This is the first installment in a two-column series dealing with the importance of proper back care in enjoying a wellness lifestyle in recovery. This column provides an overview concerning why appropriate back care precautions are particularly important to people recovering from substance abuse disorders, together with basic tips for preventing lower back problems. As always, feel free to share this column with clients who may benefit from the message.

I believe in therapy, in giving attention to the soul. And I believe in story and its power to return us to the essence of who we are and our place in a living universe. These lifelong interests have enlivened my teaching and writing for much of my life. And they have given rise to my new book of stories, As Far As the Heart Can See. Paradoxically and amazingly, all our stories meet in the invisible center of the one ongoing story of life in which we all struggle and thrive.

I want to share a few thoughts about addiction, followed by a story from the new book that speaks to the personalized dynamic of facing the life we are given. The gifted therapist and writer Gerald May offered this helpful place to begin: “The root of the word attachment, a-tache, means nailed to. Spiritual traditions see attachment as nailing our capacity for love to something other than what it was meant for.”

Poignantly, it is our insecure want to stay connected to life that often leads us to our out-of-balance attachments, which ironically, only spin us further away from all that matters. Often, our personal forms of attachment grow out of painful situations that we spend much of our lives trying to mend. My mother was an angry person. She seethed and smoldered much of the time. It was like living near a volcano, never sure when it might erupt. I’m not sure what painful situation she was reacting to. But I quickly learned how to absorb her heat and threw my attention on her like water. But it was never enough. There was always more fire than I had water. And even when leaving home, I looked for fires to put out, thought this was love. I became attached to the idea and kept thinking, “If I could only find more water.”

We all do this in one form or another. It’s just that some of us can feed our attachments and still function. Yet add the weight of suffering and our attachments can deepen into addiction—that is, we can make a god of attachment. In fact, we could say that addiction is a collapse of attention by which we pursue one thing repeatedly, as if that one thing will give us everything, as if that one thing sucked on enough will take away the pain of living.

Whatever the object of such focus— alcohol, drugs, love, sex, success, money, the thrill of adventure, or the tumble of crisis—addiction is attachment run wild until, like a selfreplicating Midas, everything we touch turns into our troubled self. Terribly, addiction attaches to everything in its path, nailing our troubled self everywhere we go, when all we want is to lead our self out of its trouble.

We may never eliminate addiction but we can offer each other our honest company, which is the steadfast work of compassion. For the gift of compassion is that when love and truth meet, we are humbled and opened into a timeless resource, which will heal us, but only as far as the heart can see.

The Bridge and the Elephant

In the dream, I was working hard to finish a bridge in order to cross some river whose current was strong. It seemed important to get where I was going, though I couldn’t put where I was going into words.

Just as I finished the arc of the bridge, an elephant appeared in the water. It was stepping down the middle of the stream. When it was squarely beneath my unfinished bridge, it stopped to douse itself with water. Then it stared at me.

All at once, the sheen of the water on its back made me question why I was building a bridge in the first place. It made me question if what I was crossing really needed to be entered. It made me wonder: If I were to enter the stream rather than cross it, would I have a different sense of where I was going?

In the days since the dream, the image of the elephant under the unfinished bridge has made me consider obstacles differently. Now when I stumble before things I don’t understand, I try to remember the elephant dousing itself in the middle of what I thought I had to cross and ask myself: Is the thing in the way something I need to cross or enter? If it’s a difficulty involving love or fear, where will I be led by crossing it? Where will I be led by entering it? At each turn, I find myself needing to know: What must I face and what must I bridge? And when are facing and bridging deeply the same?

JOURNAL QUESTIONS

• Describe something currently in your way. Consider whether it is something you need to cross or enter.

• Where might crossing this obstacle lead you?

• Where might entering this obstacle lead you?

TABLE QUESTIONS

• To be asked over dinner or coffee with friends and loved ones. Try listening to everyone’s response before discussing: Tell the story of a bridge of some kind that you contributed to building.

• How did the need for this bridge become known?

• Have you crossed what the bridge was made to cross?

• Is anything different in your life for this act of bridging?

A MEDITATION

• Sit quietly and as you breathe, allow yourself to feel your soul as a bridge that can grow over anything.

• As you breathe deeply, feel where the bridge in you resides, waiting to be of use.

• Exhale slowly.

• Again, sit quietly and as you breathe, allow yourself to feel your soul as an elephant that can enter anything.

• As you breathe deeply, feel where the elephant in you resides, waiting to be of use.

