“We will not regret, nor wish to shut the door on it.”

aaaaaaaaaaamends

This was a tough blog to write. I want to thread the needle; I want to relate some solid help from 12-step recovery sources without angering some of my faithful readers who become angry with any mention of 12 step recovery, and don’t feel they help people with opioid addiction.

So you’ve been warned.

I know 12-step recovery isn’t for everyone. Some people tell of bad experiences with 12-step groups. And I know millions of people have been helped by these groups, too. So take what you like from this blog entry, leave the rest, and if you read something helpful, I’ll be happy. If not, try again next week because my topics fluctuate.

I talk to many recovering addicts who voice regrets about their past. The stories vary; the patients’ main theme is regret for behavior during active addiction. I understand those feelings, and feel tempted to tell patients how to deal with these feelings… but I don’t say anything, for fear that I’ll sound too “preachy.” Who am I to tell someone that they can examine past regrets, learn from previous mistakes, make amends when needed, and face the future with a clean slate? Isn’t that a conversation for a priest, imam, rabbi, or pastor?

Yes, it is. And yet, this person is in my office. Many times my patients tell me they feel unworthy to join or rejoin a religious community, and feel judged by such groups. Some of my patients’ perceptions could be colored by their own shame, but I fear many of them are accurate in their perceptions. Addiction is still regarded as a sin by some religious groups. Other groups do know addiction isn’t a sin but a disease, which can cause us to do and say things we regret, which are contrary to our values

Twelve step groups like Alcoholics Anonymous and Narcotics Anonymous have mechanisms for dealing with past regrets and ruptured relationships. These groups didn’t invent anything new. They use the same approach as other spiritual and religious groups, which are also sound psychological advice. However, the twelve steps provide a handy framework for handling regrets.

First, in Step 4, the recovering person assesses past behavior, called a “moral inventory” in recovery parlance. That inventory is shared with themselves (ending denial), another trusted person, and the god of their understanding. Patterns of behavior emerge, giving information to be used in steps 6 and 7, where the person becomes willing to give up old behavior and ask the god of their understanding for help with this.

In step 8, the recovering person lists the people he has harmed while in active addiction. With the aid of a sponsor or trusted spiritual advisor, in Step 9 the recovering person makes plans for how best to make up for past behavior.

Amends can be as simple as saying, “I’m sorry,” to someone for past bad behavior, or amends can be more extended, like resolving to be fully emotionally present for loved ones.

Sometimes direct amends aren’t possible, if the person has moved away, died, or unable to be located. A more general amends can be made instead. For example, if a person shoplifted to support their addiction, it may be impossible to remember where and what was stolen. Part of the amends process is not to repeat the old behavior, but a more general amends may involve volunteering in the same community to help society in some way, like donating to a food bank or giving time to help a child in need.

If the recovering person feels guilty about stealing money, amends may include apologizing for the past behavior, and making a plan of re-payment. For example, I know a person in recovery now for over 16 years who sends a check for $25 each month to a governmental agency to whom he owned money after a criminal conviction. He may never get the full amount paid off, but he’s taking action to fix what he broke.

Recovering people can move forward by planning amends for past actions, but also should consult a sponsor or spiritual guide for help. For example, if an addict stole money from a drug dealer, it should not be paid back, especially if it puts the recovering addict at risk. In some situations, the best amends may mean having no contact with the other person.

Some recovering addicts have long lists of bad behavior to make amends for, and other recovering addicts’ lists may contain only a few people. Many addicts harmed only their immediate family, by not being completely emotionally available to their spouses or children during their addiction. Some recovering people feel just as bad about that as others feel about committing armed robbery for drug money.

Addiction taught harsh lessons at an exorbitant price, so we should learn from past mistakes.

The point of amends isn’t how bad the behavior was, but how the recovering person feels, and how he can leave behind guilt and shame and move forward.

Addiction, like some other diseases, affects behavior. Rather than living with regrets, recovery means facing regrets, learning from them, fixing what we can, and then moving on. It doesn’t matter what you call it: making amends, cleaning your side of the street, getting right with the god of your understanding, or some other term.

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6 responses to this post.

