Friday, June 28, 2013


Dr. Bill Hay is a psychiatrist who specializes in the treatment of drug and alcohol addiction, traumatic brain injury, and post-traumatic stress disorder. He is an avid patron of the performing arts, as well as an accomplished writer, blogger, and published poet. He is also on the Board of Directors of the Drug Prevention Network of Canada.

Wednesday, June 26, 2013

Insite - pros and and cons

Insite is a heroin injection site institution with millions of dollars funding and large staffing.  It provides heroin to heroin addicts.  The closest comparison that could be made to Insite would be a million dollar medical facility devoted to safe smoking for smokers.  Granted airports have 'harm reduction' glassed in chambers for smokers. The issue there is that there are no nurses or doctors to promote smoking as 'safe'.  These chambers privately funded and are not called 'safe inhalation' sites. They do not divert millions of dollars from acknowledged and scientifically proven treatments for smoking addiction.  As a consequence of the existing treatment for 'smoking cessation' millions have stopped smoking and the quitting smoking campaign has been spear headed by ex smokers and doctors and nurses committed to life.

At the turn of the century Sigmund Freud, the foremost psychiatrist of his day said that addiction was untreatable.  Carl Jung the other most famous medical doctor and psychiatrist of his day said addiction required a miracle.  Even today most countries treat addiction with jail and asylums.  Yet in the 1930's Dr. Bob Smith and Bill Wilson demonstrated that alcoholism could be cured through 'abstinence' on a daily basis and involvement with other recovering alcoholics in a group process to help others stay sober.  The Big Book of Alcoholics Anonymous was published in 1939 reported the remarkable success of 50 members recovered of chronic end stage alcoholism.   AA also espoused a 'higher power' which encouraged individuals to believe in a 'power greater than themselves' because to date they had been unable 'on their own' to stop their addiction.

Follow up research reported by the American Society of Addiction Medicine in the late 1990 showed that  those successful for 5 years or greater in maintaining abstinence  belonged to a group that supporedt their 'recovery', that they have a 'higher power' they believe is more powerful than their addiction or the object of their addiction, and they believe that personally the substance is harmful for them, in much the way a person would consider an allergy.

As a consequence of this group grass roots process millions of people have remained alcohol and drug free for their lifetime.  The AA movement spawned Narcotics Anonymous, Cocaine Anonymous,  and countless other anonymous meetings that have served to help millions more with a variety of addictions other than just alcohol.

As a result of this 'success', literally thousands of programs have developed to help the previously believed 'incurable' alcoholics and addicts.  Hospital based detox has been available since the beginning of AA when Dr. Silkworth and others treated individuals for the acute withdrawal of alcohol and drugs.  In 1986 I was the acting head of the Winnipeg Detox, a medical ward semi attached to the Winnipeg General Hospital.  Given the complications of overdose and medical complications of withdrawal including seizures, myocardial infarction, CVA's and kidney failure, these have been life saving facilities all but universally acknowledged for their benefits to individual and communities.

Since the AA movement began with the demonstrated success in treating and curing addiction, various treatment centres such as Betty Ford in the United States, Homewood in Canada, Edgewood and Orchard locally, to name just a fraction of a fraction have developed to start the process of recovery. It was long recognized that detox only treated the life threatening withdrawal physical illness and the biopsychosocial condition of addiction required months and years to overcome.  Religious organizations such as Salvation Army, the Catholic Church, and other Christian, Jewish, western Buddhist organizations have provided a powerful backbone to the recovery movement.  So often churches and temples provided the after care for patients who had been discharged from detox or treatment centres and now returned to the community.  The other cornerstone of follow up care usually modeled on 12 step programs has been the sober recovery houses where patients stay for months in a supportive non using group.

MRI studies show frontal lobe reversible damage that persist following cessation of drug abuse for up to three months. Cannabis is detected in the urine for up to three months as well.  Most treatment centres like the amusing movie of the same name only lasted for 28 days, though today it's not uncommon for programs to persist for 6 weeks, more consistent with the ideal stay lengths associated with other acute psychiatric conditions.  There is clear evidence that the longer the stay in the 'sober houses' the greater likelihood of persisting abstinence and prolonged recovery.  Some of the most successful programs have people stay for 2 years though members commonly in such houses return to work and reestablish themselves with family and  community.

