Recovery Rising Excerpt: Recovery in the Midst of Chaos


Recovery Rising Book Cover PaperbackThe Engagement Dance

The outreach workers of Project SAFE had a remarkable ability to engage women who were initially hostile or ambivalent about participating in professional treatment, but the outreach worker's ability to eventually get these women to a treatment center did not necessarily mean that the clients then lived happily ever after. The on-going engagement process was turbulent, to say the least. Within this intensive outpatient model (4-5 hours per day five days a week wrapped in day-care services, transportation, and home visits), clients would willingly come to treatment most days but also used cocaine or other drugs at night. Clients would come to treatment, get mad at their therapist or other clients, storm out shouting obscenities, and then call back later to make sure it was okay to come back to treatment the next day. Extreme attitudinal and behavioral ambivalence was the norm. On every dimension of change, the positive and the negative co-existed and battled for dominance. Here is a vivid example of such an observed co-occurrence.

A woman in treatment at a site that provided onsite day care enters the large day care room to pick up her small child at the end of the treatment day. (She has been in treatment about two weeks and has just come out of her third parenting training class.) Seeing his mother, the youngster, obviously enjoying himself, runs the opposite direction as fast as he can. The mother, with anger-etched face and hands on her hips, screams, "Jeremy, if you don't get back here right now, I'm gonna whip your ass!" Then with a strange look on her face, she adds, "But I'm gonna talk to you first."

Here we have the automatic pilot ("I'm gonna?whip your ass") and next to it this brand new fragile behavior ("But I'm gonna talk to you first"). The central task in treatment is to build a relationship through which the former can weaken each day and the latter strengthen. Clients with chaos-filled lives must be engaged in a process of change that often involves two steps forward and one back. This dance of engagement we do is a fine clinical art and tips the scales positively toward recovery and pre-recovery behaviors. It also requires a milieu focused more on care than control and more on the recovery process than rules. If we, as addiction professionals and recovery support specialists, are not willing to involve ourselves in this dance of engagement, we are not worthy of the titles. If we, as addiction treatment programs, are not willing to manage this dance of engagement, we should not admit such clients because of the resulting disservice that would likely ensue.

Women and men with histories of traumatic victimization may be as addicted to chaos and drama as they are the drugs they're using. Such chaos externalizes their pain and distracts them from painful experiences. Such clients must be detoxified from such chaos and drama in the same way the drugs in their bodies must be detoxified. They need healing sanctuaries.

Addiction to Chaos and Crisis

One of the things that most struck me about women in Project SAFE was the amount of drama and chaos that characterized their lives. At first, I saw this propensity for perpetual crisis as a function of the chaos in their environment (a function of poverty and community disorganization) or as an enduring trait of personality (a reflection of what clinicians had long described as histrionic personality or borderline personality), but those interpretations changed as I interviewed greater numbers of women over the course of their recoveries. I came to see chaos and crises, not as a trait of community or character, but as a strategy. I came to see chaos in the lives of traumatized addicted women akin to psychological cutting?a means of deflecting and diverting attention from deep and overwhelming emotional pain. The resulting crises serve to create focus and sparked a mobilization of internal resources. It serves as an external alarm bell that attracts new sources of support. Chaos is more than part of the problem, it is a strategy of resolution that works in the short run, but fails in the long run.

The function of chaos and crisis became most evident when it was temporarily brought under control. Their absence, via effective case management and a safe and nurturing environment, triggered a process of emotional thawing and release of deep pent-up emotions among Project SAFE women that was far scarier than the routine chaos and crises of their daily lives. These feelings often triggered flight back into chaos or behavior that sparked a new crisis, again shifting attention away from these emotions. The challenge in Project SAFE was not how to get women to open up emotionally, but how to get them to open up in ways that did not trigger panic, regression, and acting out. The lesson that I took from these observations was that all behavior?no matter how incomprehensibleIs purposeful. Our challenge is to ask and answer two simple questions: 1) What needs are being met by this seemingly inexplicable behavior? 2) How can new behaviors be introduced that meet these needs in less destructive ways?

Have you experienced clients whose lives reflect this "addiction to crisis" pattern? What is your own experience trying to serve these men and women?

On Lovers and Losers

In Project SAFE, this pattern of addiction to crisis was nowhere more evident than in the arena of intimate relationships. Consider the following story. While visiting a treatment program to conduct training, the director approached me with the question, "Do you remember Marla? She stopped in today to say hello to everyone and thought she recognized you as that research guy. She said she would be happy to talk to you again if you wanted to interview her." I did remember Marla as one of the first Project SAFE clients. I first interviewed her in 1987 and then interviewed her again in 1988.

I remember Marla from her responses to the following question I asked her on both occasions. "Of all the things you have been through since the first day you were admitted to treatment, what have you found most difficult?" The first time I interviewed her, Marla was five months into her recovery and she answered, "Cocaine! Not using cocaine for five months is the hardest thing I have ever done in my life."

Over a year later, I was looking forward to interviewing Marla because she was one of the most remarkable early success stories in Project SAFE, having completed her GED and enrolled in a local community college. In this second interview, Marla's response had changed. She said, "Everyone thinks I am doing so well, and in many ways I guess I am. I haven't picked up since the day I came to treatment. I have my babies back and they are doing great. I have a great sponsor." She then teared up and said, "But most days I feel like I'm losing my mind." I was witnessing a client whose sustained trauma was catching up with her. Lacking the chemical anesthesia and the diversion of daily crises, this brave woman was beginning to thaw out and experience the rawness of long-suppressed emotion. I responded as best I could to her comments but left feeling that her continued recovery, if sustained, would be something of a miracle.

So here I was more than ten years later. The miracle had occurred, and I had an opportunity to hear about it. I told the director I would be delighted to talk to Marla. She remembered our first interview but had no recollection of the second interview I found so poignant. I couldn't help asking her once again, "Of all the things you've experienced since you first came to treatment, what has been most difficult for you?" She reflected on this question and responded as follows: "Losers! This thing about losers." She proceeded to describe a litany of destructive relationships during her active addiction and early recovery years. Perhaps the only good news was that each bad choice during the recovery phase was a little less toxic than the one that preceded it.

I then asked her, "When you look back over all of this, what do you think was going on? How do you make sense out of this today?" I will never forget her response. She said, "What I understand today is: if I'm attracted to them, they're high-risk!" There it was. She wasn't attracted to these seriously disturbed men in spite of their problems and characterological excesses. She was drawn to them because of such problems. If in her earlier life she entered a room with 50 fully actualized men and one psychopath, she and the psychopath would find each other with uncanny precision.

What is remarkable in this story is that Marla somehow worked her way through this tragic pattern. Many do not. Different aspects of this pattern have been described in the research literature under such terms as scripts, codependency, non-random mating, compulsive re-enactment, victimization cycles, and assortative mating. Collectively, these terms depict a process of people selecting intimate partners whose problems mirror or complement their own. Breaking these patterns can be far harder than severing a drug relationship.

Have you witnessed such relationship patterns? Did such patterns accelerate or decelerate over time? What factors tipped the scales to help people break such patterns?