  1. Posted by John Cunningham on February 15, 2015 at 3:27 pm

    Jana Smashes it again… I really like your perception of our lives..It is just plain crazy the stigma we still face.. Keep up the great work..You are saving lives daily more than you realise I think… I am so glad I found your blogs as some of the dribble that others put out there just keeps sending us backwards instead of fixing the problems we face..I have really learn’t recently that the only one that can better myself is me and I am bettering myself daily although if I mention something about it to Blood or people that know my name but in no way know me still try to put me down and I have always let them..NO MORE I need self improvement for myself and what anyone thinks of it they can keep their oppinions to themselves as I will not listen anymore to negativety..I am so over it…

    Reply

  2. One of the truths I find in “practice based evidence” from talking with countless clients and people in my personal life is how flexible mutual aid support groups can be. People dont have to “do” anything, just show up. Many use the steps, others ignore them, others use some of them and alter it to fit with their world view or incorporate w/ other help they are getting from sources such as Licensed Therapists. Some hit a weekly meeting and leave, others go for coffee afterwards, attend a few times a wk in the beginning, or call fellow members to connect.

    Same with Smart recovery. Some use the work books, others attend meetings. Professionals seem to take AA/ NA literature too literally IMO and dont give credit to clients ability to take what they need or recognize that words writting in the language of the 30s get reinterpreted today. Many of my clients dont like the idea of it and never go, others go for a while and may or may not feel it was helpful, while others feel it has a profound positive effect on their well being, need to belong, get social needs met, and heal. Who am I to withhold or criticize any options?

    There is a lot of antagonism out there. Some is from folks who dont like that approach. thats fine. Move on and try something else. Others seem to misunderstand and feel left out especillay certain types of licensed therapists who seem to think that mutual aid among others in recovery is ‘less than”. They denigrate people in recovery having a role even though some clients benefit from talking to others on that journey. When I work with combat vets I am happy if they also get support from organization of other vets. I dont feel I’m in competition or have less value as a therapist because I havent been to war. i respect that support. Not sure why that doesnt occur with some in this field but given the background of some of the noisiest critics I suspect it also has to be with their feeling like they dont have a place.

    Some misreprent AA saying it “requires” things like attendance for life. I know about 40 people in 12 step programs and the majority go for either a few months or a few yrs, generally once a wk for an hr. I only know one who has gone for decades. I wouldnt judge that any more than someone staying longer on MAT. Nor would I judge a veteran who wanted to meet with other vets for support in addition to their work with aTX professional. This dis-ease is too broad and complex to think that one approach is better than another. Just like with obesity, some join a gym and never go, some try it then leave, others go regularily, some need weight loss surgery. Some go back to the gym after surgery. Some try a tape. Some just put on their running shoes and run alone or with a group. None is better or more worthy.

    I feel ethically i need to present all options and trust clients to choose. Some are thrilled to consider MAT others dont choose that route. I’ve rarely seen anyone in long term healty recovery who didnt use a variety of tools and resources over time anyway. What works on Park ave. where many anti aa writers practice may not be realistic elsewhere or desired. Some people will not do long term therapy or try it and if drug use is still causing problems they should move on or add on just like people who try support groups should as well. One yr meds may work, another yr someone may want or need or be ready to committ to therapy, another time a mutual aid support is essential.

    Just got an email from WAFT an AA movement to expand groups specific to atheists and agnostisc in AA. Just as there are groups for all kinds of minorities that didnt exists until they did I see more of these groups being influenced by members who have a different interpretaion of how it worked for them. There is a huge RECOVERY 2.0 movement online focusing more on healthy nutrition, meditation, and yoga in recovery. Last week over 28 K attended their online free conference. This is big in California of course. May not fly as well elsewhere. Who knows? I sent the link to several clienst, some ignored it, otehrs clicked on and said they leraned a lot. Happy to see all these options. It’s not an either/or.