Following on the successful model of AA group therapy, the leader dominated facilitated SMART group process developed along with other group follow up and on going therapy process with varying success and as yet not comparable to the overwhelming long term success associated with the AA initial group process.   Dr. Gallanter studied long abstinent AA members and demonstrated the success of AA and abstinence in those with decades of sobriety and success in community and work.

The gold standard of recovery success was the Navy Pilot Program with pilots whose training cost millions of dollars, flying planes worth millions of dollars, and because addictions knows no bounds, developing alcoholism and addiction. The program required first 28 days inpatient treatment followed by 3 meetings group involvement in AA, weekly counseling and monthly psychiatric visits. Greater than 80 % of pilots were flying successfully at 5 years follow up. These and other stats following from the initial success of AA treatment demonstrate without doubt the highly treatable nature of the disease of addiction. The success with treatment of alcoholism has through NA and CA been demonstrated with other chemical dependencies.

There are even a percentage of individuals especially as noted in the recent overwhelming success in the treatment of nicotine addiction, of spontaneous cures and individuals remaining abstinent from their chemical addiction simply by changing their social environment and abstaining from what they perceive is poisonous to themselves.

Dr. Ray Baker, a leading Canadian Addiction authority presents even more telling research showing that addiction is extremely successfully treated if the disease is "caught' in early stages, when the patients still have jobs and family.  Historically addiction treatment was criticized for its limited success with 'end stage' cases.  Dr. Baker, in his highly regarded lectures, given locally and internationally,  demonstrates well that addiction therapy treatment fares even better than other medical treatments for other chronic end stage diseases, such as kidney failures, obstructive disease and chronic heart disease.
My father and his generation believed that addiction was 'untreatable'.  It was called the 'cancer of the mind'  at the time when 'cancer' was considered untreatable as well.  Today cancer simply is no longer the big "C" and when I worked as a family physician I saw innumerable 'cures' that only a decade before would have been called miraculous.  I am thankful to day to have been treated successfully for skin cancer myself knowing that only a generation ago I might well have died from this malady but thanks to my family physician and dermatologist I'm cancer free though must "abstain' from extensive sun bathing.  This hasn't been that onerous this last year in Vancouver, BC.

Our generation, especially thanks to the tabloid lives of countless famous Hollywood alcoholics and addicts and national league athletes, is recognized by all as a treatable illness with great success.  The ubiquity of AA members is simply astonishing with every walk of life commonly having someone who has successfully "kicked the habit' with the help of others, often family, physicians, groups but  most important the positive belief that has followed from the success of abstinence based programs: AA, NA,  treatment centres, Sober House and increasingly the Drug Courts and Safety Sensitive Job movements. 
The recognition that abstinence based therapies are highly successful, that abstinent individuals save millions if not billions of health care dollars and account for the incredible advances in accident free workplace days, has created a ground swell of success building on success. . With this success has come mixed benefits, many more 'players',  increasingly government funding tied to other political agendas.  As a consequence of this recognition, publicity and success there has also been a  development of a major industry in which the alcoholic or addict is no longer considered 'sick' or a 'victim' or a "patient" but rather is called a  "consumer". These new and increasingly dominant business and socially engineered models have an inherent conflict of interest since there is never any reason to 'lose' a 'consumer.

