Dr. Adam L. Front, Psychologist

You may be reading this because you have tried - probably more than once - to get and stay clean and sober from alcohol or other drugs, or perhaps you have a family member or other loved one who has been engaged in this struggle. Over the more than 3 decades that I have worked with recovering addicts and alcoholics I have clearly seen that the more times a recovering person relapses, the harder it becomes to take up the task of getting sober and stabilizing recovery. Why is it such a struggle? For some it is the most difficult thing they have ever undertaken from the first time they tried to get clean and sober and becomes more difficult each time they relapse and renew their commitment to sobriety. For others, it seemed incredibly easy the first time but became more and more difficult with each relapse and renewed attempt.

I have come to believe that it is not the task of getting and staying sober, of stabilizing recovery and improving one's life that is so daunting. What actually makes it so tough is not the things we do that are related to recovery. The thing that makes it sometimes seem impossible is the way we frame the tasks (and the general idea of recovery) in our minds. It is the definitions of some of the terms that we subscribe to, the stories we tell ourselves about the undertaking of recovery and its component parts, the way we approach recovery that becomes the biggest set of obstacles imaginable.

So we assume that it is going to be hard. We think of it as depriving ourselves of something we want, something fun. Which can translate into the idea that fun = getting loaded, so if we are not getting high any more, we will not have any fun any more, ever. Or at least that nothing else will ever be AS fun as using our drug or drink of choice.We also may assume that whatever is good for us is more unpleasant than the things that are not good for us. Hence the way the word “bad” is used sometimes in popular lingo to mean exciting, fun, or cool.

In addition to the way we mentally and emotionally frame our experience having a massive effect on our expectations and judgments about what it will be like, there is something else about the way humans approach change that can make things seem easier or harder, and because of the resulting perception, it  can make whatever it is actually become easier or harder, depending on our perception. Many times when we want to change something, we imagine that we cannot make the change until and unless we "find the motivation" to do it differently. Usually this means that we are waiting for our feelings and thoughts to change so that we can enact different behavior. For example, I may want to start working out every day when I have had the long-standing habit of sitting on the couch, eating and watching TV. I keep telling myself that I want to go to the gym, but once I sit down on the couch it is all over, and I may think, "well, I will start tomorrow, for sure this time." I may have these same thoughts for weeks, multiple times a day, until finally I give up and decide that it is hopeless, that I am just a failure.Or, if I just decide to try it anyway, I may find that it is not as hard as I thought.  If we have a theory about how it will be, and we do not test it, we will never really know.  And if we do test it, with fair and repeated trials, we often find that there were at least parts of our theory (if not our entire theory) that end up being proven wrong.  This is true in scientific experimentation in most fields - more theories are proven wrong than proven right.  But if we never really test our basic assumptions, our theories, or only do so half-heartedly, we will think what we have always thought, and as a result we will get what we have always gotten.

How many people go through exactly this same loop about getting sober, over and over and over again? Those who actually get sober instead of just thinking about it do one thing differently - they actually DO something different despite the thoughts and feelings. The action of being sober for one day actually CREATES the motivation to stay sober the next day, in the same way as actually going to work out (in spite of not "feeling like it") makes it more likely that we will work out the next day. If we wait for divine intervention to strike us with inspiration and motivation so that we can be sober for that first day, we could wait a very long time.

So just imagine… imagine that it is possible to find fun, joy, connection with others, a feeling of purpose and excitement about each day, each moment. Imagine that this does not have to be a struggle, but instead something that we can relax into. What if that were actually possible? Well, it is, and it won’t take a lot of time, a lot of money, or a lot of struggle. In fact, you can change your feeling about your life from a living hell to a heaven that is right here and right now. It will take work, it will take doing things that are outside your comfort zone, and it will take believing that it is possible by suspending your beliefs that it isn’t. But as you try new things and find that it indeed is possible, you will create a world of possibilities, possibilities that you never dreamed could be yours. They will open and unfold right in front of you.

