The Accidental Poet Spirituality

The Choice to “End it All.”

Suicide Definition Graphic

Written by Steven Barto, B.S., Psy.

IT WAS FOUR IN the afternoon. I was driving along the river in my home town. It was the fourth decade of my struggle with active addiction. Overwhelmed with thoughts of utter failure, rabid hypocrisy and complete hopelessness, I started ruminating about the idea of suicide. Why not? It made sense. I was in bondage to drugs and had grown tired of living a life so out of touch with my Christian upbringing. Seems I could not stop lying, cheating, stealing. Doing whatever it took to keep getting high. Duplicity was the word that most described my existence. I’d grown weary of living on the down-low. I was defeated, exhausted and tired of failing.

I turned into an area boat launch and stopped about fifty yards from the edge of the water. I closed my eyes and took my foot off the brake. I’d barely touched the accelerator when I heard an audible voice. It filled the cabin of my car: Don’t. I jammed the brake pedal to the floor and gripped the steering wheel in a panic. I must be losing my mind! There was no one else in the car. The radio was off. Yet, somehow, I heard a voice that seemed to fill the interior of my car. I could feel the voice, insistent but not loud. No sense of anger or disappointment. It was simply an audible, gentle, compassionate insistence.

Don’t end your life!

It’s been said that suicide is a permanent solution to a temporary problem. Perhaps if some in-between state existed—some alternative to death—many suicidal people would take it. One question every surviving family member has asked without exception, that they ache to have answered more than any other, is simple: Why? Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note is left behind, it still never makes sense. Yes, they felt enough despair to want to take their own life, but Why did they feel that way? Alex Lickerman, MD said, “People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy, but a valid one nevertheless” (1).

A friend of mine took his own life in 1996. We met a few years earlier as co-workers at a Philadelphia law firm. We were both on staff as litigation  paralegals. He had recently started a new career trading stocks. Apparently, he was under investigation by the SEC for insider trading. His wife kicked him out and filed for divorce. He moved in with his parents and had become quite depressed and withdrawn. He stayed home from work on a Tuesday. After his parents left the house, he took his father’s .357 handgun and drove to his wife’s place. When she answered his knock, he shot himself on the stoop in front of her. I always knew him to be outgoing, hilarious, and always up for a good time. His death made no sense to me.

Unfortunately, suicide without warning is common. Patrick J. Skerrett quoted Dr. Michael Miller, a psychiatrist at Harvard Medical School, in a recent article on suicide: “Many people who commit suicide do so without letting on they are thinking about it or planning it” (2). Currently, suicide is the tenth overall cause of death in the United States. In 2018 there were 48,334 suicide deaths in America. Had I not heard God’s voice that afternoon in 2018, the total would have been 48,335. There were an estimated 1.4 million suicide attempts in the U.S. in 2018. The rate of suicide is highest in middle-age white men in particular. It was the second leading cause of death among individuals between the ages of 10 and 34. On average, there are 132 suicides per day. In 2018, firearms accounted for 50.57% of all suicide deaths in America (3).

America’s suicide rate has increased for 13 years in a row.—The Economist

According to the National Vital Statistics Report, suicide was the second leading cause of death for age groups 10 to 24, or 19.2% of deaths, and 25 to 44, or 10.9%. This report presents final 2017 data on leading causes of death in the United States by age, sex, race, and Hispanic origin. These data accompany the release of final national mortality statistics for 2017 (4). In 2017, the 10 leading causes of death were, in rank order: heart disease; malignant neoplasms; accidents (unintentional injuries); chronic lower respiratory diseases; cerebrovascular diseases; Alzheimer disease; diabetes mellitus; influenza and pneumonia; nephritis, nephrotic syndrome and nephrosis; and intentional self-harm (suicide).

Suicidal Ideation and Social Media

Various social media platforms offer an unprecedented volume, velocity, and variety of social data to researchers. Among these, the most consistently studied is Twitter, a microblogging platform in which participants broadcast 140-character posts directly to one another or to the Twitter community simultaneously. Twitter’s sociological and psychological relevance for researchers and treatment providers is elevated due to ease of accessibility to data, the fact that most data collection activities can be undertaken at no cost to the researcher, and the ease of data management. For example, because Twitter limits individual posts to 140 characters, the information is more easily stored and reviewed than longer Facebook posts.

Facebook Suicide Prevention webpage can be found at www.facebook.com/help/594991777257121/ [use the search term “suicide” or “suicide prevention”].

As with a variety of social media platforms, Twitter has been a boon to suicide researchers, who can observe the behavior of individuals in a non-invasive manner, collecting “live” (time-sensitive) information that might not otherwise be shared because of the stigma of mental illness and suicide. One researcher was able to analyze 125 users who publicly announced they had attempted suicide. Analysis of these individuals’ posting history revealed distinct signals in previous posts that could have been used to predict their upcoming attempts and initiate an intervention (5). This is a relatively large sample that otherwise might have been overlooked.

Strong correlations have been discovered between suicidal expressions on Twitter and state-specified age-adjusted suicide rates. It is believed that posting suicide-related content on social media specifically identifies at-risk individuals. In fact, unique posting patterns have been posthumously discovered for Twitter members who died by suicide when compared to those who died of other causes (6). Such results demonstrate the value of verbal content people post on social media sites—providing unique insight into suicidal behavior.

Twitter’s Best Practices in Dealing With Self-Harm and Suicide at https://support.twitter.com [use the search term “suicide,” “self-harm,” or “suicide prevention”].

Psychologists and sociologists have begun to analyze social media data—correlating the content of social media posts regarding the topic of suicide with eventual suicides or attempts. Analysis has proven most useful in this regard. It must be determined whether suicidal behavior can be correlated to online comments among peers beyond one degree of social separation. Also, it must be determined whether that correlation persists after excluding innocuous commentary regarding mood and attitude. In other words, if mood is held to a constant in the analysis, will the observed association in suicide-related behavior still be higher than chance? Recent research has determined that comments on social media relative to suicidal expressions can be studied and correlated  up to three degrees of separation between peers, but no further. 

N.A. Christakis and J.H. Fowler (7) noted that correlation held between suicidal remarks and suicidal actions even when accounting for the distribution of mood among participants in the social media network. They used the bootstrapping method (employing computer-intensive analysis of  variability within their data samples) to study real-time posting activity on Twitter. Their samples were comprised of two non-consecutive 28-day periods. Mechanical Turk (MTurk; Amazon, 2016) raters have compiled suicide-relatedness ratings for each of the 10,222 most common words in contemporary English for use in evaluating social media posts for occurrence of “suicidal conversation.” These words are correlated with a preexisting list of “sad” words (as they relate to the sad/happy continuum) used to infer the general mood of social media users. Collection and analysis was conducted via double-blind method for accuracy and to allow for detecting statistical variation and spurious correlation.