Insite is simply the kazoo in this great orchestra of science, medicine and recovery that was making extremely fine music before this latest 'sell yourself out of debt' scheme came into the works.
That said, this loud and rich, and arrogant voice, needs responding to.  The 'science' presented is highly controversial.   This is not a 'science project' but rather a very intriguing political program.  It is 'political'.  Very political. It is not surprising that it has begun in British Columbia whose principal crop industry is illegal substance. Insite has faced little scrutiny locally but has not surprisingly encountered resistance in the rest of Canada where the costs of addictions outweigh the revenue of illicit marijuana sales and heroin trafficking.  When I was at an addiction medicine conference in Washington DC,  Vancouver Canada was identified as the most concern portal for illicit heroin import into the US. 
In terms of it's political aims this is all part of the Trans-human and other social engineering agendas that would  see individuals able to buy alcohol, marijuana, cocaine or heroin at the corner store much like one buys any other commodity. As a conservative libertarian I can't fault this agenda intellectually even though it does sound more like the kind of society most attractive to the Cheech and Chong elements without other responsibilities and limited experience understanding that freedom comes with responsibility and license is a different thing altogether.     Unfortunately too the research of the great Harvard psychiatrist, Dr.  George Vaillant, who I will forever be honoured to have met, demonstrated without a shadow of doubt that the more available mind altering substances were the greater the cost to individuals and society. This is particularly concerning when in Canada we have an already overburdened medical care system with deadly wait lists and a 24 hour dead body being found in a teaching hospital waiting room in Winnipeg.   Expansion of availability of drugs and alcohol results in harm to the most vulnerable, brain injured, poor, homeless, jobless and the population that Dr. Gabor Mate so elegantly described in his book "Hungry Ghosts". 
In contrast, Drug Courts which to date are grossly underfunded despite their overwhelming evidence of cost effectiveness are just one of many scientifically proven approaches to drug treatment that are less heard about when the idea of encouraging heroin addicts to shoot heroin in their arms in the presence of nurses is just too sexy to compare with.

Now the famous Doctor William Osler treated his equally famous surgeon colleague, Dr. Halstead,  with morphine in his office near the turn of century when doctors simply approached the use of narcotics much like physicians to day do with pain treatment.   No institution is necessary and no multimillion research is needed to deal with appropriately trained and licensed  doctors who are already prescribing narcotics successfully without drama or politics to patients continuing to so so under the appropriate jurisdiction and guidelines provided by the College of Physicians and Surgeons and Federal and Provincial Ministers of Health.

To date Methadone and buprenorphone have been scientifically proven and not terribly controversial harm reduction techniques for people transitioning from addiction to needles to oral narcotics and eventually to abstinence.  The tremendous reduction in crime and spread of blood related diseases is directly a consequence of oral narcotics being substituted for intravenous drugs.  Such improvements in health of individuals and community and reduction in crimes, specifically theft have been demonstrated wherever appropriate oral narcotic substitution therapies have been instituted long before the introduction of Insite.

 I find it odd that I have personally had so much difficulty arranging for family members to give IV drugs to patients with cancer yet here is a program that supports already sick and marginalized individuals injecting themselves with highly questionable and often lethal substance bought illicitly.   Politically there may be a place for trained nurses and doctors to provide heroin IV to patients in offices though frankly I think such an approach to a treatable curable illness is disheartening and sadly abusive of patients who quite rightly would want a 'cure' if their doctors and nurses could 'believe' in them.
Harm reduction is indeed a fancy term which refers not so much to less harm for the individual , who indeed is often being written off, but rather to the community.  Unfortunately the present emphasis on "harm reduction" and the celebration and publicity of  institution injection sites may  well serve to perpetrate disease, maintain addiction and even result in withholding  funding the kinds of treatment that are proven curative.  I can't help but hear Marie Antoinette's cry, "Give them cake!" Indeed appendicitis is cured by costly surgery but it can be treated in a 'harm reduction' manner by simply giving antibiotics without surgery. No doubt there was a time when surgery was a hard sell too and people wanted simply a 'magic' solution to a life threatening disease. Thankfully our medical forefathers took an oath 'do no harm' and aimed for cure rather than watching the patient die slowly.

Palliative care is a probably  better term for Insite's  "harm reduction'.
   It is a well established  medical term in the treatment of end stage cancer patients. Insite might well be considered a 'palliative care' unit for those for whom no hope of cure is expected and all that can be done is to ease the suffering of those individuals who otherwise die would die.  As it stands Insite appears to give the impression that it is doing something special and unique and helpful for addicts.

The World Health Organization has only acknowledged the benefit of "harm reduction strategies" so long as they are directly linked and lead to abstinence based recovery.
 To date despite the claims otherwise I have not been convinced that Insite is such,  In contrast the Salvation Army and Union Gospel treatment centre and the Vancouver Daytox programs and such places as Last Door, Turning Point, Pacifica and so many other sites are clearly using harm reduction as a minor stepping stone to the greater world of recovery and abstinence.

