How can you help your clients to maintain recovery when the demands of living in our electronically connected age — an age that is full of excitement and possibility 24 hours a day — causes them to become stressed, overwhelmed and heading toward relapse? You may see the same problem in yourself, after a demanding and challenging day of counseling clients, interrupted by cell phone calls, by pages, by voice mail, by driving from office to office and then to home, you can easily end up feeling stressed, burned-out and wired.

The answer is balance. You can do it all, you can live the kind of full life, made possible by our wonderful technology, and you can live a life of passion — if you do so with balance.

Imbalance exists everywhere. You can see it in the fact that there is an epidemic of marijuana dependence and depression among our teenagers. You can see it in the fact that almost every middle-aged adult who comes for counseling is struggling with marital problems, work problems, family problems, and, all too commonly, alcohol dependence.

But the therapeutic effects of balance are out there, too. Alcoholics Anonymous works by restoring balance. A recovery program for narcotic addicts in Lynn, Mass. works by using creativity to restore balance. And, if you think about your clients who have successfully sustained recovery, you will recognize the ways in which you probably helped them to sustain recovery by restoring life balance.

The balance that I am referring to is a natural balance. It is built on the physiologic operating principles of your nervous system. You can find and sustain a natural, resilient balance by following a carefully constructed program, a program of natural and common sense steps such as:

• balanced sleep
• the right amount of exercise
• a structured diet of food and entertainment
• healthy relationships
• the right type of positive thinking or self talk

You can help your clients to establish balance and, by doing so, sustain recovery from chemical dependence. If you feel out of balance yourself — in our fast-paced, hyper-linked society, imbalance happens before you know it — you can apply the principles of balance to your own life, helping yourself to live the life you want.

Listen to the words of Allison, a teenage patient of mine. She is a high-school senior and the oldest child in a blended family. Mom and Dad work full-time jobs to make ends meet. Allison receives little direct supervision at home, and came to see me because she wanted better grades so that she could go to the 'best' colleges.

I asked Allison about her daily habits. Here is what she told me: 'I get up at 5 a.m. to do my homework before school. Then I'm in classes all day. After school, I have committees and student council. There is the school play, so I'm busy with rehearsal until about 10 p.m. I get home at 11 p.m. I talk with my friends over the Internet until 1 a.m. and then I do homework until 2 a.m. and I go to bed.'

When I asked her if she could try to get more sleep to relieve her daytime tiredness, Allison said, 'I can't sleep more. When would I do all of this stuff?'

I asked her about substance abuse, specifically about marijuana. She replied, 'I do smoke every day, but I'm not a drug user. It calms me down and sort of helps me to keep going. But since it's natural, I'm OK with it. My folks are too.'

In Allison's high school, marijuana use is an epidemic. Depression is too. A classmate recently committed suicide and three others have attempted it. Allison too, is quite depressed although she has trouble seeing her symptoms because as she says: 'I'm a positive person, so things don't get me down, I just feel kind of wired at night.'

Allison's life is terribly out of balance. She feels stressed. She can't sleep. She always feels as though there is something she must do. She is unable to calm down. Allison is tired all the time, she can't concentrate and she is depressed and anxious.

Her solution? Smoke pot everyday despite the clear evidence that her grades and health are suffering.

We live in an exciting time that is unique in the history of mankind. Consider how different life is for us, than it was for our ancestors. Until the industrial revolution in the 1800s mankind lived an unchanging life. The rhythms of day and night and the changing of the seasons balanced it. Life was structured by and focused on survival needs. To our ancestors, any imbalance was a sign of danger. Excitement, stimulation and change were all dangerous, to be avoided whenever possible.

As an adaptation to these survival needs, the human nervous system developed a robust alerting and alarming mechanism. It is hard-wired into the brain. At the earliest sign of any imbalance, a natural vigilance occurs, a dysphoric and worried scanning, to look for the cause of danger — to look for any threat to survival.

Now contrast this with modern life. All of our wondrous inventions, electricity, the automobile, the jet airplane, the telephone, and most recently, the Internet — have inexorably stripped away all of the natural, external limits, boundaries and structure that had dictated life for our ancestors until the past 200 years. Nowadays, you can literally do anything anywhere, with anyone at any time. Life is filled with possibility and passion.

As was the case for Allison, living an exciting life with no limits can leave you out of balance. When your life is out of balance, your nervous system responds, as it must, by sending you warning signals, sounding its innate alarms, causing you to feel stressed, restless, worried and depressed. When this is a daily occurrence, using alcohol, pot, cocaine or narcotics becomes a chemical solution for the dysphoria produced by an unbalanced life.

