A LETTER TO H-- A Tribute In Epistolary Form To Recovery From Alcohol And Other Substances

This article appeared in 2015 on the website of the "State Journal-Register," the newspaper of Springfield, Illinois.

From: Eli Goodman, MD

Staff Physician at Gateway Foundation Alcohol And Drug Rehabilitation Facility

Springfield, Illinois

Dear H: Happy Sunday! Trust you and your family are well, and that you continue your healthy path. Not an easy one for sure; but I am confident that you can do it, given your intelligence and insights, many of which you recently acquired during your just completed ten-week in-patient stay at Springfield’s Gateway Foundation Alcohol And Drug Rehabilitation facility.

While there, you were kind enough to tell me your “story,” unique to you, but with elements common to all who have the illness of substance use disorder, including that of alcohol. You have given me permission to share your story with others, as I will also submit this missive to the Sangamon County Medical Society that, in turn, will disseminate it in various forms for all to read, including my physician and healthcare provider colleagues.

Our exchanges have expanded my horizons and made me a better physician. How so, you may ask. Well, “my story” to you includes the fact that for the most part I have never liked my career as an internal medicine physician, even though I am pretty good at it. The charades and contrivances have worn me out. Patients and physicians too often lie to each other and “dance around” the truth. Agendas clash all the time. Physicians likely cause or enable as many illnesses as we prevent or treat. We tend to order too many tests, procedures, and medicines. We have failed to translate medical science advances into practical, affordable applications for those who may need them. We tend to be incredibly inept in those situations when it is proper to tell our patients they do NOT have an illness and do NOT need something. We spend too little time listening to our patients, and we often talk to them about things that are irrelevant to them, usually in sessions that are only a few minutes in length— impossible for proper assessment and communication. You and I know that you and your physicians were for all these years largely out of touch with the reality of your situation. I, myself, may have done just as lousy a job for you had you come to me.

But the field of "addictions medicine" appears to be different. To talk and to listen are the mainstays of the field. Here at Gateway, we can talk and listen to each other-- as often and as long as is necessary, day after day, week after week. It is actually enjoyable in this setting to truly connect with people who turn to us for help. OK, enough of that! Pardon the indulgence of my personal digression and let us return to focus on your experience.

It appears that we at Gateway have, indeed, helped you to help yourself. After eighteen or so years of multiple substances uses, your prognosis for permanent recovery is good. Not guaranteed, however, as you will have to maintain an eternal vigil over your mind’s tendencies and vulnerabilities. More on that later.

Lets briefly summarize here your “story”: At age 11, you started to smoke cigarettes; and at 12, you started to smoke marijuana. Alcohol use started at 13, in the context of familial discord that eventually led to the divorce of your parents, both of whom consumed excess alcohol. By 14, alcohol abuse became a staple of your friends' parties, as you used alcohol “to numb” yourself from the psychosocial stresses of a broken home. You bragged that you “could out drink the entire football team,” even as alcohol intoxication “blackouts” became frequent and predictable.

Your abuses escalated rapidly. You began to date a fellow who sold cocaine. Snorting it gave you “energy” to drink more alcohol. Over the next four and a half years you added “acid”, other hallucinogens, “ecstasy,” and methamphetamine to your cluster of poisons. In your words: “My ‘stop muscle’ was not working.”

Miraculously, you escaped the ravages of hepatitis, HIV, bacterial infections, trauma, overt psychoses, brutal withdrawal episodes, and legal difficulties; presumably the results of a fortuitous fortress-like metabolic constitution and much luck. You managed to get through high school, despite poor attendance and suboptimal grades. You were on the dance team and in the marching band. You enrolled in college and had a remunerative waitress job. Many people all along, including physicians, overlooked and ignored your substance use disorder. Were they lazy, oblivious, incompetent, or simply uncaring? Some were obviously enablers, including your parents in the matter of alcohol abuse. But, up to this point, you had never used opiates. That was to change, however.

At age 20, you met your future husband, also a person with a substance use disorder, who had relapsed despite previous treatment in a rehabilitation program. After an ectopic first pregnancy, your second pregnancy at age twenty-two was a healthy one, during which you admirably stopped completely the use of cigarettes, alcohol, and all other substances. Unfortunately, after the delivery, you resumed alcohol excess. But, within the year, during your second pregnancy, you again became completely sober. The delivery of your second healthy daughter was a difficult one, however, that caused a serious and chronically painful injury to your lumbosacral spine. Within a few months you became addicted to prescription narcotics and soon thereafter to heroine. Your physicians continued to prescribe narcotics, oblivious to your addictions.

Subsequently you had three spinal surgeries, none of which eliminated the pain. Your alcohol, narcotics, and heroine addictions persisted. By then, your husband had again received help for himself, this time from an outpatient program that utilized buprenorphine/naloxone. Finally, he, friends, and your parents convinced you, at age 29, to seek in-patient treatment at our Gateway Facility, to which you entered this past January.