It has become even harder right now, in 2020, because of current challenges, to feel hopeful, optimistic and motivated about the future. We face factors that compound each other, factors that have become a dark lens that makes everything look bleaker and harder. These include restricted movement and contact with others due to the COVID-19 pandemic; social tensions due to the numerous racial clashes and inequities; political divisions that are wider than ever between people who should be able to work together toward the common good; and economic pressures that are affecting many families, making it harder and harder to see how to simply survive. No wonder so many people right now are feeling frustrated, losing hope, feeling their optimism and motivation fading. We have been taught to believe that we live in a world of progress, yet everything seems to be going in the wrong direction, getting worse, not better.

Recovery is not just a vehicle for stopping the use of mind-altering substances or behaviors. It is a way of redefining yourself and re-casting the direction of your entire life. It is by finding a new direction and a new way to live and cope that we find a path away from our addictions. There is a huge clue to this hiding in plain sight in the 12 steps of Alcoholics Anonymous. Even if you don’t like, believe in, or want to follow the 12 steps, stay with me for a minute. Of the 12 steps, only the first of them has anything to do with drugs or alcohol. The other 11 are about living differently, coping with difficult situations differently. Which means that, mathematically, eleven-twelfths of recovery has nothing to do with not drinking or using other substances. Think about it: If you are primarily thinking about not drinking or using drugs, then really, you are actually thinking about drinking or using drugs. If you find things like joy, purpose and connection that take you in a different direction, then you won’t have to use so much energy pushing the alcohol and drugs away.

In future posts, we will look at how to make this a reality – things that you can do that will make it possible to Relax into Recovery.

"Facts not fear," the current tagline on a local San Francisco news channel, is a great mantra for dealing with the impact of the current worldwide health crisis resulting from the Corona virus pandemic. There is a lot of misinformation available, as well as a lot of reasonable, scientifically-based information. I recommend not watching the news TOO much, as it can heighten our anxiety about it. But there is a lot of good and simple information that can help, both in terms of preventing the spread of the illness as well as helping us to stay calm and feel better while this is all going on.

I have noticed that this unprecedented circumstance seems to bring out either the best in people or, in some cases, it can bring out the worst in us. It is shocking and concerning to me how much poor behavior I see lately on a daily basis, which I think comes partly from fear, partly from ignorance or unthinking, emotionally-driven reactivity and unreasoned bias. A few examples are discarded gloves and masks on the ground, people not respecting social distancing, people not wearing masks properly (or at all); these are three signs of the worst effects that the pandemic is having on people.

The stress and discomfort that this crisis is placing on us all is not sufficient justification to be rude or disrespectful to other people or to the environment. Please dispose of your protective gear properly and wear it properly and consistently. For information from a physician at Kaiser Permanente who specializes in infectious disease that will show you how to use a mask properly, see the article on their website at:

https://lookinside.kaiserpermanente.org/how-to-properly-wear-a-face-mask/.

I have seen some people doing each of the "don'ts" mentioned in the linked article: Not wearing a mask at all, wearing it around the chin, wearing it only over the mouth but not the nose, wearing it loosely so that it does not provide an effective barrier, or having it not pulled down to also cover the chin. In addition, for those that have N95 masks, there are some with a one-way valve that makes it less stuffy inside and easier to breathe, but some local government orders prohibit the valved N95s because they allow droplets to exit with your breath, so there is a chance that if you have the virus (symptomatic or not) you might still spread it to others. Some people are wearing a yellow or blue surgical mask OVER and N95 for extra protection.

Some stores have one-way traffic arrows in their aisles, and I it amazes me how many people pay absolutely no attention to this and other restrictions that stores have put in place during the pandemic, things that help us to keep a 6 foot distance. I regularly see people bustling where they want to go with no regard for keeping a 6 foot distance from others.