Some variants of “sad/happy” word expressions that may or may not be associated with suicidal ideation include “I’m so sad! I’m gonna kill myself!” “I’m the worst! LOL!” “My final day on earth…” “Just got in a fight…” “It’s a sad day.” “I love my life!” Analysis included placing “sad,” “happy,” and “suicidal” words into columns on a graph and quantifying the number of uses of such words or phrases. Also, degrees of separation (direct friend versus once, twice, thrice removed) were determined at one through six degrees: friend, friend of friend, friend of friend of friend, and so on. The Sad Column, Happy Column and statistically relevant variables were each plotted along the graph comparing “mood” and “suicide-relatedness” comments. Amazingly, this study may be the first of its kind, and involved collection and analysis of over 64 million post from over 17 million unique social media users in two nonconsecutive 28-day periods. Analysis of this real-time data helped predict (by an algorithm) the information collected, which typically has infinite possibilities of correlative meaning.

You might ask, But why is this important? What does it mean? How can it be utilized? Suppose a counselor is concerned with the suicide risk of students in a high school where a fellow student recently took her own life. To get the best data in the shortest amount of time, the counselor would do the following:

  1. Ask a teacher for a list of the decedent’s closest friends and screen them;
  2. Ask any friends on that list to name their closest friends and screen those friends;
  3. Ask any friends from the new group to name closest friend and screen them, and so on; and
  4. Once there are no more positives in a friend group, screen students at random until a positive is found and begin the procedure again until the resources run out (i.e., there are no more students in the population).

Although the above process will provide an  initial “hint” of an assortativity-informed treatment approach, additional research would be necessary before beginning any efficacious intervention. Researchers warn that no offline behavior was included in their study, and therefore was not available for comparison.

Co-occurring Issues and Suicide

Suicide is a major public health problem and a leading cause of death in the United States. Everyone who chooses to attempt suicide has an underlying reason for wanting to do so. Suicide does not discriminate—people of all genders, ages, religious faiths, and ethnic groups can be at risk. Most people at risk will not follow through. Still, assessing the risk for suicidal behavior is complicated. Researchers tell us that people who attempt suicide may do so in reaction to a particular event, thought, or emotion. These individuals make decisions differently than those who do not attempt suicide. Such factors for increased risk are depression, anxiety, personality disorders, psychosis, severe bullying, rape or trauma, and substance abuse. 

Suicidal acts may be connected to recent events or current conditions in a person’s life. Although such factors may not be the primary motivation for the suicide, they can precipitate it as underlying or co-morbid triggers. A major underlying cause of suicide has been combat stress and other related PTSD issues. People in this at-risk category do not necessarily have to experience the horrors of a war zone. Other types of immediate stress include natural disasters, terrorism at home, or catastrophic loss from such events as a structure fire or a serious motor vehicle accident.

People suffering from chronic pain, severe disability, or a major illness may attempt suicide, believing their suffering is too great or that their death is inevitable. Victims of an abusive or repressive environment from which they have little or no hope of escape sometimes commit suicide. Situations that fit this category may include torture, confinement, sexual assault, or persistent physical abuse. Also, occupational stress has been indicated in some suicides due to extreme tension, anxiety, disillusion or “burnout,” and job-related financial pressures.

Cyberbullying, Substance Use Disorder

In addition to the above precipitating factors, many suicide attempts are preceded by a severe change in mood that do not correlate to an underlying psychiatric diagnosis. Mood changes most likely to lead to suicide often include extreme sadness, unresolved anxiety, frustration, anger, or shame. Unfortunately, the number of teens and young adults who take their own lives has increased due to bullying at school or on social media sites. Nearly 1 in 5 students (21%) report being bullied during the school year, impacting over 5 million youth annually. See National Center for Education Statistics [NCES], 2018. 

There has been a spike in cyberbullying over the last couple of years. This is willful and repeated bullying behavior that takes place using electronic technology, including texting, comments during gaming, Internet sites, social media, emails, blogs, cell phones, and so on. Unlike traditional bullying it can happen anywhere at all hours of the day. Approximately 34% of students report experiencing cyberbullying during their lifetime. See Hinduja & Patchin, 2015. Students who experienced bullying are nearly 2 times more likely to attempt suicide. See Hinduja & Patchin, 2018.

Worldwide, more than 1 million people die by suicide every year. Self-harm deaths have been on the rise in nearly every state in America. In the U.S., suicide deaths (47,173) were almost equivalent to the number of deaths from opioid overdoses (47,600) in 2017. It is essential that suicide prevention practices be implemented and expanded wherever possible (8). Opioid Use Disorder (OUD) has a distinctly strong relationship with suicide as compared with other substance use disorders (9). Pain causes alterations in brain circuitry in the brain’s reward center (involving the ventral tegmental area, nucleus accumbens, and the amygdala), resulting in vulnerability to suicide and a higher risk of opioid addiction. This is supported by epidemiological data that have shown chronic-pain diagnoses are linked to suicide. These associations are only partially explained by co-occurring mental health conditions, which tend to further complicate morbidity.

Tolerance to THC can build quickly in cannabis users. Teens who seek help for cannabis-use problems often report withdrawal symptoms such as anxiety, insomnia, appetite disturbance and depression (Budney & Hughes, 2006). These symptoms are of sufficient severity to impair everyday functioning (Allsop et al., 2012) and they are markedly attenuated by doses of an oral cannabis extract (Sativex) that contains THC (Allsop et al., 2014). Bagge and Borges (2015) conducted a case-crossover study of 363 persons who had recently attempted suicide and were treated in a trauma hospital for a suicide attempt within the previous 24 hours in Mississippi. The researchers compared rates of cannabis use in the 24-hour period leading up to the individual’s suicide (case period) to individuals who used cannabis during the same time period but did not commit suicide (control period). They found that 10.2% of those who attempted suicide had used cannabis within 24 hours of their suicide.

Cannabis was involved in an estimated 6.5% of drug-related suicide attempts, and in 46% of attempts the person had also used alcohol. In the 23% of drug-related suicide attempts with toxicology reports, 16.8% tested positive for cannabis, although this cannabis use could have occurred days or even up to one week earlier. In general, 9.5% of all toxicology reports for deaths by suicide (Borges, Bagge & Orozco, 2016) show the presence of cannabis. There is preliminary evidence of higher detection of cannabis among suicide decedents that do not involve overdose (CDC, 2006) and higher detection among male suicide decedents using non-overdose methods than among females (Darke, Duflou & Torok, 2009; Shields et al., 2006).

