Mental Health and Routine
Exercise has always been important for my mental as well as physical health. At different times in my life, I’ve been a more vigorous practitioner than others, but it’s always been something I value highly. When I was in medical training, it was far easier for me to stay committed to an exercise routine, than as a married father of two. This was largely because I had two built-in workout buddies.
I trained in anesthesiology, and naturally two of my friends from the hospital were surgeons. One of them, was an attending surgeon at UC Davis where I was a resident. He was only a couple of years out of training, and a self-described “gym rat.” My other friend was almost as avid a bodybuilder as the young professor. I was the least accomplished in the weight lifting department, but I loved the camaraderie, constantly pushing myself to get stronger, and the mental health results were a bonus.
We are all very busy, in training and in the early days of our careers. When we’d get together, the emotional support was as valuable as our workouts.
We’d meet at 24-hour fitness, convenient for our grueling schedules. We usually grabbed dinner after the workout. Mostly a Baja Fresh burrito. We cultivated a habit, and mostly we were a threesome at the stacks. Occasionally one couldn’t make it, and the other two would go anyway. We got fit, and supported one another, while establishing what would become for me, a lifelong pattern.
When training was over, I upgraded to a fancier gym with a steam sauna. I don’t know about you, but I really like the enveloping warmth of a dense hot steam bath. Alternate it with short cold showers and you’ve got it made. It’s better than any massage.
At the new, fancier gym I’d usually workout alone. There I noticed a group of six older fellas who, every Wednesday afternoon, took over the steam room. They were around retirement age, and whenever I was in there they were friendly, but mostly ignored me.
They were focused on one another, and over time I got to know them a little bit. They’d made the Wednesday “board meeting” in the steam room a longstanding habit. They were close, they supported one another, and together made a social community. Frankly, I’m not sure if these seniors got more out of their workouts, or from the social support.
In the years since, I’ve had a chance to reflect on this ad hoc social support community. It has the four important elements which anyone trying to change a substance habit should create in their support communities.
They are: Convenience, Continuity, Candor, and Camaraderie.
NAMI and the Official Position on Community
National alliance on mental illness (NAMI) is one of the premier organizations that promotes, despite its name, mental health. According to their website, their mission is to provide advocacy education support and public awareness so that all individuals and families affected by mental illness can build better lives.
Partially due to the advocacy of NAMI, the month of May is designated as national Mental Illness month. Previously, I’ve taken issue with the emphasis of the addiction treatment community on the term “mental illness.” Naturally, if you subject your brain to high levels of damaging chemicals like alcohol or methamphetamines, eventually you will have a brain problem. Since the effects of these damaging chemicals land largely on the judgment centers of the brain, mental illness often follows drug use.
Even though this position is controversial, I don’t think that because we go crazy after long-term exposure to toxic brain chemicals that this means addiction is a primary mental illness. I’m not denying that it’s baffling why people would continue to use substances, far past any net benefit. But I think this position is better explained by a closer look at the formation and maintenance of habits.
We nevertheless look for allies. People with long-term organic, structural, traumatic, or other classifications of primary mental illness, suffer, as do those caught in the grips of substance dependence. In the 1980s, with federal funding threatened once the returning veterans from the Vietnam War mostly quit heroin without help, the addiction research community promoted the concept of “addiction as brain disease.”
In my experience, few would rather be thought of as mentally ill instead of morally weak. Both labels cause severe loss of social standing and it’s easy to see why. Referring to substance habits as mental illness also makes joining a community more difficult. The “admission price” in terms of social standing is dear. Far better to acknowledge one’s propensity or habit for substance use than to shoehorn your identity into a box that doesn’t fit.
Most modern twelve-step approaches for treatment focus on developing a community of similar individuals. In the folklore surrounding creation of Alcoholics Anonymous (A.A.), two alcoholics, Bill Wilson, and Dr. Robert Smith, met and supported one another in their early efforts at abstinence.