Now, after nearly three months of intensive in-patient treatment, you are ready to re-enter the real world of family, friends, work, responsibilities, and, of course, endless “temptations.” You report that you are confident that you will remain healthy and whole. You praised the mainstays of your in-patient treatment experience that were the group sessions that included fellow patients, true peers, and, of course, the skillful counselors.

You coached each other, as, day after day, session after session, you and they talked things out in a non-judgmental manner. You received empathy from these fellow travelers that you did not often get from others, including physicians. Your supporters convinced you that you are “not like a lost cause.”

Of note is that the Gateway group session are not necessarily separated by the categories of problematic substances or age; but those with concurrent psychiatric disorders such as mood disorders and/or ADHD do receive some separate group sessions.

Anger management, drug education, and individual psychiatric/psychological sessions contribute to the therapeutic program. Enrollments in Alcoholics Anonymous (AA) and Narcotic Anonymous (NA) are mandatory, and you are to continue indefinitely with these programs.

You did receive prescription medications while at Gateway, including buprenorphine/naloxone, cyclobenzaprine, quetiapine, trazodone, diclofenac, and acetaminophen. I would like to see you soon taking as few medications as possible, perhaps none, except for the occasional OTC analgesic. As a “therapeutic nihilist,” I agree with the best physicians and the medical literature that teach that “less is more,” including for the realm of pharmaceuticals. Not every symptom or difficulty requires a medication. No medication ever existed that does not have its “dark side."

Exercise has also contributed to your recovery, even with your chronic back pain. Low impact ones such as walking, ellipticals, yoga, and light-weight resistance training will continue to serve you well. Exercise will also bring you in contact with people who focus on health rather than bad habits. I think most highly of medicine’s physical therapy colleagues, and I recommend that you take advantage of their expertise.

Unfortunately, you continue to smoke cigarettes. This deleterious practice has to go also, and soon. A truly healthy person cannot smoke. It is a contradiction to logic, and we have already noted how intelligent you are.

Along with your AA and NA group sessions, you will have a personal mentor and coach who will be by-your-side continuously, “like a wolf after a pork chop.” There will also be Gateway’s legendary “Alumni Program.” Once a month, you and fellow graduates of the program will gather to exchange notes and reinforce the bonds of support so that all can stay healthy. Follow-up counseling sessions will be available to you.

You may need additional spine surgery. Presumably your future physicians will be mindful of your substance use disorder history, and prescribe analgesics properly, parsimoniously, and briefly.

Your long term prognosis to stay free of addictions is good, given your intelligence and recently gained insights, along with the incentive to be a healthy and superior parent for your daughters. But the risk of relapse will always be there. People and situations will tempt you. Even your friends and family may do so.

So, how will you deal with these inevitable temptations? Your Gateway program has taught you to first take care of yourself. You cannot be dependent on others to do this. Their problems and addictions belong to them, not to you. You have declared yourself to be a healthy person. It is a psychological principle that the mind cannot hold at once two disparate thoughts. As Earl Nightingale said, “As a man or woman thinks, so he or she becomes.” Every master of personal development teaches this concept. Your declaration of health will see you through the times of temptation, as will those who truly care about you, to whom you can always turn.

But there is in front of you an even higher order of meaningful life to which you can and should ascend, H. The time has come for you to be a teacher and a role model for others. Tell your story to every conceivable audience. It will be therapeutic for both you and them. If you tell it like it was for you then compared to what it is for you now— a journey of recovery to health and redemption-- you will reinforce for yourself what you need to do day after day. To talk about it or to write about it provides a reinforcement to do it.

And finally, here is, in my opinion, THE most important concept to help you and all who have abused themselves stay forever healthy: The gift of life comes from The Creator. Our bodies do NOT belong to us. They belong to The Creator, from Whom we “borrow" them. The Creator expects each of us, to the best of his or her capability, to be a proper "caretaker" of the gift of life that is his or her body. This is our sacred obligation. It is nonsense to think that we have "the right" to abuse our bodies. On the contrary, we have "the OBLIGATION" to protect them. "Obligations" ALWAYS trump "rights." In fact, the Bible NEVER references a "right," but it does mandate several hundred “obligations." I shall end this letter here. I am confident that you will continue your road to recovery. I look forward to hear and read about it. Be well. Be safe. Be brilliant. Until sooner,

------------

In addition to his work at Springfield’s Gateway Foundation facility, Eli Goodman, M.D. is the Medical Director for "Advanced Home Healthcare Services, LLC," in Springfield.

He is also a member of the Board Of Directors of the Sangamon County Medical Society, for which he will serve as one of its delegates to this month’s Illinois State Medical Society’s annual meeting in Chicago.

Dr. Goodman welcomes comments from the readers, who may contact him by phone: 217-242-7490; or by email: progressnote@aol.com

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