None of us is more important than anyone else, and neither is where we want to go or what we want to do or want to get. I have found that trying to maintain an attitude of kindness and mindfulness of others makes me feel better. If someone is in front of me in a supermarket aisle, stopped to decide what to purchase, I try to be patient and wait until they have made their decision and are ready to move on. This is not always easy. At the same time, I try to be mindful of others behind me who are waiting for me as I am stopped to decide what to purchase, and not take a long time standing there and making them wait. I try to stop and wait at the end of an aisle if someone is passing in the perpendicular aisle across my path. I try to make eye contact and smile at others (at least with my eyes, as they cannot see my mouth) because, after all, we are all in this together.

The other day, I was approaching the front doors of the post office lobby and a young woman who was about to enter held the door for me and motioned for me to exit while she held the door. It was a kind gesture, but it would have put us far less than 6 feet apart. I told her to please go ahead, as I was more than 6 feet inside the lobby, away from the door. She seemed surprised at my refusal of her kindness and hesitated, but finally she entered the lobby. I then approached the door and exited. So sometimes, the kind and thoughtful things we may do at other times and in other circumstances, with all the generous and considerate intentions that may motivate us to do them, might not be best during this time.

Another day recently, I was trying to pick up a package from the Amazon locker in the front of a store. One of the store employees had parked a shopping cart in which he had cleaning supplies right in front of the familiar yellow-orange wall of compartments. When he saw me there, he offered to move the cart. I thanked him and looked at him appreciatively.

As I said before, this crisis is bringing out the best in some of us, as well as the worst. Sometimes I find myself becoming impatient while waiting for others to move so that I can go where I want to go, but then I remind myself that keeping the distance is more important than my agenda or anyone else's. When I am able to do that, it brings me a sense of peace and a feeling of connection with the others around me. When I am not able to shift my attitude in this way, it only brings me misery, at least in that moment, when I am stewing about other people being in my way and delaying me in what I "need" to do. If I simply slow down and take a moment, take a breath (through my properly placed mask, of course), it makes me feel connected with the others I see because we are all dealing with the inconveniences, the need to do things differently. If I let impatience and selfishness get the better of me, then I am stuck in a prison of my own creation, feeling like it's me against the rest of the world. So it turns out that the story I tell myself in that moment, about my needs and other peoples intentions, makes a huge difference. It can dramatically change the way I feel and the level of physical and neurochemical stress effects I experience. I can either allow it to deplete my emotional resources or fill my coping arsenal with goodwill and patience and a feeling of belonging. We all have to make that choice every day, and that has always been true. The COVID-19 pandemic has only underlined this fact and given us a reason to think about it more, so that, hopefully, we can make decisions about how we act in each moment in order to help both ourselves and others to feel calmer, more connected and more true to ourselves, who we are and who we want to become.

I hope to start posting blog entries more regularly on this site.  One of the positive effects of the COVID-19 pandemic is that I may actually have more time to do things like that.  Of course, as we all do, I sincerely hope that the public health emergency passes as quickly as possible.  However, in addition to the many dangers and hardships that come with these times, I hope that you have had some positive changes come from the need to slow down and become more thoughtful about the way we live.

Unfortunately, I have had to disable the option for readers to freely post comments in response to my blog posts.  This is because spammers have decided that this is a good place to post advertisements for Canadian pharmacies, porn sites, etc.  Therefore, I have had to take this step and disble the commnets function.

SO...

If you would like to submit a comment in response to any of my posts, please use the form on the "Contact Dr. Front" page.  Thank you, and hoping that you are staying safe and well.

Yesterday, May 31, 2017 was "World No Tobacco Day," started by the World Health Organization in 1988.  Coincidentally, I personally quit smoking earlier that same year.  If you smoke, quitting may be the single most important thing you can do to improve your health.  The insidiousness of nicotine addiction makes this very difficult, however.  The urge to smoke, if you are a smoker (or a nicotine addict, if you prefer not to sugar-coat it) gets under your skin and can be so overwhelming that some say nicotine is more addictive than heroin. In fact, people who are addicted to other substances often minimize the seriousness of their nicotine addiction in comparison to their alcohol or other drug addiction. It is estimated that over 480,000 deaths a year are attributable to tobacco (including second-hand smoke and accidental deaths). Alcohol is estimated to cause nearly 90,000 deaths per year, including both chronic and acute medical effects as well as alcohol-related accidents. Deaths from all other drugs (prescription as well as street drugs) are estimated to be about 40,000 per year. Given the relative mortality risks, it would be clear to most that it is at least as important to quit tobacco use as it is to quit the other substances, despite the often far more dramatically life-damaging consequences of alcohol, methamphetamine, heroin, and other substances compared to those of cigarettes and other tobacco.