• Exhale slowly and enter your day with the patience to discern which you need today: the bridge or the elephant.

Mark Nepo has taught in the fields of poetry and spirituality for more than thirty-five years. The above story is from his new book, As Far As the Heart Can See (HCI Books). His other books include the New York Times bestseller The Book of Awakening, which was also selected as one of “Oprah’s Ultimate Favorite Things” in 2010. As a cancer survivor, Mark devotes his writing and teaching to the journey of inner transformation and the life of relationship. To learn more, please visit www. MarkNepo.com and www.threeintentions.com.

Life has a way of confronting us with situations that force us to move beyond our established comfort zones. One of the most challenging situations, based on my own experience, has been attempting to undertake a major geographic move. I tend to be especially adverse to moving, as during my childhood my family moved every year or two until we finally settled down on Long Island during my teens.

When my wife and I retired from our day jobs six years ago, we decided to move from Southern California to a waterfront community in Washington where my wife’s oldest daughter lived. After we sold our home in California and made the move up north I unexpectedly underwent a major relocation crisis. I found that my deck had been completely reshuffled, so to speak, as I felt the full impact of leaving behind everything I had been familiar with throughout the greater majority of my adult life.

This is the final installment in a three-column series dealing with the integration of wellness and recovery within the context of the emerging extended recovery treatment paradigm.

Extended recovery goes far beyond the prevailing treatment model, which focuses predominantly on acute stabilization, through embodying an ongoing continuum of monitoring and appropriate treatment interventions throughout the recovery process. These extended services are provided in recognition of the chronic and potentially deadly nature of substance abuse disorders – posing profound ramifications in terms of both funding and delivery of services. Significantly, in the extended recovery model, recovery is viewed as existing along a continuum of improved health, wellness and overall quality of life (Center for Substance Abuse Treatment, 2005). Wellness can be defined as the dynamic process of taking charge of our health and programming ourselves to attain optimal health and quality of life. The wellness model offers powerful applications in addictions treatment as it complements the recovery model by actively supporting the recovering alcoholic/addict in attaining a firm grounding in recovery; repairing cumulative damage to one’s mind and body; and enriching one’s overall quality of life in recovery (Newport, 2009).

The extended recovery continuum can be viewed as encompassing the following components: intervention; primary treatment; continuing care or extended care; early recovery; relapse prevention and intervention; and middle and latter stages of recovery.

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) is developing a treatment improvement protocol for “Building Health Wellness and Recovery in Substance Abuse Treatment.”

This two-column series addresses specific considerations in applying the wellness and recovery model to the growing number of older clients seeking treatment for addictive disorders. The previous column highlighted application of nutritional foundations for recovery, fitness and recovery and conquering nicotine addiction. This column focuses on the qualitative aspects of recovery—including life satisfaction and central purpose—as they apply to this growing segment of the treatment population.

Loss and social isolation
Loss and grieving are predominant components in the lives of many older people. Loss associated with aging takes many forms, including: loss of one’s career focus accompanying retirement; loss of one’s central identity as a parent as children leave the home; loss of a sense of youthfulness and vitality enjoyed in earlier years; and loss of one’s spouse or primary partner, other relatives and close friends due to death.  

Loss is recognized by social scientists as a precursor to distress, depression and many forms of illness, and has even been implicated as a factor in premature death (Hafen, et al, 1996). In a study of 42 consecutive patients admitted to the Rochester Memorial Hospital with a wide range of medical problems, Schmale found that 31 patients—approximately 75 percent—developed their disease within one week of the loss of a loved one (Dossey, 1991). Researcher Steven Schleifer based at New York’s Mount Sinai Hospital estimates that 20 percent of all people who die within a year of losing a spouse die as a direct result of the loss (Lynch, 1977).  

Many older persons are also plagued by an acute sense of social isolation. Men, in particular, are often devastated when they retire and relinquish their occupational roles and social supports at work. Likewise older men, more so than women, often encounter severe social isolation following the death of their spouses. Older women often suffer isolation and loss of identity associated with the “empty nest syndrome”; this isolation can be exacerbated if they are geographically distant from their grown children and grandchildren.  

The severe sense of social isolation that characterizes the lives of many older people can trigger excessive drinking and drug use, including overuse of prescribed medications, especially pain medication. At the same time, these problems are often difficult to detect as these persons are cut off from the mainstream as a consequence of their isolation.

