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

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

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.

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 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.

Addiction taught harsh lessons that came at exorbitant prices, so we should learn from past mistakes. 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.

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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8 responses to this post.

  1. Posted by Mikael Langner on February 13, 2017 at 5:21 am

    My goodness, what a controversial topic. Several years ago, in 2013, one of your posts received 43 comments on this topic. Having read through those posts, it is somewhat surprising to see you take another stab at it, but perhaps your perseverance is a clue to the importance of this topic in your clinical experience. I want to thank you for giving new practitioners a foretaste of the feast that will come with more clinical experience. One of the approaches I haven’t seen mentioned very often in reading about treatment approaches is a harm reduction approach. This approach seems to acknowledge that mistakes are a way of life, and that it is better to embrace the mistakes, rather than treat them as regretful. For example, the notion that my substance-using behavior is hurtful to my relationship with others is met with the harm reductionist approach that no relationship is perfect. Alas, the 12-step programs take an abstinence-only approach, which is not consistent with a disease-based approach to addiction. For example, from a harm reductionist approach, a relapse is seen as akin to a diabetic having a piece of cake. Would a doctor kick a diabetic out of treatment for this “relapse?” It would seem that many of the commenters from the earlier blogs have indeed met with such dismissivenenss in their 12-step meetings when they reveal they are in medication-assisted therapy. Yet, a “whatever works” rationale would seem to be the status quo for continuing to recommend it to those in recovery. Thanks again for your insights into MAT from a clinical perspective. For me, the insights gained through your blog help me to understand MAT as one part of a larger recovery journey. One other thing I have noticed from the business side of things is that very few practitioners accept Medicaid patients. For example, a survey of practitioners done by the California Society of Addiction Medicine says not one practitioner accepted Medicaid. The editor of the CSAM newsletter noted the zero number as surprising. When I google the office visit rate for a new patient, the rate is about 200 dollars for a 60 minute appointment with a patient. The Bureau of Labor and Statistics gives the average hourly rate for a physician in private practice at 80 dollars and that for a physician in non-profit practice at 60 dollars, so the zero number also seems surprising to me. Maybe my perplexity is why I am in medicine and not in business. Then again, for at least the last 30 years medicine has been a business, so to say, by definition, a physician is also a business-person is probably the way out of my perplexity. Apparently, most physicians are going the way of private reimbursement. One wonders how many patients understand this fact, but my guess is that it would not make them happy to find out. When one considers that some people relapse to heroin because it is cheaper than Suboxone only adds fuel to the fire.

    Reply

    • Wow. I don’t live in CA, but I can tell you that a new patient Medicaid visit in NC wouldn’t reimburse anything close to $200!
      For a routine buprenorphine office visit, I charge around $85. Medicaid would pay me $26. I have 2 Medicaid patients and I see both of them for free, because the irritation and aggravation of trying to get that $26 isn’t worth the time and effort I would have to expend.

      Reply

  2. Posted by Terry on February 13, 2017 at 5:30 am

    I think you did about as fine a job of discussing these issues as anyone could have done. good job.

    Reply

  3. Many people in therapy, with or without a support group or 12 step resource as part of their “team”, come to terms with past behavior as part of treatment/recovery/change/growing up. Healing and self reflection are part of lots of journeys not just 12 step or Budhist (Refuge Recovery, Recovery 2.0) oriented ones. Some family members are so relieved when their loved one gets back on track and they soon “let go” of past drama and trauma. Others have been deeply hurt by the addiction so if “facing” this and their own “mistakes” as familiy members is a way to empower the person and family to take ownsnership and create new healthier bonds, whatever helps one get there is positive.

    As to why you get attacked for giving any “credence” to groups like NA, AA or others, thats something our profession needs to come to grips with since for many with a SUD theres a need for lots of resources and tools over time. Just like with weight control why argue if running or nutrition or yoga is best since really all can be helpful. It often comes down to which the person is willing to use. Harm reduction is a big umbrella that should also include abstinence based support for those who choose it. No one should be put down for their choice of support whether its Methadone, AA, SMART, or EMDR.

    Reply

  4. Posted by John Bachman, PhD on February 13, 2017 at 8:14 pm

    Over the years, I’ve asked many people (patients) who say they’ve benefited from working the 12-Steps which one(s) were most helpful to their recovery. Most say “making amends” and “being of service” were most influential. This makes sense to me- insight into how past behavior harmed others and willingness to behave empathically going forward- alleviate the guilty suffering that necessitated drug use to relieve existential pain.

    Reply

  5. I loved this post. I found it very inspirations and I learned a lot from it. Thank you from the great read!

    Reply

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