In the human nervous system, excitation is delicately balanced by inhibition. Excitation generally arises in the brain stem and in the subcortical areas of the brain. Collections of nerve cells — the locus ceruleus in the brain stem, the thalamus, the hypothalamus and the amygdale in the subcortex, and, in the limbic system — provide the excitation. These areas are the power supply for the brain. If you feel excited, emotional or energized, it is because the subcortical areas of your brain have swung into action.

Subcortical activation is balanced by inhibition from the neocortex. You experience this neural inhibition as conscious thought. The neocortex, the part of the brain that is newest, produces conscious thought. The neocortex, especially the frontal lobes, gathers information, comparing and contrasting input. The neocortex plans and then executes an action, when and where it is needed, using the emotion and the energy from the subcortical areas of the brain to power the needed action.

The brain and nervous system function best when they are in balance. But, as Allison's story indicates, the external factors of modern life conspire to throw the nervous system out of balance. Many turn to chemical abuse as a last ditch effort to restore balance.

Here is what my patients have told me:

Like Allison, every one of these patients had a serious problem with balance.

Fortunately, it is possible to live a life of excitement and possibility, without the pain of chemical dependence. It takes balance to do so. Recovery from chemical dependence, or prevention of chemical dependence is achievable by structuring life, using tools and techniques derived from the neurophysiologic principles of balance.

The areas of balance listed below are based on the balance between excitation and inhibition that is central to the function of the nervous system. Each represents a set point, intrinsic to the nervous system, a balance point that has been discovered and verified by current neuroscience research.

To start to re-establish balance, help your clients inventory each of the seven essential areas of balance. Outline the ways in which your client's life is out of balance. Then, using tools and techniques, derived from the natural physiology of balance, you can develop a program of structure and balance for life —- a program that I call, the 'rules for living.'

The 'rules for living' are common sense techniques, specific to your client's life, that help them to avoid imbalance, or to re-establish lost balance.

When you help your clients to apply their own 'rules for living' you will be teaching them how to facilitate a healthy balance — preventing stress, minimizing dysphoria, decreasing worry and unhappiness. This helps to sustain recovery.

You can use the 'rules for living' as a curriculum for therapy, providing the structure, the content, the goals and objectives for a successful program of recovery. It takes about six to 12 visits of focused work to diagnose balance problems, to set up the 'rules for living' and to educate your client about using their unique program of balance. After the initial visits, you shift to a longer-term model of therapy to explore the difficulties your client may experience in trying to apply the 'rules for living.'

You also can use a longer-term therapy to understand and explore the life-changing effects of restoring balance.

As you do this for your clients, and perhaps for yourself, you will be establishing a natural balance. Each of the rules for living that you derive will help to establish and maintain a natural balance in your nervous system. A natural balance that leads to a calmer, more resilient and chemically free approach to life.

