outside of the alcoholic voice that reminded me so much of my eating disordered voice. I truly believed that she was separate from her alcoholism, in the same way I believed I was separate from my eating disorder. I truly believed she was a wonderful friend to me.

I had never even heard the term codependency until this year. And now I fully realize that I 100% enabled her drinking. What are the core aspects of codependency? Overinvolvement in the other person’s drinking, attempts to obsessively control, use of external sources for self-worth, and making personal sacrifice. I have done all of these. I have encouraged her drinking by drinking with her. I have listened to her explain how she can compartmentalize her alcohol problem and still lead a fully functional life. I have seen her passed out drunk; I have driven her home; I have fought for her keys; I have woken up to pages of texts announcing all the regretful actions she had made while under the influence.

She is an alcoholic. There is no denying that.

Yet, she defines the stereotypical, “functional alcoholic.” In fact, she is one of the smartest, most driven people I have ever met. Her IQ nearly qualifies her as a genius. She has been through hell and back. She comes from the stereotypical, textbook-cliched broken family, enduring abuse, rape, poverty, neglect, etc. Given her background, most would believe that she belongs in three places: dead, jail, or rehab. In other words, she nearly has every reason to drink. She has lived through tremendous pain and turmoil.

And today, I told her if she cannot get help for herself, I cannot continue this friendship. She is too triggering to me right now, and I cannot work on my own recovery and mental well-being while I am still putting others needs before my own. I cannot work my own twelve steps and learn to be a better and healthier person while taking care of someone who does not want to be taken care of.

Do I feel guilty? Incredibly. Am I sad? Yes. Do I know I made the right choice? Yes.

Slowly, but surely, I am purging myself from all these toxic relationships and emotionally-imbalanced people in my life. I never realized how taxing they were on my self-esteem and energy. These past two days have been incredibly painful and trying. I have been examining two pivotal relationships in my life extensively (the one with my ex-boyfriend and now, my ex-best friend). And, yet, I know, I KNOW, this is the best thing for me. I also know this is the best thing for HER. Maybe this is the reality check she needs. I don’t think anyone has truly confronted her problem in such a harsh and blunt way before, and while I hate being the person responsible for doing it, I know that it had to be done.

Maybe one day, she will realize that I did this out of genuine love and concern for our friendship. Maybe one day, she will realize that her defensiveness and vicious attacking towards me was her way of denying the ferocity of her disease. Maybe one day, she will commit to sobriety because she realizes she has no other choice.

I will be there for her on that day. I will be the friend to walk into AA with her, to go to Al-Anon for her, to find a therapist for her, to even give up my own drinking for her. But until she wants help for herself, I cannot watch her ruin and destroy her life.

What does a dry drunk look like in eating disorder recovery?

Dear Bee,

In the addiction community, they use the term, dry drunk, in reference to the individual who abstains from alcohol, but changes nothing else in his or her life. Consequently, even though the person is no longer drinking, he or she may continue hanging out with the same toxic friends, remain in the same loveless marriage, engage in the same reckless behavior, stay in the same unsatisfying job, etc. As a result, the dysfunction continues to unravel, and the individual finds that a life of sobriety does not actually make a life of happiness. 

Of course, this would make anyone angry. And why not? When they talk about sobriety, they gloat about its virtues. They promise that the pain is worth it. They promise a life of fulfilling relationships and undeniable self-worth.

Is it a scam, these dry drunks wonder? Was it all a big lie? 

At least when I was having drunk, I was having fun.

I wonder about this in my own form of eating disorder sobriety. A few months ago, I disclosed to my therapist that even though I had severely minimized and even quit most of my disordered habits, I still felt extremely anxious and preoccupied with these intrusive thoughts. At the time, this bothered me. 

I mean, I wasn’t bingeing. Wasn’t restricting. I had 95%  let go of the diet mentality. Shouldn’t things just fall into place? 

Why wasn’t I feeling better?

HA! You certainly found that idea entertaining.

Since then, the anxiety and preoccupation has lessened, but I hold onto my recovery with fierce arms, as if it is still a very fragile child that can be easily taken from me.

Why is recovery so challenging? Because fixing the behaviors without addressing the driving compulsions, distorted thoughts, and patterns that trigger those actions is only a sling on a broken arm. It holds up in a pinch. It could make do…if nothing else. But throw in an extreme stressor and all logic goes right out the window. You come right back with a vengeance. 

You remind people that you are always there whether they like it or not. 

This is why relapse is common. This is why relapse hurts.

I have seen many girls who physically recover from eating disorders. Yet, erasing the symptoms of the diagnostic criteria does not provide any assurance that the individual will suddenly feel better. In fact, recovery can feel far worse. Suddenly, you are forced to deal with all the emotions you either stuffed or starved. You must face the positive or negative changes in your body and appearance. You need to relearn how to appropriately cope with stress, anxiety, and depression. Even though the body may return back to “normal”, we all know the mind can remain severely disturbed. 

Lately, I have been thinking about what other things I need to change in order to achieve a well-balanced recovery. It is not enough to just live a life free of the bondage that is my eating disorder. That keeps me confined to a label, categorized into a diagnosis.

Recovery may involve the removal of friendships that no longer positively benefit me. It may involve addressing my compulsive need for always being busy. It may involve a spiritual component, although I am unsure what that would look like. It will definitely involve examining my intimate relationships and the dysfunctional men I tend to choose to date. 

This journey never fails to amaze me. I am so grateful for our relationship. It has taught me more than any textbook, person, or classroom.