Part way through a busy day of family practice, on a cold grey November afternoon in 1984, I quietly let myself out the back door of my clinic and walked away. I was convinced my life was over. I knew I drank too much and was ashamed of secretly injecting more and more opioids. Suicide had become my friend: if it got any worse, I could end it. I believed I was using substances to escape my desperation. I really had no idea I was suffering from something called addiction.
I’m now nearly 70, over 31 years since my last use of alcohol or other drugs, married for almost 47 years and training for the world finals in the ITU long-course triathlon this summer. After a satisfying career in Addiction Medicine I finally retired from clinical practice. I feel blessed with a wonderful relationship with my wife, my adult offspring and my brand new twin grandchildren. My life is happy and full. How was that even possible?
I learned little about addiction or recovery in medical school. During my training for addiction medicine I learned that people with addiction come from all walks of life and cultural backgrounds and we have the same brain changes and, although somewhat variable, our addictive disease followed similar, somewhat predictable courses. There are many potentially effective treatment choices and recovery resources to enter and sustain recovery. As a Caucasian male raised in a middle class home in a family where my needs were met, suffering no serious emotional trauma, receiving a good education and having good mental and physical health - other than the disease of addiction, I would be described as having relatively high levels of ‘recovery capital’. Like others with adequate recovery capital, the intensity and duration of treatment I needed to enter and remain in recovery was less than for those with low recovery capital. People who grew up in poverty or shame, survivors of emotional trauma, those with serious medical or psychiatric problems and people with few learned skills for coping with life’s difficulties require longer and more intensive continuing care in order to raise their recovery capital to resist the inevitable cues and risky situations that result in relapse. But they can and do recover. Sometimes we must make drastic changes in our environments, our friends, our patterns of behaviour and even our jobs in order to raise our recovery capital and lower our relapse risks.
Although I may sound unique, being a doctor and all, really I’m not. There are close to three million Canadians, previously suffering from substance use disorders who are now in recovery. Although we follow different pathways, many or even most of the changes we made in our lives were similar. Some start out our recovery journeys taking medication for a while prescribed by a physician with expertise in addiction medicine. Most find that we and our loved ones need to make some important changes in our lives. Years ago with the help of my recovering patients we came up with the acronym CARESS, to describe some of the essentials of our programs for recovery.
The C is for coping skills. Find out those things you aren’t good at, such as time management, organizing clutter, recognizing and dealing with emotions, setting healthy boundaries, or resolving conflict - get some training on them, then practice those new skills.
A is for accountability. Choose a few people you trust, inform them of your goals and plans and keep them informed of your progress.
R is for responsibility. It’s up to you to make the changes only you can make (and maybe stop blaming others).
E is for education. Just like with diabetes or heart disease there is much to learn about addiction and effective strategies for long-term recovery. Recovering people must become expert about risk factors for relapse, such as dangerous medications, risky people and situations.
S is for social support and spiritual growth. Addiction is a disease of isolation. We must stay connected to our (safe) friends and family, to a group of like-minded recovering people and for me at least, I need to hook up with people engaged in similar athletic training to make my health behaviours easier to sustain. The spirituality piece might not be so much about religion or God, but about our connection with the universe, our purpose, the value and meaning of life and our attentiveness to the here and now through mindfulness and meditation.
Life is good. I am able to give back, to mentor others and to volunteer for worthy causes. It may sound strange but I can honestly say that I feel fortunate to have become addicted. Otherwise I would never have stumbled upon the amazing miracles unleashed by my recovery.
After 12 years serving as family physician in a rural BC community Dr. Baker trained and certified in addiction medicine in 1986. He operated a recovery oriented primary care addiction medicine practice for several years in New Westminster before focusing on occupational addiction medicine. At UBC Medical School he developed and directed the Addiction Medicine curriculum from 1990-95 winning the UBC Killam Teaching Prize and a national teaching award from the Association of Canadian Medical Colleges. He operated a recovery oriented methadone maintenance program and served on the College of Physicians and Surgeons provincial oversight committee for methadone maintenance, winning the prestigious AATOD Nyswander/Dole award. He wrote a chapter on Alcoholism for Conn’s Current Therapy. On behalf of the Railway Association of Canada he developed the medical rules for safety critical Canadian railway workers with substance use disorders. He serves on the Editorial Board of the Journal of Addictive Diseases. Recently Dr. Baker served on a national expert committee for the Canadian Centre of Substance Abuse designing and analyzing Canada’s national Life in Recovery Survey.
Dr. Ray Baker is currently researching and writing a book, Recovery Medicine and will be speaking at the Recovery Capital Conference this coming September.