The reality is that those who quit drinking alcohol and using other addictive substances increase their risk or relapse to those substances if they continue to smoke when they get clean and sober. The habit pattern linkage of smoking with other substance use is considerable, leading to increased cravings for those other substances. In addition, the same addiction trigger in the brain that is tripped by other drugs is also tripped by nicotine, again leading to an increase in cravings for those other substances.

Many who consider or attempt quitting tobacco feel that it will be too difficult and uncomfortable to withstand the withdrawal that occurs and the cravings that persist after detox is accomplished. Many turn to other forms of nicotine replacement such as nicotine gum, trans-dermal patches, and vaporizers (“vape pens”). These substitutes, however, only perpetuate the dependence upon nicotine and continue the problem, not to mention continuing to line the pockets of corporations intent on making a profit from the misery of others; tobacco companies and the pharmaceutical industry both profit on nicotine replacement “therapies” such as nicotine gum, patches, lozenges and vaporizers.

An interesting fact makes it clear that these “therapies,” which are expensive, largely ineffective (many who use these alternative nicotine delivery systems relapse to smoking) and in the case of vaporizers possibly as deadly or perhaps more harmful than cigarettes, are really unnecessary. The fact to which I am referring is this: while cravings for alcohol, street drugs and addictive and abusable prescription drugs generally last about 15-20 minutes before they pass, the craving for nicotine lasts only two minutes. Period. The urge will return multiple times a day for the first few days, but if one distracts him or herself for just that two minutes each time the urge strikes, in about 3 days the body is fully detoxed. DO deep breathing, run up and down the stairs until you have to fall down on the couch, wath a funny video or two, chew on carrot sticks or toothpicks, call someone who supports and udnerstands your nicotine addiction and can offer supportive fedback (remember that not everyone who supports you knows what kind of support you need at tthose moments).

The biggest factor in successfully quitting is really being ready to do it.  No reservations about going back to it once you are "cured," no illusions about being able to smoke "just one here and there," you really have to want the monkey off your back.  A big part of this is to prepare yourself, to really be ready and willing to quit. Developing a set of images that represent your own motivations to quit are important. You will want to find the most vivid images and representations you can for both the negative consequences that you are giving up by quitting as well as similarly vivid or compelling images of the good things that you are attaining by quitting. These, along with distractions, will get you through each of the two minute intervals you will face over those first few days. And once you have quit, never let your guard down. After nearly 30 years tobacco-free, I know that if I allowed myself to have even one cigarette at one of those moments when still, after all this time, someone's freshly lit cigarette smells enticing, it would not even be a week until I returned to being a pack-a-day smoker.

You can quit. If you are disgusted by the smell, the lack of tasting your food, the fuzzy-headed feeling, the feeling and taste in your mouth when you awaken each day, only to light up again, perhaps before you are even fully awake, hang onto those unpleasurable images, perceptions and ideas, even after you feel better Please know that it is possible to quit and that you will feel so much better once you do. Pass the word to friends who smoke also – two minutes at a time is all it will take. Best of health to you!

     Most people think that addiction is a problem for a minority of the population. It's "those people," and certainly not me. But suppose that addiction is something more to do with the way our brains are wired than any particular substance that people abuse?

      Statistically, about 10% of the population is alcoholic. Probably another 10% are addicted to either street drugs (cocaine, marijuana, methamphetamine, etc.) or prescription drugs (pain pills, tranquilizers, amphetamines or other stimulants prescribed for ADHD, etc.). So we have about 20 of the population accounted for with addictive substances.

