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[INTRODUCTION]

There is no shortage of autobiographical stories that describe the horrors of addiction. Many of these also depict people’s journeys into recovery. Some of these narrative self-portraits have been painted by those who rose from the ashes of their active addiction to find recovery and go on to become addiction counselors. The usual sequence of events is active addiction to recovery to counselor/therapist/helping professional. This story is a little different. Like no small number of things in my life, I got it ass-backward insofar as I was a behavioral health professional, working in high-level management capacities for many years, plenty of which were in addiction treatment settings—before I entered recovery.

As I moved up the promotional ladder, I transitioned from full-time direct practice as a therapist to providing clinical supervision and teaching treatment approaches and techniques to dozens of counselors, therapists, interns, and other staff. I was responsible for overseeing the clinical operations of (in succession) a residential addiction treatment center for adolescents, a hospital-based inpatient addiction treatment program for adults, and multi-program outpatient treatment services for adults, children, and families—all while I was in active addiction. In these settings, I was highly regarded as a practitioner and administrator.

Of all the twists and turns my life has taken, I never expected to be confronted by the challenges and complexities that lie at the nexus of addiction and chronic pain. As an experienced clinician with a master’s degree in social work and advanced training and credentialing in clinical hypnosis, I knew a thing or two about the connection between thoughts, emotions, and physical pain.

I had treated others’ suffering from chronic pain with unanticipated success using hypnosis. However, with the onset of my own chronic pain condition and its intersection with the addiction that had long predated it, all my professional knowledge and experience faded away. For all rational and practical purposes, it was nonexistent to me.

I allowed myself to become utterly dependent upon the prevailing conventional Western medical approach to pain management with its merry-go-round of opioid painkillers, lumbar epidural steroid injections, occasional episodes of physical therapy, and the ever-looming option of spinal fusion. I effectively assumed the position of victim. And in doing so, I submissively succumbed to the admonitions of my doctors (all extremely experienced, skilled, and well-intentioned) and relinquished sports and other physical activities that potentially put me at risk for further injury. As a lifelong athlete, this was an especially devastating loss. As I became more sedentary, my physical functioning only deteriorated further, and the vicious circle of chronic pain and addiction to the narcotic medications prescribed for it progressively hijacked my priorities, and my world became smaller and smaller.

In fact, my need for the opioid painkillers reawakened an addiction to narcotics that had been in hibernation for over fifteen years. I convinced myself that I had somehow outgrown the use of such “hard” drugs while I settled into a long-term pattern of marijuana and alcohol maintenance. My chronic pain gave me medical sanction to dive into my real dope of choice, as the serpent of my addiction awoke full force and began to devour me.

Physical pain became my main river of feeling. All other emotions—sadness, fear, anxiety, hurt, guilt, frustration, anger, depression, etc.—were tributaries that ran into it, fed it, and increased its flow and power. These uncomfortable, often painful emotions became harder to distinguish from one another, and my inability to tolerate them created a truckload of internal stress that only made my pain worse—inviting, no, demanding, that I use more and more opioids.

The disease of addiction is known for being “cunning, baffling, and powerful.” It is also exquisitely patient, as well as treacherous and seductive in the ways it attempts to convince those who suffer from it that they don’t have it. Ironically, as long as my addiction was active, my education and professional experience obstructed my ability to see it for what it was, to admit to it, and in turn, to take responsibility for it and seek help.

My internal self-talk kept feeding me various reassuring lines of bullshit about how different I was from other addicts, especially those who I had worked with in my professional capacities. I was definitely not like “them.” After all, I was on the other side of the desk. And with the injection of chronic pain into the landscape of my addiction, I easily relied on the rationalization that my using was medically necessary. My head was relentless in arguing that I was not an addict, in spite of knowing that addiction is an equal opportunity illness that can afflict anyone, regardless of race, community, socioeconomic status, or occupation.

It wasn’t until I got to a dark and desperate enough place, where I could no longer avoid a reality that had long been evident, went into treatment myself, and began to work a program of recovery that my professional background began to shift from impediment to asset. Once I started to actually do something about my addiction and make some significant changes in the way I was living, I realized that my recovery could benefit from my knowledge and skills.

My professional experience had the potential to be a strength in that it gave me a well-developed frame of reference for the therapeutic process of change. By therapeutic, I mean in the most general reparative, restorative sense. I had a solid understanding of the processes of learning, growing, and healing—which happen to be intimately related to recovery from both addiction and chronic pain. Admittedly, this frame of reference and understanding was primarily intellectual, but nonetheless it was a valuable resource to build upon.

My behavioral health background also had great potential to be an ongoing obstacle. In spite of the wreckage my active addiction left in its wake, my thinking could have cajoled me into continuing to believe that I was still somehow unique and so much less messed up than my peers in treatment. My head might have convinced me that I could use my professional bona fides to fall back on what I already knew, or to believe that I knew it all, or at least to believe that I knew “enough.” My internal voice could have talked me into acting as if I didn’t have to put in the inherently difficult and extremely challenging daily work of recovery—that it really wasn’t necessary for me to practice the open-mindedness, willingness, and humility (among many, many other ingredients) required to look at and do things differently.

Wrapping my mind around the need to give up my primary coping mechanism of over thirty years, in addition to finding alternative ways to live with a chronic pain condition, has been a profoundly uncomfortable and often arduous process. However, this is a beautiful, warm, sunny day on a tropical beach compared to the hellacious challenge of truly accepting it at the much deeper level of my heart. Only by embracing the process of recovery (or any process of meaningful change for that matter) with my heart can I apply its principles in the moment-to-moment unfolding of my life.

Because addiction and chronic pain have physical, mental, emotional, and spiritual elements, recovery from both requires mental, emotional, physical, and spiritual components. Successful, sustained recovery requires balance between these four life domains, as well as within each of them.

Recovery has gifted me with opportunities to see beyond the limitations of the lenses of my past experiences:

• to recognize how aspects of bio-psycho-social development and specific theories of psychology connect with the twelve-step approach and can enrich my understanding of the recovery process; and

• to appreciate how certain counseling models and approaches can dovetail with twelve-step philosophy and programs, along with particular spiritual perspectives and mindfulness practices, to create the synergy of a whole that is greater, more powerful, and more therapeutic than the sum of its parts.

Putting these pieces together to change how I relate to myself, to others, and to the world is an extraordinary undertaking, requiring no small amount of mental, emotional, and spiritual renovation. Keeping my heart fully engaged as I learn how to be okay with myself, as well as with life on its own terms, in this moment, in order to continue my growth and healing, one day at a time, is a Herculean task. And, there is no adventure more worthwhile.

This book is part memoir, part self-help guide, and part clinical-psychoeducational exposition on addiction and chronic pain. As you will notice, the material alternates between these three elements, shifting gears as it moves from the personal to the professional and back again. It provides a framework for recovery from these life-altering co-occurring disorders that has served me well, and which I hope will be of value to others.

I have had the benefit of living in different areas of the United States. I’ve made cross-country trips of 2,000–3,000 miles many times. I’ve driven the 3,000 miles from Long Island to San Francisco (driving our van off the side of Interstate 80 and nearly down an embankment in western Pennsylvania in a pot-induced daze in 1980), and flown from Phoenix to Tel Aviv (fortified by two liters of wine and a pocket full of pills). Yet, the longest distance I have ever traveled is that from my head to my heart.