So Now What?

The Centers for Disease Control and Prevention (CDC) released data on the ten leading causes of death in the United States recently. Tragically, suicide—too often a consequence of untreated mental illness and substance use disorders, and as such a preventable condition—remains on that list as the 10th leading cause of death for adults and the second-leading cause of death in our youth. Suicide rates increased from 29,199 deaths in 1996 to 47,173 deaths in 2017. Click here for more information.

What are the contributing factors to a state of mind that ends in a person taking his or her life? What can be done to intervene? How can we turn the numbers around? The increased number of suicides year after year say something about the conditions under which people live and die, and about our society at large. Our teens and young adults are deciding in record numbers that killing themselves is the best solution to what is usually a temporary situation. Citizens at the lower end of the socioeconomic scale are significantly more vulnerable due to negative views about life and an increased amount of psychological and social difficulties. Many of these conditions are not diagnosed in time or go untreated. Many are turning to substance abuse to cope, which often increases the risk of self-harm behavior. This speaks to an environment that can promote depression, anxiety, and elevation in substance use disorder. Some sociologists have referred to these suicides as “deaths of despair.”

There are a number of interventions we can apply to these dire circumstances:

  • Safety Planning. Personalized safety planning has been shown to help reduce suicidal thoughts and actions. Patients work with a caregiver to develop a plan that describes ways to limit access to lethal means such as firearms, pills, or poisons. The plan lists coping strategies and people and resources that can help in a crisis.
  • Follow-up phone calls. Research has shown that when at-risk individuals receive proper screening, implementation of a Safety Plan, and a series of supportive phone  calls, their risk of suicide goes down.
  • Cognitive Behavioral Therapy (CBT) can help people learn new ways of dealing with stressful experiences through training. CBT helps individuals recognize their thought pattersn and consider alternative actions when thoughts of suicide arise.
  • Dialectical Behavior Therapy (DBT) has been shown to reduce suicidal behavior in adolescents. DBT has also been effective in reducing the rate of suicide in adults with Borderline Personality Disorder or related personality disorders. These mental illnesses are typically characterized by an ongoing pattern of varying moods, self-image, harmful or risky behavior, and impulsive actions. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.

If you are struggling with thoughts of suicide, please reach out to someone before the fog of desperation clouds your mind. If you have a friend or loved one who has expressed an intent to take their own life, do not dismiss it as a cry for attention—instead, it is a cry for help. If you are interested in becoming a volunteer or mental health professional and want to be a part of the solution for this national epidemic, please talk to a teacher, professor, mental health professional, pastor, or mentor to find out how to get started.

NATIONAL SUICIDE PREVENTION HOTLINE
1(800) 273-8255

Footnotes

(1) Alex Lickerman, M.D. (April 29, 2010). “The Six Reasons People Attempt Suicide.” Psychology Today. https://www.psychologytoday.com/us/blog/happiness-in-world/201004/the-six-reasons-people-attempt-suicide

(2) Patrick J. Skerrett (Sept. 24, 2012). “Suicide Often Not Preceded by Warnings.” Harvard Health Publishing.

(3) “Suicide Statistics.” American Foundation for Suicide Prevention. https://afsp.org/about-suicide/suicide-statistics/

(4) Melonie Heron, Ph.D., (June 24, 2018). “Deaths: Leading Causes for 2017.” National Vital Statistics Reports, Vol. 68, No. 6. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdf

(5) Wood, A., Shiffman, J., Leary, R., and Coppersmith, G. (2016). “Language Signals Preceding Suicide Attempts.” CHI 2016 Computing and Mental Health, San Jose, CA.

(6) Bryan, C.J., Butner, J.E., Sinclair, S., et al. (2018). “Predictors of  Emerging Suicide Death Among Military Personnel on Social Media Networks.” Suicide and Life-Threatening Behavior, 48, 413-430. http://dx.doi.org/10.1111/sltb.12370

(7) Christakis, N.A., and Fowler, J.H. (2013). “Social Contagion Theory: Examining Dynamic Social Networks and Human Behavior.” Statistics in Medicine, 32, 556-577. http://dx.doi.org/10.1002/sim.5408

(8) https://doi.org/10.1016/j.jcjq.2019.10.001

(9) Bohnert KM, Ilgen MA, Louzon S, McCarthy JF, Katz IR. Substance use disorders and the risk of suicide mortality among men and women in the U.S. Veterans Health Administration. Addiction 2017; 112:1193–1201.

 

 

The Accidental Poet General

Mental Health and Addiction

The first section of this post is taken from the blog of Sophia Majlessi,
National Council for Behavioral Health
Released January 8, 2020

Voters More Likely to Support a Candidate Who Promises to Address Mental Health and Addiction, According to New Polling from the National Council for Behavioral Health Released Ahead of December 16 New Hampshire 2020 Presidential Candidate Forum

WASHINGTON, D.C. (December 11, 2019)—New polling released today by the National Council for Behavioral Health shows strong bipartisan agreement among registered voters in New Hampshire that the federal government is not doing enough to address mental health (84% of Democrats and 72% of Republicans) and addiction (77% of Democrats and 53% of Republicans) in America. The National Council released the new polling in advance of the Unite for Mental Health: New Hampshire Town Hall, a public forum for 2020 presidential candidates to discuss mental health and addiction policies. The National Council for Behavioral Health, Mental Health for US and the NH Community Behavioral Health Association will host Unite for Mental Health: New Hampshire Town Hall on December 16 at the Dana Center at Saint Anselm College in Manchester, N.H.

“The message is clear: candidates who want to win New Hampshire need to tell voters they have a plan to address the mental health and addiction crisis, one of the most important health issues facing the nation,” said Chuck Ingoglia, president and CEO of the National Council for Behavioral Health. “The Unite for Mental Health: New Hampshire Town Hall will provide an important opportunity for presidential candidates to engage with New Hampshire families, mental health professionals and local policymakers to discuss the issues and share solutions voters—and the nation—are eager to support.”

This statewide poll comes on the heels of new national data from the U.S. Centers for Disease Control and Prevention (CDC) confirming that suicide is the second leading cause of death among teenagers in the U.S. The suicide rate among people ages 10 to 24 years old climbed 56% from 2007 to 2017, according to the CDC report. These findings, compared with high rates of death nationwide from drug overdose, are leading to calls for the 2020 presidential candidates to engage communities across the country in order to better meet the needs of millions of Americans.