Many doctors, judges, pilots have become successfully abstinent with the help of AA and returned to be leaders in their field.  To date the normal approach to doctors, judges, politicians, pilots, and  multi millionaires is to send them to  treatment such as Betty Ford and then encourage them to continue in an aftercare program either associated directly with the facility or to attend AA/NA or such 12 step self help programs. I would be more optimistic about INSITE if I heard that the Physician Health Program or the Lawyer Assistance Program is recommending their members to participate in heroin injection facilities.  Anesthetists who have developed opiate addictions have to date used methadone, buprenorphine and detox, then abstinence based treatment programs such as AA/NA and the recent SMART group follow up.  This has caused some to be reasonably concerned that INSITE is like offering candy to diabetics rather than insulin.

Now personally I really would like to "live and let live" and can only admire colleagues who find ways to become rich in their practices so long as their patients benefit alongside their wealth creation schemes.  However I have noted a strident loudness, much like the voices of drunks and drug addicts promoting the single handed success of free heroin injection sites in conquering all the dragons and monsters of addiction single handedly.  There are even those who believe that Insite is a truly important player in the recovery success in the Downtown Eastside community.  They overlook the amazing work of Harbour Light, Union Gospel, Doc Side Medical, Pender Clinic, Dug Out AA, the downtown east side drug court and countless other individuals and groups that have for decades been working together for the increasing success in the community which comes as a culmination of scientifically based abstinence programs and harm reduction programs leading to abstinence.  This Insite kazoo is richly amplified but it's really not new, a variation on palliative care and highly controversial medically and psychiatrically.  I am not surprised that the world over all has not jumped on the band playing political wagon.  I like kazoo music I thought it might be important for others to remember that the poorly paid, often unpaid, huge and ever larger and more successful orchestra of recovery has been playing an increasingly happy tune thanks to years of work of countless individuals and the scientific approach to successful therapy of addiction.  The 4 pillar strategy was right on the need for prevention and therapy but seems to have done little for prevention and put an unholy emphasis on one questionable 'get rich quick' basket.

As a tax paying psychiatrist and addiction medicine specialist I'm not so sure this Kazoo is even in tune with the music of this new generation.  Last I saw they were into yoga, cycling, extreme sports and healthy food. Even Timothy Leary, the great GURU of the LSD generation said that 'if we'd had the computer and internet' we'd probably never have done drugs.  I don't think we should be doing anything given the winds of change to encourage anyone to put needles in the arms when all of life awaits them.  The success of the 'safety sensitive employment' programs, drug courts, public health measures for addicts, with truly drug free housing, detox, treatment centres, continues to show success which has been building since the breakthrough programs of AA began in the late 30's .

But please correct me if I'm wrong. 

Friday, June 21, 2013


June 20, 2013

Councillor hopes recovery house will be a precedent


Service provider leasing site from municipality to build and operate nine-bed facility

After stickhandling a proposed recovery house through a lengthy approval process in the District of North Vancouver, Councillor Doug MacKay-Dunn hopes the facility will become a template for other jurisdictions.

"This is a model that can be replicated across the province," Mr. MacKay-Dunn said on Thursday. "It costs the city or municipality essentially nothing. And it provides a level of service that has not been provided in the past and it is being managed by an NGO [non-governmental organization], not by a tax-funded agency."

Under the proposal, the District of North Vancouver will lease a site to Vancouver-based Turning Point Society, which will build and operate a nine-bed women's recovery centre on the property.

The province is also involved, through providing a loan that will allow Turning Point to build the centre.
The site is on the north end of Lloyd Avenue on the edge of Murdo Frazer Park. Some area residents objected to the facility because it would require rezoning what had been park land for development.
Proponents, however, said the site had been previously developed – a home that once stood there was demolished in 2010 – and was already connected to city services.

The rezoning process began in 2011 and included an "alternative approval process" for a bylaw to remove the land from park status. Under that process, opponents would have had to gather signatures of at least 10 per cent of eligible voters, or several thousand people, to block the bylaw. By the January deadline, only 176 voters had sent in opposing responses, clearing the way for council to proceed with the bylaw. The rezoning received final approval at a council meeting on June 10.

Mr. MacKay-Dunn, a former police officer who has championed the facility, says he was encouraged by support from residents who agreed that such a service was required in the neighbourhood.

Some residents said they were not opposed to the idea of a treatment centre, but to the precedent of removing land from a park. Mr. MacKay-Dunn, however, calls the site a "brownfield" property that was not going to be developed for any other purpose, and suggests other municipalities have sites that might be suitable for recovery facilities.

