What Works in Treatment?: Tim’s Story

rsz_img_2891Here are Tim’s experiences of treatment. Well, actually two different forms of treatment, one which did not help and the other that helped Tim overcome his addiction to alcohol and opiates. Tim is a doctor and his Story is packed full of insights. Here, I’ll start with his moment of clarity.

‘The epiphany which did eventually provoke some help-seeking was relatively simple. I came down to the kitchen one morning feeling wretched and defeated. I opened the cupboard and reached up. With one hand I brought down the cornflakes and with the other the whisky bottle.

I flexed my elbows to bring the two closer to me and weighing them up in my hands I thought, “There’s something not right about this… there’s something very wrong with this picture.” The bit of me that wanted to drink finally began to yield to the bit that didn’t. Shortly after, I went so see my GP.

6. First go
A couple of weeks later I attended the Alcohol Problems Clinic at the local psychiatric hospital. I filled in diaries with the details of my drinking (how much, when, where and why?), completed some worksheets aimed at behavioural change, and ended up getting an outpatient detox at the local hospital.

The consultant psychiatrist was kind. He put time aside for me, but his approach was pharmacological. After detox, treatment involved commencing disulfiram, which gives an unpleasant and potentially dangerous reaction if you drink on it, and acamprosate, which is supposed to reduce craving.

Add in some anti-depressants and a ton of vitamins and I was rattling in more ways than one. I had to travel to the hospital ever day to have my medication dispensed.

Mutual aid, in the form of AA, was mentioned, but only really to dismiss it. I’m still not entirely sure why, but I suspect that the psychiatrist saw me as a professional man and did not associate AA with helping professionals. The other support group, the British Doctors and Dentist’s Group, was not mentioned at all, despite there being a large meeting very close to the hospital.

Those post-detox days were black days. I was riven with anxiety and dread and the desperate desire, no it felt like a need, to drink. If alcohol had occupied my life pretty fully in the few years before this treatment, there was not much difference now. I thought about a drink every minute, dozens of times an hour and hundreds of times a day. There was no sleep and no peace. My solution to living – drinking – had been removed and I had no replacement save some pills.

Over time, the anxiety and low mood showed some signs of settling, but the bleakness and thinness of life did not. It felt like a reverse process to the Wizard of Oz; life had suddenly gone from Technicolor to black and white. Or at least that’s how it seemed. I felt empty inside, as if someone had taken out the living heart of me with a kitchen utensil and then discarded it thoughtlessly.

7. Relapse
Eventually, I got back to work, although I decided to give up my job in my practice. I reckoned that if I did locums then I could still enjoy general practice without the stress of management and responsibility that partners in practice have.

I was still plagued with cravings. It was at this point I made a discovery. I found that codeine or dihyrocodeine from my medical bag were great solutions for craving. It was as if a switch were turned off. When I tested this a few times, I actually believed I’d made a new scientific discovery. And what’s more, opiates seemed to lend me the qualities of patience and peace too.

Now, opiates can be addictive, but I rationalised that as a doctor I wouldn’t run into any such problems. I was too wise now for that, so I just needed to practise better living through a little bit of chemistry.

It seemed to work for a while. While it seems ludicrous looking back, I made no connection between my burgeoning dependence on opiates and my alcoholism. I thought, “It’s not alcohol.”  In the same way that my alcoholism progressed, so did my opiate addiction. My tolerance increased and I had to be smarter at how to get hold of prescription drugs. I began to cross lines again, rewriting my moral code when it needed a revision.

Where there was anguish it had to be dealt with. Uncomfortable feelings could be medicated away with pills. This phase of my addiction was the bleakest of my life. It felt like a finger was on the “fast forward” button of my own personal disaster movie. As my addiction grew, my morals withered and I really did not like myself much.

People in recovery often talk about the experience of “hitting bottom”. Although there was a precipitant to my nadir, by far the most alarming aspect of this black chasm was the effect on my mood, spirit and personality. It was as if the last flicker of life was being strangled out of hope and spirit. I did not see how any sort of meaningful life could ever be regained.

My relationship was in tatters and neither my partner nor I could see a way out. I did not actively plan suicide, but not being here was looking more and more attractive.

8. Getting the right help
During this whole episode, it never struck me that it might be a good idea to get some help. The shame that characterised my alcoholism continued to cripple me.

Nevertheless, the possibility that I might be forced to ask for help was not too distant in my mind. I had seen an advert in the British Medical Journal for the Sick Doctors Trust, an organisation offering support to addicted doctors, and one morning when I got a telephone call from a recent employer to say that my addiction was uncovered and that“steps were being taken,” I knew where to turn.

I phoned the Sick Doctors Trust helpline and spoke with another doctor in recovery. Although I had attended the local NHS addiction clinic (and was still attending), I never really felt connected to it in an emotional sense. With the Sick Doctors Trust there was an instant emotional connection.

The doctor volunteering on the helpline seemed to understand what was wrong with me and much more than that, he knew what I needed to do about it. He knew because he had been in a similar place to me and he knew how I could get out of it. He was in recovery.

He talked about going in to treatment. I said I already was in treatment. He laughed. He was talking about residential treatment. Two days later, I was admitted to residential rehab unit where I stayed for four months.