“Mental health and addiction continuously poll as key issues for many Americans, yet our leaders rarely prioritize prevention, treatment, and recovery strategies,” said former U.S. Rep. Patrick J. Kennedy, founder of The Kennedy Forum and Mental Health for US co-chair. “This new polling data from New Hampshire is the catalyst we need for change. The Mental Health for US coalition is proud to stand with the National Council and the NH Community Behavioral Health Association as we call on policymakers and candidates to walk the walk for the those with mental health and addiction challenges.” “The results of this poll are compelling. The need to invest in caring for those with mental illness is clear, and the voters want to see candidates for public office at all levels address these important issues,” said Roland Lamy, executive director of the NH Community Behavioral Health Association.

Results from the full survey have a margin of error of +/-6%. Click here for full polling results.

My Thoughts

The struggle to break free from active addiction is among the hardest undertakings a person can face in his or her lifetime. Putting the drug down is more difficult depending on the substance, amount used, and duration of use. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, has sequestered substance abuse under the new heading Substance Use Disorder (SUD). The substance-related disorders encompass 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; cocaine (powder or rock); opioids; sedatives and hypnotics; stimulants (amphetamine-type, cocaine, and other stimulants; tobacco; and other (or unknown) substances. It is important to note that all drugs (when taken in excess) have a common direct activation of the brain reward system, typically leading to dependency and addiction.

Mental health issues can become a complicating factor; this is often referred to as dual-diagnosis, or, in the vernacular, “double-trouble.” Moreover, individuals with poor self-control may be particularly vulnerable to substance abuse. Accordingly, the roots of substance abuse for some individuals can be seen in behaviors long before the onset of actual substance use itself. It is also important to note that substance-related disorders are divided into two groups: substance use disorders and substance-induced disorders. These secondary issues can include intoxication, withdrawal, psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders.

Features of substance use disorders include a rather important element: change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders. The behavioral results of such changes may manifest in repeated relapses and intense craving for the individual’s favorite drug. This craving is often set in motion through a mere drug-related stimuli, which is referred to in the addictions field as a trigger. Typically, the longer an addict remains clean the easier it is to recognize and defeat such cravings. A craving is likely rooted in classical conditioning, and is associated with activation of specific reward structures in the brain. These structures are rather individualized; not every addict is triggered by the same thought or stimulus. Instead, triggers are established by what the individual is agitated or distressed by, and inversely related to the ability to properly handle such stimuli.

Not surprisingly, treating co-occurring substance abuse and mental illness calls for simultaneously addressing two critical and sometimes confounding problems. In fact, double-trouble can often complicate differential diagnosis—the comparison of symptoms from multiple likely mental or physical conditions. From a personal perspective, it was quite difficult for me to clearly determine what was “wrong” with me. Severe anxiety, constant ruminations, insomia, and underlying depression crippled me for decades. In addition, I felt powerless and helpless, unable to relax or sleep. This is likely what initially led to my substance abuse. I started drinking alcohol and smoking marijuana the summer following my high school graduation. My use was extensive from the beginning, but I was able to calm down, stop my thoughts from racing, and finally get some sleep. Unfortunately, I was not “sleeping” as much as I was passing out. It did not take long for my substance use to become excessive, leading to a decades-long season of poor choices and serious consequences.

Reasons for drug and alcohol abuse by individuals with mental illness varies by individual. Substance abuse could be primary or secondary to psychiatric issues, or may even in some cases be independent of mental illness. The association between mental disorders and substance abuse is complex. The relationship of substance abuse to onset, course, and severity of mental issues, and problems in the evaluation of dual-diagnosis patients, is often complex. Adding to this difficulty is the likelihood that the individual often engages in self-medication to alleviate troublesome symptoms for which they have no explanation. This psychodynamic perspective must also include neurochemical considerations. Affective disorders (those impacting mood, often including depression, bipolar disorder, anxiety disorder) are particularly difficult to manage. I found welcome relief through drug and alcohol us—albeit only temporarily.

Unfortunately, chronic substance abuse can also lead to the development of organic conditions, such as psychosis, mania, and mental confusion. Other disorders can include chronic apathy and dysphoria, and personality disorders such as Antisocial Personality Disorder and Borderline Personality Disorder. Again, there is often confusion regarding co-morbity. For example, addicts quite frequently use, abuse, manipulate, and disrespect friends, family, and other acquaintances in order to get what they need, whether it be money, shelter, or (at times) the drug itself. These traits are also typical of several key personality disorders.

As these traits become routine, the addict often slides down the slippery slope to criminal behavior—theft, embezzlement, forgery, kiting checks, burglary, armed robbery. A serious, unfortunate end-result for the dually-diagnosed addict can lead to suicide. I have personally considered taking my own life on many occasions during active addiction. I would become remorseful for the way I treated family and friends. The disconnect between my Christian worldview and my behavior haunted me. It seemed suicide was the only option. As my uncle once told me, I was unable to see the horizon. Truly, I have not faced a more difficult situation in my life than suffering from mental illness while in active addiction.

In my review of the diagnostic criteria for Borderline Personality Disorder, I determined I’ve displayed eight of the nine criteria for making such a diagnosis. I’ve demonstrated a pervasive pattern of instability in my interpersonal relationships, self-image, affect (mood swings), impulsivity (sexual behavior, drug and alcohol abuse, risk-taking, excessive impulse spending, reckless driving), recurring thoughts of suicide, chronic feelings of emptiness, and recurrent anger. Thankfully, I have seen a vast improvement in the lion’s share of these symptoms. However, I still deal with poor self-image at times, tend to “sanitize” the truth, occasionally manipulate others, and remain rather impulsive in areas such as impulsive spending.

Given the pervasive nature of dual-diagnosis, it is critical to identify when you are suffering from mental or emotional symptoms, and more importantly to recognize if you are using or abusing drugs or alcohol to dampen or defeat uncomfortable thoughts or feelings. Depression, anxiety, and insomnia tend to “respond” initially to substance use. However, the need for one’s drug of choice to “treat” these types of symptoms increases as use leads to abuse; abuse leads to tolerance; and tolerance leads to dependency. Consequently, self-medication of emotional or psychiatric difficulties by consuming drugs or alcohol is doomed to fail—often with quite devastating results. If you, or someone you know, is caught in the vicious cycle of addiction (with or without a co- occurring mental condition), it is vitally important to seek professional intervention.

It is impossible to “go it alone” and achieve anything like helpful results. In fact, it is likely your situation will deteriorate. I was told years ago by an addictions counselor that because I had an underlying mental illness, treating my addiction without addressing my psychiatric problem is like having two broken legs but only putting a cast on one of them.

If you or someone you know is struggling with substance use disorder and want more information or help quitting, please contact your local AA or NA chapter, or click here to visit the National Institute on Drug Abuse official website. You can also scroll back to the top of this post and click on the COMMENT bar to open an dialog with me. I will be glad to speak with you any time.