Turning Point currently operates one facility in Vancouver and two in Richmond.

The group is also part of a consortium developing a planned, 130-bed affordable housing project in Richmond. That project, announced last year, involves Turning Point and five other non-profit agencies along with the provincial and city governments. Richmond has agreed to lease a city-owned site at a nominal rate to the non-profit groups, which will operate the facility. The province is expected to help pay for construction, but final details – including how much the province will contribute – are still being negotiated.

Richmond, which backed the project as part of its affordable housing strategy, has said the facility should be complete by the spring of 2015.

Wednesday, June 12, 2013

Keep heroin out of our backyards

Do you want a supervised drug consumption site in your community? These are facilities where drug addicts get to shoot up heroin and other illicit drugs.

I don't want one anywhere near my home.

Yet, as I write this, special interests are trying to open up these supervised drug consumption sites in cities and towns across Canada  over the objections of local residents and law enforcement.

We've had enough — that's why I am pleased the Harper government is acting to put the safety of our communities first.

Today, the Harper government introduced tough new rules that will give local law enforcement, municipal leaders, and local residents a voice before a permit is granted for a supervised drug consumption site.

The Trudeau Liberals and Mulcair NDP are against us. They want to repeat the experiment of Vancouver's Insite facility across the country  maybe even in your community.

Because of the tough rules the Harper government introduced today, your voice will now matter.

Add your name if you demand a say before a supervised drug consumption site is opened close to your family:


Jenni Byrne
National Campaign Manager, 2011

P.S. Forward to your friends and family, and encourage them to add their name if they would want to be consulted before drug consumption sites are allowed to operate in their neighbourhood.

The Downside of High

Saturday June 8 at 1 pm on CBC-TV

Related Video


The Downside of High

Watch this film online.
45:05 min

  oiled bird

Downside of High

Watch a trailer.
:30 min

Teenagers who start smoking marijuana before the age of sixteen are four times more likely to become schizophrenic. That's the startling conclusion of some of the world's top schizophrenia experts, whose research is featured in the new documentary The Downside of High.
The scientists' groundbreaking work on the connection between marijuana and mental illness also reveals that, for all young adults, smoking marijuana nearly doubles the risk of developing recurring psychosis, paranoia and hallucinations - the hallmarks of schizophrenia.
Ben Nixon
Ben was first introduced to marijuana while at a high school in BC. His increasingly psychotic behaviour led to a year-long hospitalization.
The Downside of High, directed and written by Bruce Mohun, tells the stories of three young people from British Columbia who believe - along with their doctors - that their mental illness was triggered by marijuana use. All three spent months in hospital psychiatric wards, and still wage a battle with their illness. Today's super-potent pot may be a big part of the problem. Modern growing techniques have dramatically increased the amount of THC, the psychoactive ingredient in marijuana - ramping up the threat to the developing teenage brain.
But there's an intriguing twist to the story: in the process of cultivating more potent strains of pot, growers have also been breeding out a little-known ingredient called cannabidiol that seems to buffer the effects of THC. So today's high-octane pot actually contains a double-whammy - more psychosis-producing THC, and less of the protective CBD or cannabidiol.
Tyler Rideout
Tyler was 14 years old when he first started experiencing psychotic episodes.
For many people, smoking marijuana is not a big deal - it is, after all, the most widely-used illegal drug in the world. The Downside of High provides a scientific perspective on some of the little-known and little discussed risks of marijuana, particularly for teenagers.
The Downside of High is directed and written by Bruce Mohun, story-produced by Maureen Palmer, and produced by Sue Ridout for Dreamfilm Productions of Vancouver.