      But addiction is not limited to just substances. Many alcoholics or drug addicts get clean and sober and their addiction grabs onto a new source of gratification: food, sex, gambling, shopping, video games or other screen addictions, hoarding or other compulsive behaviors can be just as addictive as any mind altering substance. So can compulsive working, compulsive and impulsive angry and violent behavior, or taking care of others to the detriment of ourselves (also known as codependency). It is likely that at least 50 to 70% of the general population has compulsive behavior in one or more of these areas. For some, this is the original focus of their addictive tendency - perhaps they never really got hooked on a substance but instead were drawn to one of these behavioral addictions.

      If we include these other non-substance addictions, there are not too many people who are not affected. Some people are addicted to being right, or proving that others are wrong. This is one of the teachings of Buddhism and other spiritual paths that originated in Asia - that the cause of our suffering as humans is our "attachment" - we could as easily refer to it as addiction - to our view of the way things are and the discrepancy between between our view of reality and the way we think or know things "should" be.

     Many people have moral judgments about people who are addicted. This is because we have been taught that the mind is supposed to be the captain of the ship. If I have a problem, I should be able to decide to do differently and then do so on my own without any help, and if I cannot make this change by myself, then I am a failure. If we cannot think our way into behaving the way we believe we should, then we either rationalize why it is not our fault (or why it is okay to continue on as we have), judge ourselves harshly and punish ourselves severely, or bounce back and forth between these two positions at different times. Even the expression we often use to describe doing something on the basis of sheer solitary willpower does not make any sense. We say, "I'll just have to pull myself up by my bootstraps." If we look at the literal image of this expression it tells us much. If you were sitting on the floor, intent upon standing up, how successful would you be if you grabbed the backs of your shoes and pulled really hard? You could do this as hard as you like, repeatedly, and the most you would do is rock back and forth on your butt very vigorously, but standing up by that method is out of the question. Thinking it so is just not enough.

     If we examine the 3 sources of our behavior - thoughts, feelings, and bodily urges, we may see things differently. If I have an emotional, unreasoning urge to eat ice cream, for example, but I think that I should not eat it because I should lose weight and get healthy, it is common for the feeling to win over the idea. Similarly, if I think I should go to the gym and work out, but I really don't like to, I will become one of the people who keep health clubs in business by continuing to pay for membership but never using the facility. If my body and nervous system are set up to crave gratification but my thinking tells me that giving in to these urges is unhealthy, I will be prone to either rationalizing why it is okay "just this once," or "in moderation,"or decide that it's a good idea but I'll start tomorrow. It is clear that the body and the emotions are stronger than our thinking. Either by themselves is enough to overcome the best of mental intentions. If the body and the emotions gang up on our resolutions,we are done for. It just isn't a fair fight.

     The fact is that in order to make a change, we need to do something different. Many people approach therapy with the idea that if we talk about things with a therapist for long enough, we will gain insights that will change our thoughts and feelings so that we can then do things differently. The reality is that this can take a very long time.  However, if I do something differently in a planned and consistent way, even if I don't want to, even if I don't believe it will work, even if it seems "silly," it will often work. Acting differently is more likely to produce a change in our thoughts and feelings (due to the observation that if we do things differently we get a different result). This is much more often effective than focusing on our thoughts and feelings while doing the same things as we always have; although this approach has the possibility of giving us a vision of what we would like to be, at the same time it confirms that we will always get what we don't want because our actions have not changed, and doing the same actions will produce the same results time and time again.

      Twelve step recovery programs sometimes get a bad rap. People think that they are cults. In fact, they are, but this is not necessarily a bad thing. Of course, nobody in Alcoholics Anonymous or Overeaters Anonymous is offering people Jonestown suicide punch or advocating preparing to leave Earth when the alien ships arrive. Technically, a cult is a subculture, a group with its own behaviors, language and customs, different from the dominant culture. These subgroup norms in 12 step groups are the vehicle of the needed behavior change that leads to a different experience of life.