In recognition of the loss, grieving and isolation issues confronting many older patients, primary treatment and continuing care programs need to place special emphasis on actively assisting these patients to forge connections with healthy, nurturant social networks that are supportive of ongoing recovery. This is especially true in reference to social engagement that fosters the qualitative aspects of recovery, particularly maintaining a positive outlook on life and living each day to the fullest. Such involvements can include: participation in 12 Step programs or one’s chosen recovery focused support group; structured exercise programs, such as walking, hiking and biking clubs, yoga, etc.; involvement in one’s chosen religious or spiritual community; part-time employment; and sharing life experience with others through mentoring younger people and other volunteer service.
To the extent that treatment and continuing care programs are able to actively assist their patients in breaking the cycle of despair and withdrawal associated with loss and social isolation, these patients will be motivated to anchor themselves in quality sobriety while acquiring valuable coping mechanisms to safeguard against relapse.

Life satisfaction and striving for an integrated life
In the classic text, Relapse Prevention, Marlatt emphasizes the critical link between life satisfaction and reduced likelihood of relapse (Marlatt, 1985).  Unfortunately, many older persons with addictive disorders experience low levels of life satisfaction due to loss, grieving, isolation and a general absence of joy in their lives. Treatment professionals working with this population are challenged to motivate their clients to work through loss issues that are holding them back from pursuing truly fulfilling lives.

In my book, The Wellness-Recovery Connection, and in my trainings, I like to refer to central purpose as the royal road to health and longevity. I have always been fascinated by the fact that throughout history, people who have left their mark on the world have enjoyed life spans far in excess of their contemporaries. I am also convinced that there is a strong link between fulfillment and successful sobriety maintenance. Simply stated, I believe that when we feel good about what we are doing, we are motivated to take care of ourselves, work our recovery programs and fully embrace the joy of recovery!  

All too often, older people succumb to the stereotype of aging as a progressive process of deterioration. They become risk adverse and
create self-imposed barriers that block them from fully pursuing their dreams. To counteract this inertia, counselors need to serve as cheerleaders in encouraging older clients to bolster their self esteem through uncovering—and actively pursuing—their heartfelt dreams.

I firmly believe, for example, in actively encouraging older clients to break free from conventional stereotypes and embark on exciting new careers and ad vocations that reflect their true values and ­aspirations.

Counselors also need to be attuned to profound shifts in our concept of central purpose that can occur as we grow older. For example, when I retired from my day job, I had a burning desire to launch a new career as a self help writer and speaker. While this continues to be an important focus, I find myself increasingly drawn to other areas of life.   These include a passion for hiking in the desert, singing and drumming (I’m a wannabe jazz vocalist), and focusing on deepening the bonds of love and joy in my marriage to Ann. Concurrently, inspired by the breathtaking beauty that surrounds us, Ann has thrown herself into creative photography and creating expressive DVDs.  

Counselors working with older clients should encourage them to pursue fully integrated lives. This entails striving to create that elusive quality of balance in our lives, together with enhanced self esteem and joy in living. We need to actively motivate our clients to embrace long forgotten dreams involving creativity, giving back and other fulfilling pursuits. Among other things, creating an integrated life in our later years involves opening up to a deepening attunement to a sense of calling, together with a profound awareness of the importance of developing mutually nourishing relationships with both our higher power and our fellow travelers on this planet.

In conclusion, applying the wellness model to older patients suffering from addictive disorders poses special challenges and opportunities to treatment professionals. As always, feel free to share these columns with colleagues and clients who may benefit from these thoughts. Until next time—to your health!    

References
Dossey, Larry. (1991). Meaning and Medicine: A Doctor’s Tales of Breakthrough and Healing. New York: Bantam Books.
Hafen, Brent Q. et al. (1996). Mind/Body Health: The Effects of Attitudes, Emotions, and Relationships. Boston: Allyn and Bacon.
Lynch, James J. (1977). The Broken Heart: The Medical Consequences of Loneliness.  New York: Basic Books Inc.
Marlatt, G. Alan & Judith Gordon, eds. (1985). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guilford Press.
Newport, John. (2004). The Wellness-Recovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction. Deerfield Beach, FL: Health Communications, Inc.

John Newport, PhD, is an addictions specialist, writer and speaker based in Port Townsend, Washington. He is author of The Wellness-Recovery Connection: Charting Your Pathway to Optimal Health  While Recovering  from Alcoholism and Drug Addiction, and is currently completing a Wellness and Recovery Workbook Series in collaboration with the Gorski-CENAPS® Corporation.  For further information on The Wellness-Recovery Connection, visit www.wellnessandrecovery.com. For information on the Wellness and Recovery Workbook Series, visit www.relapse.org.