The Spectator

Russell Brand on heroin, abstinence and addiction

The last time I thought about taking heroin was yesterday. I had received ‘an inconvenient truth’ from a beautiful woman. It wasn’t about climate change (I’m not that ecologically switched on). She told me she was pregnant and it wasn’t mine.
I had to take immediate action. I put Morrissey on in my car and as I wound my way through the neurotic Hollywood hills my misery burgeoned. Soon I could no longer see where I ended and the pain began. So now I had a choice.
I cannot accurately convey the efficiency of heroin in neutralising pain. It transforms a tight white fist into a gentle brown wave, and from my first inhalation 15 years ago it fumigated my private hell. A bathroom floor in Hackney embraced me like a womb, and now whenever I am dislodged from comfort my focus falls there.
It is ten years since I used drugs or drank alcohol and my life has immeasurably improved. I have a job, a house, a cat, good friendships and generally a bright outlook.
But the price of this is constant vigilance, because the disease of addiction is not rational. Recently, for the purposes of a documentary on this subject, I reviewed some footage of myself smoking heroin. I sit wasted and slumped with an unacceptable haircut against a wall in another Hackney flat (Hackney is starting to seem like part of the problem), inhaling fizzy black snakes of smack off a scrap of crumpled foil. When I saw the tape a month or so ago, what was surprising was that my reaction was not one of gratitude for the positive changes I’ve experienced. Instead I felt envious of this earlier version of myself, unencumbered by the burden of abstinence. I sat in a suite at the Savoy hotel, in privilege, resenting the woeful ratbag I once was who, for all his problems, had drugs.
That is obviously irrational, but the mentality and behaviour of drug addicts and alcoholics is wholly irrational until you understand that they are completely powerless over their addiction and, unless they have structured help, they have no hope.
This is the reason I have started a fund within Comic Relief, ‘Give It Up’. I want to raise awareness of, and money for, abstinence-based recovery. It was Kevin Cahill’s idea — he is the bloke who runs Comic Relief. He called me after reading an article I wrote after Amy Winehouse died. Her death had a powerful impact on me, I suppose because it was such an obvious shock, like watching someone for hours through a telescope advance towards you, fist extended with the intention of punching you in the face. Even though I saw it coming, it still hurt when it eventually hit me.
What was so painful about Amy’s death is that I know that there is something I could have done. I could have passed on to her the solution that was freely given to me. Don’t pick up a drink or drug, one day at a time. It sounds so simple, it actually is simple, but it isn’t easy — it requires incredible support and fastidious structuring. Not to mention that the whole infrastructure of abstinence-based recovery is shrouded in necessary secrecy. There are support fellowships that are easy to find and open to anyone who needs them, but they eschew promotion of any kind in order to preserve the purity of their purpose, which is for people with alcoholism and addiction to help one another stay clean and sober.
Without these fellowships I would take drugs. Because even now the condition persists. Drugs and alcohol are not my problem — reality is my problem. Drugs and alcohol are my solution.
If this seems odd to you, it is because you are not an alcoholic or a drug addict. You are likely one of the 90 per cent of people who can drink and use drugs safely. I have friends who can smoke weed, swill gin, even do crack, and then merrily get on with their lives. For me this is not an option. I will relinquish all else to ride that buzz to oblivion. Even if it began as a timid glass of chardonnay on a ponce’s yacht, it would end with me necking the bottle, swimming to shore and sprinting to Bethnal Green in search of a crack house.
‘We’re invited to dinner at the Biebers’ — seven for nine-thirty.’
‘We’re invited to dinner at the Biebers’ — seven for nine-thirty.’