    Reply

  3. Posted by John Cunningham on February 18, 2015 at 12:26 am

    Very well put Deb Owens… I myself in no way would put down anyones recovery which ever way they choose if it works for them more power to them… As you say some need meetings some don’t some get a lot out of them others get nothing or just go as they have to for program reasons.. In Australia where I am from I have been on MMT for over 23yrs and I have seen one counselor in all that time as you see a counselor before program and then private Doctor for 3mthly reviews.. Whether they would have helped me I don’t think so as the couple of times I did go to NA andd AA meetings It was like a dick sizing competition of who had the biggest habits..I have enough trouble in my own head than listening to crap like that and half of the ones sharing would be outside selling dope after so It did not help me… The best help I have had this past year is a social media Methadone Support Group only for us on MMT and we are a family…The love and support we give each other is quite special and again I have joined a couple of others and As soon as you say you are Clean on MMT they kick yo off the page?? My drug of choice was Heroin..I have not used heroi this Millenium so if someone wants to say I am not clean they are not worth a Zac of my time or thoughts..More power to them if it works for them. I have also met a few commbat vets and yes they go through a very hard time,,It is not right and they should be given and accepted in to any program groop or meeting they choose.. I do have a friend starting a Smart Recovery and it does sound a great new way at trying to give more support to us On MMT..We struggle immensley everyday and when some 19 yo kid goes to N/A and shares that they are on MMT they get shunned..Do not recieve there coims as unbelievably they are told they are not clean? I think if you had a shower this morning you are clean and if you stop using you drug of choice with the help of MMT well good bloody on ya.for them to be so proud and to be put down is just wrong..Anyway great that you have your outlook it is certainy refreshing to hear from another Health Worker fighting the fight,,Keep up the great work and so hope others listen to you and Yana…I am so sad of hearing all our children passing away from what knows is in the poion these days,,Take care have a great night John

    Reply

  4. Well said John. Decades ago people in AA didnt yet understand about anti-depressants. Decades ago, many members recalled Doctors putting them on meds that then they became addicted to. So understandibly there was a little skepticism and hesitation at first. Now itd be fair to say that half of attendees are on, have been on, or will at some point need or decide to take them. Here in the Philadelphia area there are some NA groups that feel since they offer an abstinence based approach that they should be consistent so all are welcome but they ask those who take turns leading meetings subscribe to that philosophy. each group decides that. Yet there are a few meetings where lots of people on MAT attend, specifically ones near Methadone Clinics. The clinic staff tend to learn which meetings are more open and suggest accordingly. So I think over time things evolve and if someone prefers using both resources they can do so or not.

    Recovery historian William White predicts those on MATS will either form their own Mutual Aid Support Groups and that’ll take hold or NA/AA will slowly but surely embrace them and those programs will once again evolve. He couldnt predict which will occur. My guess is both.

    I am very much in the “whatever works” camp. I wish this field didnt try and polarize people or stigmatize them. Just as people on MAT feel discounted so do people choosing AA/NA type programs. Neither is good or bad. All can and do work. Nothing should be taken off the table. Last month on a well visited web site a person describing themselves as the head of a well known harm reduction group responded to a person with an addiction posting their own story. it wasnt’t meant to be an opinion. Just someone sharong their own jouney. In his case that included several attempts at formal tx then a stay in jail which led him to a 12 step process which had been working for him at the point he wrote it. This person was not only attacked by the other person but called a “jailbird”. I was shocked. has it come to that? Its as if the war on drugs failure has become a war on recovering people.

    It’s time to honor and respect any and all paths to recovery. “Young people in Recovery ” is a good example of an all inclusive approach. “Recovery 2.0 ” takes it to another level and is big on nutrition, meditation, yoga and healthy living. Some will find that appealing. Others will not. So nice to see so many options.

    Reply

  5. Posted by kevin on February 25, 2015 at 1:00 am

    I have something weighing deeply on my chest and I need to get this out. My boyfriend of 10 years is constantly nagging me about my methadone. He says that all methadone clinics are just legal drug dealers and that I don’t need the sh!t. He constantly says if I don’t stop I must not love him. I have some other health conditions going on at the moment. He blames them on methadone and says that the methadone is the problem. I love him with all my heart. He is my soul mate. We have problems occasionally but what couple doesn’t . But it’s causing an argument at least 2 to 3 times a week. I gave up on him ever supporting me and my addiction/pain. I know I’m a life timer. If I quit tomorrow, I wouldn’t make it. I have tried. Done this already. But I don’t want this to end our relationship. He oviously doesn’t care about what’s best for me and for him to say” you either quit tomorrow or you don’t love me” is never gonna make me quit. If anything I’m gonna rebell worse. I honestly do what’s right in my treatment. I don’t abuse it or take other drugs. But methadone has been a lifesaver for me. In every sense. What can I do? Probably nothing.

    Reply

    • I don’t understand why he says you should stop an effective treatment for your potentially fatal illness if you loved him….would he be willing to come to your program and talk to the doctor/counselors/nurses so that he could understand addiction IS a disease? I sounds like he doesn’t understand much about what addiction is.
      Unfortunately, some people are sadly unteachable.
      This makes it a bad situation for you. I it takes a strong person to say, “I’m going to do what I know is right for me and if you can’t or won’t accept that…I’ll miss you but bye.”

      Reply

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