1. The balance of sleep and wakefulness
   Sleep and wakefulness are the fundamental balance in life. Sleep too much and you become lethargic, unmotivated and depressed. Sleep too little and you become forgetful, edgy, irritable and impatient. Sleeping is an inhibitory process that allows your brain to become refreshed and renewed for the next day's activity. Sleep can be disturbed by day-to-day over- stimulation, and by under-stimulation. Chemicals such as alcohol, marijuana and amphetamines can disturb the balance of sleep. When sleep is disturbed, a cascade of imbalance affects all aspects of mental function. Balancing sleep and wakefulness must be the first step in any program of recovery. Sleep programs always include a structured adherence to the cycles of day and night, proper diet, avoiding sleep-disrupting chemicals and the right type and timing of exercise. If a sleep disorder, such as obstructive sleep apnea is present, it's necessary to refer to a sleep specialist.
2. The balance of movement and rest
   Research has shown that daily movement such as an exercise program, walking or manual labor can lower blood pressure, decrease heart rate, improve cognitive function and increase well being. Movement counteracts the inevitable physical tension that results from sustained mental activity. It does so at the deepest level of the nervous system, where physical inactivity, combined with vigilant, mental activation is equated with danger.
   If you spend your day immobile, in a car, in front of a computer or at a desk, you do not feel rested, you feel tense, restless and slightly wired. Try to relax without movement and you really can't. A regular program of movement — it could be walking, a workout at the gym, yoga, dance, tennis, gardening, progressive relaxation or Eye Movement Desensitization and Reprocessing (EMDR) — will dissolve the restless tension that comes from physical inactivity. It will reset the workings of your brain and allow a refreshing type of rest; one that leaves you feeling renewed and invigorated. Movement and physical inactivity work best in a dynamic, daily cycle.
   As my patients have told me, chemical use, especially alcohol and marijuana, becomes an antidote for the dysphoria that comes from a day spent mentally active but physically inactive. Sadly, the chemical use further interrupts the natural balance of movement and rest. A person using chemicals never truly becomes rested. The result is more tension, irritability, lethargy and chemical dependence.
3. The balance of appetites and abstinence
   The natural human reaction to abundance is to consume. For our ancestors, this was adaptive since times of abundance may have been uncommon. Appetites such as hunger, thirst, sex drive, the drive to acquire goods, were neural signals that it was time to plan and take action, so that the appetite could be satiated. Nowadays we live in a world of abundance. There are no periods of abstinence naturally interposed between periods of consumption —-so we consume at will. Intuition tells us that the right thing to do when feeling a strong appetite is to consume. But intuition is wrong. Physiologically, when feeling the stimulation of an appetite, the right thing to do is to plan an activity and to carry out that activity and then only after the planned activity, to consume. This is the essence of abstinence. You maintain abstinence by using cognitive processes to inhibit the impulse to consume and by interposing a planned activity, that redirects thought away from the appetite. Controlled abstinence is healthy and is fundamental to recovery. With chemical dependence, abstinence must be absolute, however, the balance of appetites and abstinence, applied to other areas of life, such as eating, shopping, working or sex, will reinforce the absolute abstinence so necessary for recovery.
4. The balance of relationships and being alone
   Directly or indirectly, we are constantly in contact with others. It is a stimulating experience that evokes strong reactions from deep within our brains and our hearts. Too much of this contact is virtual, through television, the Internet, and over the telephone lines and not enough is in person, with people to whom we have strong connections. Virtual contact with others through electronic means usually occurs when you are alone. Then, your nervous system becomes stimulated by visceral, emotional reactions without the calming structure of an in-person relationship. Witness the phenomena of email 'flaming' as an example.
   Despite the fact that we are surrounded continuously by images of people and by electronic communication with others, we spend too much time alone. Time alone is counterbalanced by time spent with other people, with whom you have an attachment. Spending too much time alone in contact with others only through electronic media produces a state of unbalanced, subcortical, visceral stimulation. It leads to depression, loneliness and frustration. It leads directly to chemical dependence.
   Time alone must be balanced by time spent with real life, in person, contact with people. Not just any people, however. The contact must be with people with whom you have an attachment, a relationship, so that there is a matrix of understanding that exists from person to person — each person, knowing well, and caring about the other person. This is one reason why Alcoholics Anonymous is so successful in treating addictions.
5. The balance of emotion and intellect
   Your brain works through a dynamic balance between emotion and intellect. Emotion is an excitatory process that powers action, memory and thought. Intellectual activity or thought is an inhibitory process, where the brain, to inhibit, time, modify and plan action, manipulates mental images and symbols. The visceral aspects of emotion, the energy of emotion, come from the older parts of the brain in the limbic system and subcortical areas. Intellectual thought comes from the newer, neocortex, primarily in the frontal lobes. These two areas of the brain are hard-wired together because the balance of emotion and thought is fundamental to proper brain activity. Too little emotion and you become flattened, dull, withdrawn and unhappy. Too little intellectual thought and you become labile, reactive and over-emotional, ultimately burned out and depressed. Either state is dysphoric and leads to chemical dependence as a solution.
   The balance of emotion and intellect is an active process. Cognitive behavioral researchers have shown us how to use specific learned techniques to balance emotion with cognition and to balance cognition with emotion. The techniques involve a type of self-talk; helpful, positive and affirming self-talk, to counter negativity, fear and self-doubt, and to modulate emotional excess. In recovery from chemical dependence, learning these techniques works like a buffer, to prevent either an excess of emotion or an excess of intellect from leading to dysphoria and relapse.
6. The balance of past and present
   The time-saving tools available to us, tools such as the automobile, the fax machine, the Internet, to name a few, are so seductively fast and immediate, that they draw us into being overbalanced toward a present, or real-time orientation. Spontaneity, creativity, action and impulse are characteristics of working in the present. Subcortical, noncognitive thought processes control in-the-moment thinking so it is tied closely to emotional reactivity. Being overbalanced toward the present can result in an overemotional, impulsive, albeit, highly creative lifestyle. It can lead directly to chemical dependence — the decision to consume becomes a spontaneous impulse with no regard for consequence.
   Thinking about the past requires time and space. In the right amount it aids in planning, it can be pleasurable, it can help prevent you from repeating mistakes.
   Thinking and processing based on past experience is a higher level thought process, based in the neocortex, requiring contributions from many areas of the brain such as the limbic lobes, the amygdale and the hippocampus. It is an inhibitory process. Too much thinking about the past can lead to melancholic immobility.
   Chemical dependence develops when people need intoxicating chemicals to help them to forget, to help them to be more spontaneous and to facilitate in-the-moment behavior patterns.
   Techniques that facilitate in-the-moment function include writing and other creative arts, role-playing and exposure techniques. Past-oriented functioning is facilitated through self-reflection and dialogue with a sympathetic listener.
7. The balance of belief and doubt
   Because of the scientific revolution —- a profound societal change that began in the Renaissance —- ours is a culture of doubt, questioning, cynicism, worry and anxiety. In some ways, this is unfortunate because our brains are hard-wired to be anxious, worried and doubtful.
   A recent study using MRI imaging found that children with obsessive-compulsive disorder (a condition that is the sine qua non of worry and anxiety) have an enlarged thalamus — the thalamus is a key, subcortical structure that processes visceral or bodily reactions.
   Worry is effectively counterbalanced by belief. Mankind has long used religious belief as a way to quiet basic worry and doubt. Researchers have shown that belief in a positive outcome can help to rid you of social anxiety, depression and panic attacks. Twelve-step programs are based on the use of belief to counterbalance the deep denial (read cynicism and doubt) of the alcoholic. Too much worry and you become anxious and immobilized by doubt.