References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th edition (Washington, DC: American Psychiatric Publishing), 2013.

 

The Accidental Poet Theology

Regarding Christian Theology and Psychology in Treating Mental Illness

The place God calls you to is the place where your deep gladness and the world’s deep hunger meet.           —Frederick Buechner

GOD CALLS PEOPLE. It might not be the calling of Abraham to leave the land of Ur and go forth into wilderness he knew nothing about, or the calling of Moses, confronted with the command of the burning bush, or the calling of Isaiah who encountered the glory of God, or the calling of the apostle Paul to bring the message of Christ to the Gentiles—but an awareness of “call” is both mysterious and powerful. And it is always a demonstration of love and an initiative from God.

god banner

Certainly, it is helpful to understand that God calls the Christian in three distinct ways:

  • First, there is the call on your heart to be a Christian. The God  of creation invites us to respond to His love in numerous ways. This call comes through His Son Jesus, who invites us to be His disciples. This tends to open the door for our service to others in His name. Everything about us is understood in light of this primary call on our life. Every aspect of our lives flows out and finds meaning in light of the fact that we are a called people. The entire body of Christ is made up of the called.
  • Second, for each individual there is a specific call—a defining purpose or mission, a raison d’être. Every individual is called of God to respond through service in the world. Each person has a unique calling in this second sense. We cannot begin to understand this second calling except in the light of the first. In other words, when we fulfill our specific vocation, we are living out the full implications of what it means to follow Jesus.
  • Third, there is the call that we face each day in response to the multiple demands on our lives—our immediate duties and responsibilities: the call to be present to our children when they are in a high school musical, or to help our local church when they host a baseball camp featuring retired greats from professional baseball. Or to take a homeless veteran to Denny’s for a hot lunch and talk to him about the Gospel and options for getting him off the street. These activities represent the immediate tasks placed in front of us by God—our tasks for the day, if you will.

We are all called to work. We want that work to be meaningful, joyful, and significant. We want to know that the work we do is good; that in word and deed we are doing something that is fundamentally positive and worthwhile. Each person brings beauty, creativity, and significance to the table. We all add to the community. It does, indeed, take a village, but we speak here of a village of believers—the Body of Christ. And yet we must never lose sight of the inherent value and potential of the individual person who is loved, called, and empowered by God to do good work.

Older notions of vocation and career development assumed that people wrestled with matters of vocation as early as young adulthood. It has been commonly assumed that vocational counseling was provided in high school for those seeking to pick a career. But in a more accurate understanding of vocation, we learn that vocational questions follow us throughout the course of our lives—and that perhaps vocational counseling needs to be presented to us at each transition throughout our lives. The questions remain the same: Who am I? Who has God called me to be? What should I do next? Of course, our answers to these questions can change at different stages of our lives. We naturally think differently during adolescence than early adulthood; likewise during early-to-mid adulthood, and mid adulthood into our senior years.

ORIGINS OF PSYCHOLOGY

Clearly, psychology did not emerge directly as science. This presents a rather challenging problem: Where to start? Ancient civilizations surely studied one another to determine who was reliable and trustworthy, and evidence suggests they attempted to record and interpret dreams, mental illness, and emotions. Was this an early form of psychology? Or did psychology start with the first systematic explanations of human cognitive experience, which can be traced back to the early Greeks? Plato and Aristotle, for example, established elaborate theories that attempted to account for memory, perception, and learning. Maybe this was the starting point?

Early adherents understood it was difficult to consider psychology a hard science in the traditional sense given that experimenters cannot “observe” the workings of the mind or “measure” emotions. Many initially considered psychology to be a specialized branch of philosophy—a sentiment still held by some. They based their conclusion on several factors. First, they had a difficult time accepting subjective reports as evidence. Second, can unconscious inference be considered a coherent—logical and consistent—concept? Rene Descartes gave us the concept of dualism—the position that mind and body are in some categorical way separate from each other and that mental properties are in some respects non-physical in nature. Certainly, this concept plays at least a part in the idea of nature versus nurture.

Physiology and brain research led to applying scientific methodologies to the study of human thought and behavior. Wilhelm Wundt began applying experimental methods. Edward B. Titchener founded psychology’s first major school of thought, which he applied to studying human consciousness. William James outlined his theories in his classic textbook The Principles of Psychology. He focused on how we interact with one another in our everyday lives, using methods such as direct observation, feedback, impression management, and body language  to study the human mind and behavior.

Prior to the psychology of Sigmund Freud, early psychology stressed conscious human experience. Freud changed the face of psychology by proposing a theory of personality based upon the unconscious mind. Although Freud’s theory had a huge impact on psychology, social science, art, education, and business, skepticism eventually set in. Admittedly, it has many followers to this day. Psychology changed dramatically, however, with the advent of behaviorism, which rejected abject reliance on the conscious and unconscious mind. In a nutshell, behaviorism looked at classic conditioning and reward versus punishment.

 PSYCHOLOGY VERSUS THEOLOGY

Many are surprised to hear that Christian Theology and psychology are compatible. In his book God’s Psychiatry, Charles L. Allen notes that the word psychiatry comes from two Greek words: psyche and iatreia. The word psyche really means “the person,” and is translated as “breath,” “soul,” “mind,” “reason,” and the like. The word iatreia means “treatment,” “healing,” “restoration,” and so on. If we put the two words together, we get the term “the healing of the mind,” or, perhaps more specific to Allen’s intention, “the restoring of the soul.” This can mean medical treatment per se, or it can refer to ministering to the soul. Allen wrote, “…the very essence of religion is to adjust the mind and soul of man, and we have long ago learned this…”

Psychology and theology are both concerned with philosophical anthropology. It draws its name from the root psyche, a Greek word whose use can encompass the physical, the psychological, and the immaterial aspects of humanity. In both clinical and experimental expressions, the nature and functioning of human beings in the central concern of psychology. Theology is concerned with the nature of God and with God’s relationship to the world. Psychology may be able  to describe human beings as they are, but only Christian theology can describe them as they were intended to be—questions of ultimate concern, such as how did we come to be, what is our purpose, what is our destiny?

“The biopsychsocial model is both a philosophy of clinical care and a  practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care.” —Borrell-Carrio, Suchman, and Epstein

Sarah Rainer, PsyD (2014), said in an article for Christianity Today, “Pastors largely feel unequipped to address mental illness, and mental illness is still taboo in many ways.” Rainer further notes that in recent years psychologists have begun recognizing that our spirituality impacts our lives, but have yet to buy into the idea that it is imperative for life. Of course, not all secular psychology is wrong. We cannot just throw the baby out with the bath water. Indeed, there are many helpful and positive aspects of psychology to consider when diagnosing and treating a patient. This is precisely why there is a need for integrating psychology and Christian theology.