Although I’d had one or two patients who’d gone to rehab before, I really didn’t know much about it. I thought it might be like the version seen in the movies, but when I arrived nobody took my bags to my room, a room that I had to share with five other men. If there was a pool to lounge beside, I never found it. Food reminded me of school dinners and there was almost no privacy.

In fact, it turned out not to be the rest I thought I deserved, but bloody hard work.

The treatment centre ran a therapeutic community, a set up where there is a sense of community, a hierarchy and an atmosphere in which peers are expected to challenge each other on behaviours not compatible with getting well from addiction. At the core of treatment is group psychotherapy, daily meetings of a dozen of so patients who brought their issues to their peers for feedback, challenge and support.

This is not an environment where an isolated, middle-class doctor might find himself instantly comfortable. It wasn’t comfortable and I spent the first few days writing a list of all the things wrong with the place. Therapists call this externalisation: a device to avoid looking at what’s going on internally.

There were difficulties. I had to give up being a doctor and become a patient: something that was very challenging to me. The idea that I knew better had to be jettisoned. Achieving a degree of humility was painful.

My peers in treatment told me to get off my pedestal and join the rest of the human race. In one particularly challenging group, I was confronted by almost every peer and encouraged to look at my attitude. They reckoned I saw myself as different and above the rest of the human race. I was affronted to hear this. Me, stuck up? But the truth is, I needed to hear that and I needed to change.

Today, I still have my list of the faults I detected in the treatment centre all those years ago. I keep it to remind myself of my lack of insight at that time and of my arrogance.

One thing that helped me though was the fact that many of the staff in the treatment centre were in recovery. Sure, they were qualified in various disciplines, but they had lived experience of addiction and how to get better from it. I could see they were people who lived what they believed and they certainly knew more than me about the process of recovery.

I learned more about addiction and recovery than I thought it possible to know…and more besides. The most valuable stuff I learned from my peers and other recovering people. Mutual aid meetings were an important component of the treatment programme.

I remember sitting in my first meeting of Narcotics Anonymous (NA), with perhaps twenty other people in recovery from addiction – I’d never seen this number of recovering addicts in my life! – and wondering, “Why is this a secret? Why did I not know about this before?”

I found the group therapy and the peer-to-peer support hugely more valuable than the medication I’d previously been taking. Understanding what I do now about recovery, it seems naive to have thought that medication can ever be anything more than an adjunct to a more comprehensive approach.

I started to feel different, but struggled at times to identify emotions. Some of the time I was angry, but other people had to tell me that’s what was going on. At other times, there was sadness. To me it was, “I don’t feel right”. Often, my emotional state was clearer to my peers than it was to me.

About five or six weeks after being admitted to residential treatment, I remember lying on my bed wondering what the hell it was I was experiencing. It felt amazing, but new. I was frightened it would leave me. After a while, I was able to put a name to this feeling. It was peace.

I discovered I had trouble being honest with myself, preferring to see things in a certain way. Group therapy is very helpful at giving you a new pair of spectacles through which to see the world, and very quickly I gained insight into the repetitive and self-destructive patterns of thinking and acting that had tripped me up so many times in the past.

One of the first lessons I learned was that I was responsible for my own feelings. Although now that sounds very self-evident, for much of my life I had believed that what was happening around me would determine the way I felt; as if I was passive and had no choice in how to respond to circumstances. There was a scared little kid in me who was still dictating the way I would deal with difficult life circumstances and difficult people.

Discovering that how I responded was actually down to me, and not to the circumstances I found myself in, was an eye-opener and very empowering. Treatment helped me to move away from being a perpetual victim to life’s challenges, and develop a bit more self-assurance and confidence.

I was also able to start the process of letting go. Throughout my life, I had been anxious when I did not feel in control. I realised through treatment that it was not possible to always make things turn out according to my plans, that in fact it was okay for things to turn out the way that they were going to turn out without any help from me. When I practised the art of doing my best and letting go of the responsibility for the outcome, I felt a sense of relief.

As time went by, I began to recognise in others coming into treatment the very traits that had been holding me back and I was able to start to share my experience of identifying and changing these traits.

I began to see that a key part of my own recovery was supporting others in the recovery process, of helping them to move on as I had been helped myself. This practice in recovery communities (recognised by mutual aid groups through the phrase “you only keep what you have by giving it away”) means that recovery is self-generating and constantly spreading.

Framing recovery as a concept – a journey and a state of mind – was helpful to me.

I began to realise that getting better was going to require two things – time and hard work. One thing that proved hugely helpful was getting connected to other recovering doctors. The British Doctors and Dentists Group (BDDG) is a mutual aid organisation for medical and dental professionals with addictions. I was taken to a local meeting from the treatment centre and have continued to be active as a member ever since.

I remember the relief of hearing my own story, or something very close, at a meeting and realising that I wasn’t necessarily a bad person, just a sick person. I realised that even someone like me could recover. The power of peer support and positive role modelling is astonishing.

My two experiences of treatment could not be further apart. The first, medicalised version was good as far as it went, but I needed much more. I needed the instillation of hope and that cannot happen through prescriptions. It happened when I started to meet with other recovering people.

Even today, addiction treatment professionals generally don’t get this. There are a lot of odd beliefs held about mutual aid. Few view connecting their clients to peers in recovery as important. I know that I hadn’t done previously, yet when addiction happened to me, finding mutual aid groups was something that completely changed my life.’

Why not check out the rest of Tim’s Story?