The core of any program of recovery involves restoring belief.

Let's return to Allison and her balance problems. Allison's life is overbalanced toward stimulation. She does not have enough movement and exercise to counterbalance the nervous tension generated by the endless hours of immobile mental activity spent in school, in student activities, in front of the computer. She is overbalanced toward superficial and electronic socialization. She does not spend enough time relating to someone with whom she has an emotional attachment. Because her parents work so hard and cannot provide the guidance she needs, her life is overbalanced toward doubt. She questions and doubts everything without a framework of belief provided by a mentoring adult. Her appetites are unstructured, unobserved and as a result, uncontrolled. She eats and drinks whatever is at hand. She cannot calm down, cannot sleep. Marijuana smoking is her answer to her problems of balance, and lacking the personal resources to be abstinent, she has become a daily pot smoker.

My prescription for Allison — the 'rules for living' that will structure and facilitate a balanced life, ridding herself of fatigue, worry, poor concentration, depression and marijuana dependence are as follows:

1. Arrange to get a minimum of eight hours of sleep nightly by stopping all stimulating activity at 9:00 p.m. Do not nap in the day to 'catch up' (the balance of sleep and wakefulness).
2. Exercise daily by taking up dance. Find the time for this by substituting dance for her work with drama (the balance of movement and rest).
3. Spend 30 minutes daily painting (she loves visual arts) to help her to have a better understanding of her reactions to the events of the day and to minimize her ruminations about past events (the balance of past and present, and the balance of emotion and intellect).
4. Find an experienced adult, such as a coach, a parent, a teacher or a therapist, who will take a genuine interest in her and who will provide reasoned, structured guidance (the balance of belief and doubt, and the balance of relationships and being alone.
5. Cut down on the size of her social circle, and spend more time with a smaller circle of close friends (the balance of relationships and being alone).
6. Have a planned dinner each night with family or close friends and avoid eating on the run (the balance of appetites and abstinence, and the balance of relationships and being alone).
7. Since her family professes strong preference for religious beliefs, start going to church and use prayer to help maintain abstinence from pot. In other words, look to a belief in a higher power to help her to fight off her cravings (the balance of abstinence and appetites, and the balance of belief and doubt).

It took some time, but using her rules for living — rules that we developed together — Allison was able to stop smoking pot and to feel better. She established a healthy balance in her life. Her grades improved and she became happier.

As Allison discovered, you can establish a healthy, substance-free life by using balance. You establish a natural balance by finding the right amount of excitation or passion in your life balanced by the right amount of inhibition or structure.

Apply the principles of balance and you will find natural pathways to sustain recovery. Apply the principles of balance and enjoy the excitement, possibility and passion of modern life. 

Paul J. Sorgi, MD, is a psychiatrist who practices in Concord Mass. Dr. Sorgi's expertise lies in the evaluation and management of depression, anxiety, ADD, learning disorders and associated problems with chemical dependence. He can be reached at 978-287-0810 or by sending This e-mail address is being protected from spam bots, you need JavaScript enabled to view it '; document.write( '' ); document.write( addy_text93482 ); document.write( '<\/a>' ); //-->\n This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

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