Entwistle (2015) notes that although psychology has much to teach us about human behavior, it cannot provide the larger context that gives meaning and direction for life itself. Pope Benedict XVI said, “Without God man neither knows which way to go, nor even understands who he is.” It is theological reflection that often sets the stage for poor self image that leads to malaise and self-doubt. Consider the many levels at which we exist: social, psychological, physical, systemic, economic, spiritual, sexual. It is through these many lenses that we ask ourselves Who am I? Does my life really matter? How can I change my circumstances when I feel stuck? What is the meaning of life? Where is God in all this mess?

ON INTEGRATING CHRISTIAN THEOLOGY AND PSYCHOLOGY

Pierre Teilhard de Chardin said,”We are not human beings having a spiritual experience; we are spiritual beings having a human experience.”

Unless you’re an atheist, you probably believe the world we live in is not the only plane of existence. Accepting that reality is only temporal is paramount to understanding spirituality and how it relates to mental health. 2 Timothy 3:7 says man is “always learning but never able to come to a [full] knowledge of the truth” (NIV). Countless books have been written by psychologists over the years that attempt to describe our personalities, the boundaries within which we must operate, our dysfunctional development, interpersonal relationships and their inherent problems, how our children should be raised, and so on. This has caused an intellectual/spiritual crisis, causing believers—indeed our very clergy—to often treat human beings in a manner that differs from how we were instructed by Jesus through Scripture. To me, this is where integration of Christian theology and psychology may prove helpful.

Naturally, Christians have always been intrigued by God’s creation. We’re well-aware that as the heavens are higher than the earth, so are God’s ways higher than our ways, and His thoughts higher than our thoughts (see Isaiah 55:9). We cannot begin to understand the intricacies of creation—from as far outward as we can see to as far inward as we can see—let alone the subtleties of brain chemistry and mood, or the machinations of memory and learning. And don’t get me started on quantum physics and black holes or old age versus young age earth.

What does fascinate me is how Christian interest in psychology has exploded over the past fifty years. Countless books have been written by Christians that describe how our brains have developed, what constitutes our fight or flight response, how we fall in love, why we become addicted to drugs or food or shopping, or why some of us isolate while others love to stand in front of a congregation and preach or sing. Most publications on psychology are secular in orientation, which makes for fascinating dinner conversation to say the least. Naturally, there are as many disagreements about psychology as there are schools of thought. Fundamentalism still speaks more often than not about “psychoheresey.” One of the reasons my first wife divorced me was my interest in psychology. Granted, at the time I began studying philosophy and psychology I was in the midst of an identity crisis as a believer. Today, I see the need for a healthy integration of the two schools of thought, and am pursuing a master’s degree in support of a faith-based counseling career.

“CHRISTIAN” PSYCHOLOGY?

The field of psychology has been retooling itself over the years. Initially, it was concerned solely with what makes people mentally ill. Today, much focus is on what makes people mentally healthy, positive, joyful, happy to be alive. Studies show that those who believe in life after death, for example, are happier than those who do not. Sociologist Christopher Ellison of the University of Texas at Austin says, “Religion provides a unifying narrative that may be difficult to come by elsewhere in society.”

Christian psychologist Paul Vitz says the work of Martin Seligman, former president of the American Psychological Association and professor of psychology at the University of Pennsylvania, is the catalyst for what he terms positive psychology by emphasizing mental health instead of mental illness. Seligman said, “What is needed to balance our understanding of the person is recognition of positive human characteristics that can both heal our pathologies and help to prevent psychological problems in one’s future life.” And what are these positive human characteristics? Virtues such as wisdom, courage, humanity, justice, temperance, and transcendence. These core virtues are quite similar to the fruit of the Spirit (see Galatians 5:22-23).

I admit we need to stay alert as Christians to so-called “self-help”  or “self-potential” psychologies that often seem faddish and change with the wind. Any “psychology” that suggests we can only be happy, healthy, or spiritual when we forget the past and “live in the moment” must be avoided. The truth is “self-help” is an oxymoron because the individual who uses such an approach always arrives at a solution to his or her problem either with the help of a therapist or by following the formula of the self-help book.

Christians understand that for 2000 years there has been a relationship between an individual’s mental outlook , his or her belief about God, Christ, salvation, and how he or she fits in the whole scheme of things. I think Christian psychology has ample incentive to focus on core virtues and what it means to be a human being with a substantive center of soul, spirit, heart, mind, and consciousness—rather than on self-improvement—because of Christianity’s foundation on Scriptural principles. It is God who forgives our sins, heals our sinful human nature, and replaces our guilty conscience with the fruit of the Spirit—it is nothing that we do in our own strength. 

References

Entwistle, D. (2015). Integrative Approaches to Psychology and Christianity, 3rd Edition. Eugene, OR: Cascade Books.

Rainer, S. (September 25, 2014). “The Integration of Christianity and Psychology: A Guest Post by Sarah Rainer.” Christianity Today. Retrieved from: https://www.christianitytoday.com/edstetzer/2014/september/concerning-psychology-and-christianity-guest-post-by-sarah-.html

Seligman, M. Ph.D. (2002). Authentic Happiness: Using the New Positive Psychology to Realize Your Potential For Lasting Fulfillment. New York, NY: Free Press.

The Accidental Poet Spirituality

Mental Illness and the Christian

Most of us know someone who is in counseling, on medication, or who has even taken or attempted to take his or her own life as a result of mental illness. Among the many topics high on the list that trouble Christians today, mental health would most likely be at or near the top. Ed Stetzer wrote an article for Psychology Today (2018) in which he asks, “Why is it uniquely challenging for us to address issues often associated with mental illness?” girl gazing at sunset

It seems whenever the topic of mental illness or suicide comes up at church or among our Christian friends, we automatically wonder, Why? Aren’t we saved from these types of issues? Aren’t we healed and set free? Yet this is a conversation the church truly needs to have. Thankfully, my church does not shy away from topics like mental illness and addiction. Admittedly, suicide and addiction may be two of the most complex and demanding topics of all. Joyce Meyer and Max Lucado have written several good books on the issue of mental health. Meyer (1995) began with her seminal Battlefield of the Mind. Lucado (2017) recently published Anxious for Nothing.

