Welcome to the inaugural blog post for Some Assembly Required! Achieving recovery―or any meaningful path of bio-psycho-social-spiritual healing―is not unlike the process of constructing furniture purchased in “knock-down” or ready-to-assemble form. For instance, when we need a new desk and purchase one from IKEA, it comes in a large box that contains many different parts. Some of these parts are familiar while others may be completely alien to us.
The challenge of putting these pieces together to create the desk we want and that will meet our needs can seem overwhelming. It is not uncommon for parts to not fit properly or be missing altogether, and the instructions can be so difficult to interpret that they might as well be in a foreign language. Assembling the desk successfully often involves negotiating negative thoughts and beliefs that feed a morass of distressing emotions such as anxiety, self-doubt/inadequacy, frustration, and anger. Progress takes place in small, often halting increments. Yet, one piece at a time, the desk gradually comes together to assume its intended form and function.
Of course, recovery from addiction and chronic pain is infinitely more abstract and complex, but the fundamental architecture and processes are more similar than we might think. By themselves, addiction and chronic pain can be debilitating. Each of these conditions evidences an intricate interplay between cognition and emotion. This interplay is characterized by parallel patterns of stress-amplifying thinking―catastrophizing, personalizing, overgeneralizing, black and white thinking, and “musturbation,” (as in things must be a certain way for us to feel okay) and feeling―anxiety, fear, sadness, depression, frustration, anger, guilt, and shame.
When combined, addiction and chronic pain comprise extremely complicated co-occurring disorders that effectively activate each other continuously. Addiction frequently originates as a way to escape from, numb, and ultimately avoid emotional and physical pain via mood-altering substances that are reinforced and habituated through repetition. With chronic pain, physical pain becomes the primary river of feeling. Uncomfortable emotions are tributaries that run into it and increase its flow and power, imploring the chronic pain sufferer to use increasing amounts of substances, particularly opioid pain medications.
Emotional and physical pain feed one another, frequently becoming so intertwined that they are indistinguishable. People use more drugs in the attempt to medicate their physical and emotional pain. A vicious circle ensues as the escalating effort to keep emotional and physical pain at bay only ends up creating more of it.
Avoidance doesn’t work because pain is an inevitable part of life. It is an essential aspect of being human. Everyone experiences uncomfortable, painful thoughts, emotions, and physical sensations. It is in how we choose to respond to the emotional and physical pain we experience that determines whether we are able to get through it, or unwittingly extend and increase it. Recovery from addiction and chronic pain requires moving from avoidance of one’s pain (both physical and emotional) to mindful awareness and acceptance of it. It is about the way we think, how we express and cope with emotion, how our body is functioning, and our spirituality.
Assembling the pieces of this process entails identifying and accessing the necessary parts, seeing how they fit together, and often reconfiguring them—replacing some parts with others and arranging them to create the most functional and healthy fit. The fit is individualized: what fits beautifully for me may not fit for you, and vice-versa. Sometimes we put the pieces together and they work well for a time. After being in place for a while they may not work as well for us, and we need to seek out new parts or a different configuration that fits and works better for us in the present.
Life takes its toll on all of us, and everyone, whether or not they struggle with addiction,
chronic pain, or any other serious condition, sustains a certain degree of damage along the way. Recovery provides a pathway to heal from that damage and become stronger, just as broken bones can become stronger after they heal than they were before.
Whenever we pay conscious attention with intention in the here and now, observing our internal and external experience—without trying to push away what feels bad or cling to what feels good—our relationship to pain changes. When our relationship to pain changes, the pain itself also changes. It is possible to develop the awareness and skills to diminish our subjective level of emotional and physical pain and live with the pain we do experience as gracefully as possible.
Copyright 2013 Dan Mager, MSW
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