     For anyone who has tried to stop addictive behavior and failed, trying something new and different is often what is needed. What have you got to lose except your inability to resist the compulsion? Please see the links to various 12 step resources on my links page. It is recommended that you try at least 6 different meetings of whatever 12 step group pertains to your particular problem before you decide whether or not it is a useful solution for you.

      One example of the "medicalization" of human unhappiness is ADD (Attention Deficit Disorder) or, as it is now referrred to in the diagnostic manual, ADHD (Attention Deficit Hyperactivity Disorder). I do think that Attention Deficit Disorders exist, but I believe that they are not half as common as many people (including doctors who treat such disorders) think they are.  I have become acutely aware of this "disorder of the month club" selection.  It has been at the top of the charts for way too long. About 700% more prescriptions are written today for stimulants than were written 20 years ago. In 1991, approximately 5 million U.S. prescriptions were written for stimulant medications. In 2007, there were 35 million.  Attention Deficit is a neurological condition. It seems unlikely that seven times as many people now have this brain disorder than did only 2 decades ago.  

      Yet many people seem to think that they have ADHD these days. I believe that this misconception comes from the fact that ever since Bill Gates coined the term "multi-tasking," everyone thinks that it is something that we should be able to do. So we all accept responsibility for keeping far too many balls in the air, more than any one person can really handle. When the balls begin to fall to the floor, when there is so much on our plate that things start dropping off the edge, we think there is something wrong with us.  We have been set up to believe that we should be able to do more than we really can. Because of this discrepancy between the beliefs and expectations we hold about what we should be able to do simultaneously,  versus what is reasonably possible for humans, either we tell ourselves (or someone else tells us) that we have Attention Deficit.

      The reality is that the human mind can only do one thing at a time. Even computers (which is the original source of the term multi-tasking) can only process one function at a time, unless they have more than one processor in the box. I don't know about you, but I have yet to meet anyone who has two brains in their skull.

      When we split our attention between things, we are actually switching back and forth between them, not actually holding them both in our mind simultaneously.  One of the results is that the quality of our focus on each of the things we are holding in awareness becomes less sharp.  In practice, multi-tasking is used as a concept in the business world to foster the assumption that we should all work more for less money. This idea seems good to business owners and managers who are dealing with shrinking budgets and pressures to produce more and sell it for less.  However, this is not realistic for those on the front line, delivering goods and services, who end up being expected to actually produce mroe with less. This may be a large part of the reason that the quality of many goods and services generally has fallen so dramatically over the last few decades.  The tyrrany of the stock market necessitates that short-term quarterly earnings reports become more important than long-term quality and service that would keep customers coming back and better serve the long term profitablitiy of a company.

     It is an appealing prospect to think that a medication can help with our problems with focus and attention.  And yes, anyone who takes stimulants (whether they have ADD or not) will function better and faster - for a while.  Methamphetamine addicts can be really busy and productive at first, in the early days of their drug abuse.  Eventually though, whether we look at meth addicts or patients who are prescribed medications for ADHD, tolerance sets in and the dosage must increase in order to maintain the effect.  Eventually what we have is addiction to the stimulants, and things start to fall apart.  Some college students who are prescribed Adderal, for example, report after a while taking it that they are unable to functiuon without it.

      Our ability to focus and concentrate can be affected by many things - anxiety, depression, family or relationship problems, boredom, substance abuse or dependence, addictive or compulsive behaviors, worries and stress about money or work, insomnia or other sleep disorders, poor nutrition or other lifestyle stressors. Stimulant medications that are prescribed for Attention Deficit will merely temporarily mask these other problems.

      It is often only by addressing these other issues directly that we can regain focus.  Psychotherapy that addresses our life in context can accomplish this.  By re-assessing our values, expectations, beliefs, behavior, and the way we deal with our emotions, we can clarify a perspective that is grounded in what is truly important to us in life, and then commit to action that affirms our values and goals.