Meyer notes that daily emotional ups and downs are one of the major struggles we have in life. Instead of riding the emotional roller coaster, it should be our goal to become stable, solid, steadfast, and determined. If we let our emotions rule over us, we’ll never be the person we were meant to be. Of course, we can never be completely free of our emotions, but we must learn to manage and control them rather than let them control us. Let’s be honest: Life is no fun when we’re ruled by our emotions.

It’s important to realize that emotions lie to us. They paint an inaccurate picture, typically convincing us that all is lost based on one bad day. Without any effort on our part, our brain takes in and evaluates information throughout the day. Our emotions are regulated automatically in the limbic system. The center of emotional processing and mediation of resulting behavior—defensive versus aggressive—is the amygdala. The limbic system is also responsible for memory. The amygdala has been the focus of study for decades. It’s been stated that emotional memory (how we respond to pleasant, unpleasant, fearful, and painful situations) occurs long before we develop language skills. I believe the formative years of 0 to 5 are critical relative to formation of our personality and to how we handle situations in the future that remind us of painful experiences from our past. This is, perhaps, the very basis for emotional baggage.

Anxious for Nothing

Lucado (2017) describes anxiety in a manner worth repeating here:

“It’s a low-grade fear. An edginess, a dread. A cold wind that won’t stop howling. It’s not so much a storm as the certainty that one is coming. Always… coming. Sunny days are just an interlude. You can’t relax. Can’t let your guard down. All peace is temporary, short-term. It’s not the sight of a grizzly but the suspicion of one or two or ten. Behind every tree. Beyond every turn. Inevitable. It’s just a matter of time until the grizzly leaps out of the shadows, bares its fangs, and gobbles you up, along with your family, your friends, your bank account, your pets, and your country.”

Lucado calls anxiety “a meteor shower of what-ifs.”

The word anxious defines itself. It comes from the Latin words angere (to choke) and anxius (worried, distressed). The earliest sense of anxious is from the 17th century, meaning “troubled” or “worried.” Lucado notes that fear screams, Get out! Anxiety ponders, What if? Fear results in the response of fight or flight, as it should. Fear is the pulse that pounds in your ears when you’re being followed by a hooded figure late at night just after you withdraw $300 from the ATM. Anxiety, on the other hand, creates a general sense of doom and gloom that you can’t quite figure out. Anxiety robs us of our sense of safety and security. It steals our energy. Our well-being.

Meyer (1995) says anxiety and worry are both attacks on the mind intended to distract us from serving the Lord. These are primary tools used by Satan to press our faith down so deep that it cannot rise to the occasion and aid us in our times of trouble. She says worry is definitely an attack from the devil upon the mind. She adds, “It is absolutely impossible to worry and live in peace at the same time.” She believes some people have such a problem with worry that they might be addicted to it. I’ve heard it said that a person will continue doing something as long as they get some type of benefit from it. So what might a person get from worrying?

To determine if you’re addicted to worrying, take the following quiz:

  • Do I worry about many things every day?
  • Is it difficult to stop watching anxiety-provoking news on TV or the Internet, though I try?
  • Do I experience separation anxiety when I can’t access my smartphone or computer?
  • Do I make problems larger, not smaller?
  • Do I worry about things that no one around me worries about?
  • When one anxiety is solved, do I immediately focus on another?

If you answered “yes” to all six questions, worry plays a very large, addictive role in your life. Four to five “yes” answers indicate a large role. Two to three “yes” answers indicate a moderate role. One “yes” indicates a low level. Zero “yes” answers suggest that you’re more warrior than worrier!

Meyer believes life is intended to be of such high quality that we enjoy it immensely. I’m not implying that bad things never happen to good people; that’s a topic for another day. Jesus was clear, however, in John 10:10 when he says, “The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full” (NIV). Eugene Peterson calls it “…more and better life than they ever dreamed of” (MSG). Worry is one of the many ways Satan steals the good life. Paul echoed this sentiment in Phillipians 4:6: “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God” (NIV).

God Heals

We can love God with our whole heart, follow His commands, even put Him first, yet still be struggling with anxiety or depression. We can find ourselves face-to-face with the grim reaper, a gun or a bottle of pills in hand, no longer wanting to be alive. Wondering, How did I get here? For me, it started with marijuana and beer. Once addiction took hold, I lost sight of God, His love and grace, and all hope. My uncle, in recovery now for decades, told me several times, “You’ve lost all hope. You can’t even see the horizon anymore.”

Theologians and philosophers call man a tripartite being. That is, we’re made up of a body, soul, and spirit. It’s in our spirit that we find meaning and purpose in life. It’s in our soul—that is, in our mind—that we suffer mental illness. Anxiety and depression begin there, but spread throughout the body and quickly affect the spirit. In fact, mental illness causes us to doubt God’s grace and healing power. It cuts us off from the sunlight of the Spirit. This is critical because it’s through the Spirit that we learn discernment and intuition. It is through the Spirit that we’re able to love one another. There’s an interchange involved: our spiritual health impacts our mental and physical health, and our mental and physical health impacts our spiritual health.

We are impacted—either good or bad—by how we handle the stress that life brings. If chronic stress is left unchecked, over a period of time it will take a toll. A strong faith can help us cope with the stress that we experience and enable the impact of that stress to be less significant. Without a strong personal faith, we’re left to our own devices. Often we attempt to cope with stress through addiction, sexual promiscuity, shopping, gambling, and other methods of escape. Such behavior can further exacerbate the effect of stress on our physical health. A strong personal faith can be a resource that helps manage stress before it manages us.

Matthew 9:35 says, “Jesus went through all the towns and villages, teaching in their synagogues, proclaiming the good news of the kingdom and healing every disease and sickness” (NIV) (Italics added). Jesus had compassion and healed those besieged by mental illness, many of whom had been despised, rejected, persecuted, and feared by their community. Interestingly, the history of psychiatric treatment has its roots in the Christian church. The Quakers in Philadelphia opened the first inpatient psychiatric facility in 1752. John Wesley and the founders of The United Methodist Church practiced a faith grounded in the redemptive ministry of Jesus Christ, with a focus on healing the whole person: physical, spiritual, emotional and mental. 

All aspects of health—physical, mental, and spiritual—were of equal concern to Jesus whose healing touch reached out to mend broken bodies, minds, and spirits. His intention was to restore well-being and renew communion with God and neighbor. Interventions are needed to heal mental illness. If you or someone you know or love are struggling with mental illness, especially as a believer, do not hesitate to pray with them and to suggest meeting with a minister. Also, there are many faith-based counseling services available today. It is God’s intention that you are fully restored. Christ is the Great Physician. Jesus came that we might have life, and that we might have it abundantly. That includes being of sound mind, free of anxiety and depression.