I looked to drugs and booze to fill up a hole in me. Unchecked, the call of the wild is too strong. I still survey streets for signs of the subterranean escapes that used to provide my sanctuary. I still eye the shuffling subclass of junkies and dealers, invisibly gliding between doorways through the gutters. I see the abundantly wealthy with destitution in their stare. I have a friend so beautiful, so haunted by talent that you can barely look away from her, whose smile is such a treasure that I have often squandered my sanity for a moment in its glow. Her story is so galling that no one would condemn her for her dependency on illegal anaesthesia, but now, even though her life is trying to turn around despite her, even though she has genuine opportunities for a new start, the gutter will not release its prey. The gutter is within.
It is frustrating to love someone with this disease. A friend of mine’s brother cannot stop drinking. He gets a few months of sobriety and his family bask, relieved, in the joy of their returned loved one. His life gathers momentum, but then he somehow forgets the price of this freedom, returns to his old way of thinking, picks up a drink and Mr Hyde is back in the saddle. Once more his face is gaunt and hopeless. His family blame themselves and wonder what they could have done differently, racking their minds for a perfect sentiment wrapped up in the perfect sentence, a magic bullet. The fact is, though, that the sufferer must be a willing participant in their own recovery. They must not pick up a drink or drug. Just don’t pick it up — that’s all.
It is difficult to feel sympathy for these people. Can there be any other disease that renders its victims so unappealing? Would Great Ormond Street be so attractive a cause if its beds were riddled with obnoxious little criminals who had ‘brought it on themselves’?
Peter Hitchens is a vocal adversary of mine on this matter. He sees this condition as a matter of choice and the culprits as criminals who should go to prison. I know how he feels. I bet I have to deal with a lot more drug addicts than he does, let’s face it, I share my brain with one, and I can tell you first-hand they are total nightmares. Where I differ from Peter is in my belief that, if we regard alcoholics and drug addicts not as bad people but as sick people, then we can help them to get better. By we, I mean other people who have the same problem but have found a way to live drug- and alcohol-free lives. Guided by principles and traditions, a programme has been founded that has worked miracles in millions of lives. Not just the alcoholics and addicts themselves, but their families, their friends and of course society as a whole.
What we want to do with Give It Up is popularise a compassionate perception of drunks and addicts and provide funding for places at treatment centres where they can get clean using these principles. Then, once they are free of drugs and alcohol, to make sure they retain contact with the support that is available to keep them clean.
I wound down the hill in an alien land; Morrissey chanted lonely mantras. The pain accumulated and I began to tell myself the old, old story. I thought of places I could score. Off Santa Monica, there’s a homeless man who I know uses gear. I could find him, buy him a bag if he takes me to score.
In my mind, I leave him on the corner, a couple of rocks, a couple of $20 bags pressed into my sweaty palm. I get home, pull out the foil, neatly torn. I break the bottom off a Martell miniature. I make a pipe for the rocks with the bottle, lay a strip of foil on the counter to chase the brown, pause to reflect and regret that I don’t know how to fix, only smoke, feeling inferior even in the manner of my using. I see the foil scorch. I hear the crackle from which crack gets its name. I feel the plastic fog hit the back of my yawning throat. Eyes up. Back relaxes. The bottle drops and the greedy bliss eats my pain. There is no girl, there is no tomorrow.
Even as I spin this web I am reaching for my phone. I call someone, not a doctor or a sage, not a mystic or a physician, just a bloke like me — another alcoholic, who I know knows how I feel. The phone rings and I half hope he’ll just let it ring out. It’s 4a.m. in London. He’s asleep, he can’t hear the phone, he won’t pick up. I indicate left, heading to Santa Monica. The ringing stops, then the dry-mouthed nocturnal mumble:
‘Hello. You all right, mate?’
He picked up. And for another day, thank God, I don’t have to.