According to government estimates, over 90% of addiction treatment in this country follows the 12-step model. Unity, service, and recovery, are the three tenets of A.A. In many cases, what passes for treatment is an elaborate version of the 12 step meetings. Most rehabs take their customers to open meetings of A.A. Treatment centers encourage graduates to get sponsors at meetings, and almost always recommended as a follow-up course of treatment when they return home as part of an aftercare program. These are all good suggestions but they’re hard to pull off.
It is a paradox of treatment that the “classmates” and staff who client gets to know, are necessarily left behind at graduation. Ideally, community support to maintain absence would be developed along the journey of recovery. There is a jarring disconnection between graduation from a treatment facility and reentry into the customer’s normal life. Worse, all of the challenges, and problems have festered whilst you were away in rehab, and are waiting for you when you get back home.
Treatment Is broken down into two phases. First is stabilization, and is generally known as “detox”. This is a period of days to weeks when the brain and nervous system are acclimating to the withdrawal, or absence of the drugs/alcohol. It’s important to note that the body does this for you when you quit poisoning it. Doctors may prescribe a tapering course of medications to lessen the severity of withdrawal symptoms, though not always.
The next phase of residential treatment is supposed to be preparing you for life after you’ve camped in the treatment facility. This is filed under the categories of life skills, relapse prevention, and other standard approaches found in an addiction treatment center.
Even with the intrinsic disconnection of community, you’re still advised to meet other sober people and to become part of abstinence support community wherever you live following discharge. It’s well-known that a supportive community is important for any habit change goal, especially beating a substance habit. Question though: what if your goal isn’t abstinence, but rather to “cut down?”
Social media can be either a hindrance or help. Social support is critical when you want to make changes as significant as beating a substance habit. But the use of social media platforms like Facebook, Instagram, and others, can sometimes be a double-edged sword.
Take the dating apps like Hinge, Bumble, and the granddaddy Tinder. Sometimes people overlook them as social or community apps, because the main function for many users is “hooking up.” But underlying the driver is intimacy: a yearning for social connection. Here, the genuine desire for community and meaningful connection can sometimes get you into hot water.
Take drinking. On a date, for example, many of my patients report significant social anxiety when they attempt socializing or having sex without mind-altering chemicals. For a lot of people, they haven’t had an experience of sober dating, much less sober sex. The anxieties that drove them to drink during intimate time with another person, resurface with their tenuous abstinence. Taking away the medicine (alcohol, drugs), makes the awkwardness, and apprehension of embarrassment all the more acute.
On the flipside, when we can be honest about our efforts to drink or use less, mostly we will find support from the people we would really rather date. Personally, I would much rather spend time with somebody who’s “all there,” rather than somebody who is “out of it” and intoxicated. Though you may have to risk awkwardness and embarrassment, the benefit of honesty as you seek a social community is ultimately well worth your effort.
Social support communities help with stress, motivation and encourage a spectrum of additional healthy behaviors. I cannot overstate the benefits of a social support community, and that’s why we designed VHAB around the idea of mutual community support. Community alone helps a lot. Here are a few of the ways you’ll benefit from a strong, supportive community.
Community Helps People Cope
Social support also helps people to deal with stress. Stress causes serious health consequences. They range from weakened immunity to elevated risk of heart problems. Surrounding yourself with people who care and support you, helps you to see yourself as more capable. Research shows having strong social support in a crisis reduces the chances of PTSD.
Community Improves Motivation
Social relationships also help people stay committed to their goals. People losing weight or quitting smoking find that being a member of a supportive helps not only themselves, but also people who are actively trying to attain those same goals. Talking to peers who are going through the same experience lightens the load and improves motivation.
Community Encourages Healthy Choices and Behaviors
Voluntary participation in social groups has a smoothing influence on individual behavior, influencing whether people eat a healthy diet, exercise, smoke, drink, or use illegal substances.
Clearly, social groups can also have a negative influence. When peer pressure and influence leads to poor or even dangerous habits. However, group pressure and support can also lead people to engage in healthy behaviors as well.
In summary, community is an essential component of any successful program of habit change. As a wise person once said, friends help multiply your joys and divide your sorrows. If you would be successful in changing a stubborn habit, best get yourself a supportive community. The importance of a support community cannot be overstated.