For God has not given us a spirit of fear, but of power and of love and of a sound mind. (2 Timothy 1:7)

References

Lucado, M. (2017). Anxious for Nothing. Nashville, TN: Thomas Nelson Publishing.

Meyer, J. (1995). Battlefield of the Mind: Winning the Battle in Your Mind. New York, NY: Time Warner Books.

The Accidental Poet General

Pale As Milk

I live in a constellation of memories
of visits to Grandpa Roy and rides on his bulldozer,
visits to the hospitals where Uncle Jeff insisted on illness
for the free room, free meals, the free cable TV,
visits through the phone line after midnight
when Uncle Culby wanted to play me a song
by The Who after a few days off his meds—
we never visited him
in the psych wards or in jail,
we never visited Jeff on the skids,
we never visited our own Pop
aside from Sunday afternoons,
and I wonder now
where he spends his Sundays,
or if his last was spent alone.

We never visited our family’s men for any celebration
until we collectively broke the law
when we broke into that golf course by moonlight
to scatter Grandpa Roy’s ashes
and I sat there in Pop’s driver’s seat, sixteen,
permitted to drive only with an adult
but only my thirteen-year-old brother beside me

as I gripped the wheel and squinted at the shapes
approaching from the darkness—the strangest
figures in full stride—my uncles,
wet from the golf course sprinklers, laughing,
and then Pop’s boots crunching gravel—
the first time I’d seen my father run.
And he too was wet, but also pale as milk,
not laughing, not even in the neighborhood
of a smile,
as I turned the key
and he shoved me from the seat
to drive.

Jason Allen

Jason Allen is a poet and prose writer with an MFA from Pacific University. He is currently living in upstate New York and pursuing a Ph.D. in creative writing at Binghamton University, where he is an editor for Harpur Palate and at work on his first book of poetry, a memoir, and his second novel. His work has been published or is forthcoming in: Passages North, Oregon Literary Review, The Molotov Cocktail, Paterson Literary Review, Spilt Infinitive, Cactus Heart, Pathos, Life With Objects, and other venues. He hopes to one day meet Tom Waits and buy him a cup of coffee.

The Accidental Poet General

The Psychology of Dual Diagnosis

I am  powerless over my mental disorder. I am powerless over my addiction. It has taken me a long time to admit these facts. Before I was able to admit my powerlessness, my life was unmanageable. I was unable to handle life without drugs and alcohol or to take care of my mental health. I thought that drugs and alcohol would make me feel better. They did, at first. I have some fond memories of partying and hanging out. But ultimately, those substances had control over me. Today, I truly accept the fact that I am an alcoholic and a drug addict with an underlying mental disorder. I accept both diagnoses.

Being honest with myself did not come easy. I wanted to blame others for my dilemma. As I reviewed my past, I saw that I lied, cheated, stole and manipulated people. I was dishonest, self-centered, self-seeking, inconsiderate and frightened. I lived in absolute opposition to the truth. I tortured myself with cocaine, crack, opiates, marijuana, LSD, mushrooms and booze. I found out that I suffered from a mental obsession to use drugs and get drunk, and that once I took a substance into my body I unleashed physical cravings that spiraled out of control. I would lose all touch spiritually and mentally, in full flight from reality.

Drinking and taking drugs frequently made my mental disorder symptoms worse. No words can describe the torture I felt. I spent a week in a psychiatric hospital in the mid 1990s. I was a week from being homeless in 2008. I was overrun with despair and self-pity. Drugs, alcohol and my mental illness had mastery over me. I only stopped using drugs and drinking when I was incarcerated or hospitalized. When released, I started all over again.

I really have to focus on my first problem: addiction. At some stage of my drinking and drugging, I reached a point where, as soon as I started using, I would lose control over the amount I would use. Craving became sufficient reason in and of itself to keep using. I was both physically and mentally impaired. I literally could not resist. So I had to be honest with myself that once I put alcohol or drugs in my body, it seemed virtually impossible for me to stop. Accepting that fact is key: once the substance is in my system I lose control and cannot stop. I have to remember that addiction is a disease that tells me I don’t have it.

The process of addiction may be a gradual one. For me, I found over time that I built up a tolerance to various addictive substances. Most recently, it was opiates. I could take a number of Percocet tablets and literally feel only a slight “buzz.” I needed more and more to get the same effect. Not only that, I was becoming dependent on it. Before I knew it, I needed a pill just to relax and not feel any pain. When I tried not to take Percocet, my back pain and overall body aches increased and I became restless and irritable.

I had to be mindful of the second part of this picture. Is my struggle with addiction compounded by a mental disorder? With regard to mental health, it is wise to seek professional help. But we must come to a point where we “own” our particular diagnosis. When we’re told we have a mental disorder, we have to take it seriously. We have to take a look at our life experience and see where our mental health gets us in trouble. Our mind will lie to us — about its own health and about our addictions. We need to search our own experiences and honestly ask ourselves  Am I powerless over alcohol and drugs? Do I have a mental disorder?

We become honest by discovering our own truth. Understanding comes through awareness and acceptance of conditions as they are. We know we have problems. That much is obvious. But the truth is hard to accept. In order to recover, however, the truth must be accepted. We come to know this as a fact in our recovery. Admitting powerlessness is not a sign of weakness. It simply means that when it comes to substance abuse and struggling with mental disorders, we are not in charge. Willpower has no meaning when it comes to controlling our use of drugs and alcohol and our mental processes. We certainly had a distorted view of ourselves and the world around us before we addressed our addiction and mental illness.

Honesty sets us free. Once we accept our powerlessness, many of us experience being freed from active addiction and from the obsession to use again. Here is the paradox of recovery: that in accepting our powerlessness, we become empowered to stop using drugs and alcohol and to work on our mental health. This comes at a great relief. With recognition and acceptance, we are free. We never need to go back to drugs and alcohol again. Instead of being filled with our addictive thoughts of self-destruction, remorse, despair, rage and sadness about our past, we look with great joy and comfort at these precious moments we are now given. Admitting complete defeat is not what we wanted, but it is what we needed. For me, there was a part deep down inside that always wanted to be free. I was so tired of living a life of active addiction. I kept saying I would do something about it tomorrow. Not now. Not today. Obviously, a part of me was still committed to getting drunk and high.

I came to realize that my addiction was greater than my will. It was a monster with an insatiable appetite, and I let it take from me all my self-sufficiency and my will to resist its demands. If you still think you can handle that monster, try this simple test. Go ahead and stop. Now, stay stopped. Do without. If you can do this, there is no addiction. But if you cannot stop and stay stopped, no amount of willpower will change the fact that you’re addicted. You need a program to help you stop. It won’t be easy at first, but it is more than worth the effort.