Life begins at the end of your comfort zone: recovery from addictive behaviours

Life begins at the end of your comfort zone—so true.
I love this saying, and wish I could take credit for thinking it up. In my humble opinion, whoever came up with it is a genius—and when I saw it on a fridge magnet many years ago, I bought several of them to give as gifts to people I recognized as being entrenched in their comfort zones. (Sometimes it really does take one to know one.) Having given most of them away, I am now down to just the one that lives in its special place on the side of my fridge, where I can see it every day.
For those of you who follow my Loving an Addict, Loving Yourself page on Facebook (see link at the end), you recently saw a post with a photo of an awesome purple cake adorned with that exact saying: “Life begins at the end of your comfort zone.” A client of mine, upon seeing my fridge magnet, took this sentiment to heart in a big way—and when it was finally time to celebrate a truly terrific and hard-won milestone in her life, she decided to reward herself with that very cake. After some hard inner work, she was able to embrace a vitally important understanding: in order to become emotionally free, she needed to make the conscious choice to move past what was comfortable for her and actually start living.
I’m so happy for her—and for all of us who eventually arrive at this place within ourselves.
What is a ‘Comfort Zone’?
Although this expression has become a catch phrase in self-help psychology, the term can be misleading. A comfort zone is really anything but comfortable. Neither is it an emotionally healthy place to be, and a lot of people unwittingly become stuck in them for long periods of time.
A comfort zone most often stems from family-of-origin dynamics. Over many years, we grow to know those well and easily fall into them. Sometimes a comfort zone can be the result of a negative feeling we’ve developed about ourselves, and we can hold onto that defective—and untrue—self-image well into our adulthood.
For example, one of my favorite comfort zones when I was growing up was to be a ‘good girl’ at all costs and to never make any waves, because I understood at a very early age that there would be difficult consequences awaiting me when I tried to speak my truth or act in a way that my parents didn’t appreciate. That particular comfort zone tenaciously had its roots in my faulty core beliefs about myself. Built up over a lot of years, those beliefs informed me that my opinions didn’t matter and that I somehow didn’t deserve to be treated as a valuable member of my own family. And, in the short run, it became more ‘comfortable’ for me to believe that and act as if it were true, than it would have been to challenge those beliefs and face the potentially uncomfortable consequences. With my wiser adult self-awareness, I see now that this was the perfect environment for many of my long-lingering comfort zones to develop and hold me hostage—until I learned about the pain that accompanies us when we make the choice to stay trapped in unhealthy behaviors.
The Two Kinds of Pain
What really happens in a comfort zone?
Comfort zones provide us with what is referred to in 12-Step literature as the ‘easier, softer way out’—until it no longer feels like that for us anymore, which is when change can happen. When we get stuck in a comfort zone, it’s like getting used to clothes that are just too small for us—until that magnificent moment when we realize we’ve outgrown them. But until that time, we continue to practice our learned behaviors in order to protect ourselves from the perceived potential pain of evolving and growing.
What many people don’t understand is that there are two distinctly different types of pain: there is the pain that goes on and on, and the pain that has a light at the end of the tunnel. When we choose to remain in a comfort zone, we are ultimately choosing the former because if we keep doing the same things, we keep getting the same results. As the profoundly wise saying goes, if nothing changes, nothing changes. Although that choice can appear easier, it will only feel like that in the short run. In the long run, the pain continues.
All addictions are comfort zones. If you are struggling with any form of addictive behavior, you’re using it in an attempt to shield yourself from the harsher realities of your life. As understandable as this coping strategy may be, addiction is ultimately a twisted form of self-care—with ‘twisted’ being the key word. There is nothing self-caring about hurting yourself over and over again just to be able to keep your eyes closed and stay in denial. That will only serve to create the kind of pain that never ends.
Coming out of Your Comfort Zone—Yes, You Can!
I don’t always agree with everything good ol’ Dr. Phil says, but every once in a while he comes up with something great. An example of this is the question he inevitably asks almost every one of his TV guests:
How’s that been workin’ for ya?
Interestingly, virtually every time I ask this question with my clients, I get the same response: “Not so well.” And when that is the case—when we finally recognize how stuck we are—the next question that needs to be asked is:
Are you ready to try something different?
When we decide to raise the bar for ourselves and choose a healthier behavior, most of us will immediately experience will be an overwhelming feeling of fear. This is a reasonable response because we are basically giving up an option that has felt like a security blanket or a best friend. We need to be gentle with ourselves when we make this courageous choice—we need to allow ourselves to vent, grieve, cry our tears, and then get on with facing reality outside of our comfort zone.
And let’s remember to pat ourselves on the back for being so brave!
It might help you to know that the second experience you’ll have is a marked increase in your self-respect—and in my opinion, nothing is more valuable than that. Once you’ve made the choice to actually feel your fear and embark on the journey of recovery from your comfort zone anyway, you will automatically feel better about yourself, even if you’re still a little scared. You will undoubtedly recognize that you’re now on the right track, even when this decision leads you into growth periods that make your hair stand on end. We all have times like that, whether we stay in addiction or choose recovery from our unhealthy coping behaviors. During these times, we need to remind ourselves of the two distinct types of pain and re-commit to being on the higher path, the one that will ultimately lead us to freedom from our addictions.
The truth is that you alone are responsible for making the decision to leave your comfort zone—but the good news is that you don’t have to do the inner work this requires by yourself. Please don’t hesitate to reach out for the help you need. There is no shame or stigma in needing help from others—the real tragedy occurs when we try to protect our pride and our egos by not asking for assistance. I have needed help many times over the years, and I still reach out for it today when I need to. I so appreciate the many people who have been there to help me, and I am profoundly grateful to be able to pay it forward with others who come to me for this.
Will you choose to opt for the pain that will actually end?
Are you ready to live the amazing life of freedom that awaits you at the end of your comfort zone?