Distress Tolerance

It was about this time 11 years ago that I was spiraling down, thinking about making a change. It would be another week or two before I would be admitted to detox for the first time. I remember that I was working my 24-hour shift and really struggling to not drink. I was pretty new to transplant call. I knew that I should never drink while on call. I shouldn't drink while working ever. When I switched to 12 hour nights in December 2009, I was struggling to keep it together. I would drink between my shifts without enough time to be 100% sober by the time I got to work. I loved what I was doing for transplant and knew something needed to change if I wanted to stay in this job. Something also required to change if I wanted to continue to live. I was dying a slow death, and it was starting to be not only mentally painful but physically painful as well. 

My first attempt at treatment was technically 2007. I was hospitalized for 10 days after a suicide attempt. I wanted to go to treatment then. It was the first time I was ever honest with anyone about the extent of my drinking. At that time, it was 1/2 liter a day, 3-4 times per week. My insurance was allowed to deny me the appropriate treatment level because I didn't "fail" on a lower level. I remember feeling like the wind got punched out of me. I would see the MI/CD (mental illness/chemical dependency) treatment groups going on, and I wanted to attend. The social worker presented me with some options for outpatient groups. I took the one where I could still drink. I attended 1 group and decided that I didn't like treatment. 

By the time I got into inpatient treatment in 2010, I was a daily drinker who was shaking like a leaf after not drinking for 5-6 hours. I was obsessed with drinking. I made all sorts of justifications about what I was doing. "I am not hurting anyone." "I could quit, but I don't want to." I totally dismissed all the people I was hurting and annoying with all of my antics. I knew that I was going to have some health ramifications because of this. I knew I would have to make some significant changes, with the first admitting what was happening with me and taking responsibility for all that I did. Let me tell you, I really, really did not want to have to do that. I wanted all the lies and justification for my actions to be true. I was embarrassed. I feared everyone would reject me. I felt like I was going to lose the only life I had ever known. I didn't want to be held accountable. 

In my first treatment, I learned a lot. I was in a very stuck place emotionally. I was a good little patient. Terribly compliant and did everything I was told to do (except the whole part about reporting myself to the nursing board). I did the extra meetings that were available. I collected numbers of other patients who seemed to be looking at sobriety seriously. I asked for a temporary sponsor and got one. I felt physically better than I had felt in years. Thanks to detox, my cravings were significantly less because I wasn't withdrawing so hard. I started on a new anti-depressant before leaving. I had a therapist. I was signed up for aftercare. I knew which meetings I was going to do. Honestly, none of it felt terribly authentic. I still saw myself as different. I was excited to get back to work. I was not excited to talk about my absence from work.

Knowing what I know now, I was missing some critical pieces to finding recovery. With my depression came a lot of shame. I was (and still am a little at times) embarrassed for my actions. I would have these vague drunken memories of things that I did and said. I felt horrible for my family and everything that I had put them through—all they ever wanted to do what see me well. I dodged questions and concerns for several years. So, as I was walking out of treatment the first time, I had no distress tolerance. It wouldn't be until late 2010, when I started with an outpatient mental health group, that I would learn about distress tolerance. I was unable to identify the levels of distress I was experiencing. Everything that was triggering an emotion was either 0 or 1,000. There was no in-between. Many of the situations didn't warrant a 1,000 response. Not to mention my 1,000 response was drinking. 

Regulating emotions is interesting to learn. Most of the skills I learned in relation to emotional regulation seemed really obvious. When I felt my feelings getting stronger, I distract myself for a few minutes. If I was thinking about drinking, delay the thought for a few minutes and see if I still want to after engaging my logical mind. If I was feeling particularly depressed, attempt to do one thing and rest. If I was stuck on a thought, quiet the mind with meditation. I was looking at the list as we were learning and thought, "geez, this isn't so hard." Well, yes and no. The skills are reasonably straightforward. The trick is knowing what skill works in what situation. Not to mention, I have to take some time to rewire my brain. My brain had 1 track, and it was the track to get overly emotional at everything. I had to build some new paths in my brain, with the foundation being - "I can handle this." 

I almost gave up halfway through these groups. There was a woman in my group who I called the "skills master." She would review her days and talk about being in a manic state. She used every skill offered to her to get her symptoms in better control. She worked so hard and tried so hard. I didn't feel like I had the same commitment to the process as she did. I was reminded, though, I get out of this what I put into it. I met with my counselor weekly, and she kept me forward-facing. OK, I didn't like how scenario #1 went. OK - now that you are in a different place, how would you like to handle this situation? Then we would put a plan together and practice. I started to believe that these skills could work for me. I just needed some guidance. It was the most profound thing I learned in my early recovery.

I still rely on those skills today. Sometimes I need to be reminded of them. I don't find my emotions to be as overwhelming as they used to be. That doesn't mean that I don't struggle with emotion. For the past couple of years, my emotions were sort of all over the place. My emotions were slowly elevating to my pre-sober days/early sober days. It's easier to see that now with some distance between me and that time. I did try to use my skills, and I did. The biggest struggle was regardless of my interventions, the situation was not changing. I have been in situations like this before - no matter how skillful I am, there are times when the situation has to change to get any relief. I think I reverted back to a little bit of denial back then too. It's a coping mechanism of sorts, but not very effective. Hindsight is always 20/20.

One of the best things that came out of recovery for me is that I have more control over my mind than I ever believed. Just because I have a negative thought doesn't mean it's true. Just because I am thinking about something, it doesn't mean I need to get stuck there. I may not be able to control my drinking; however, once I accepted that, I became empowered to do many other things. There are times that I wished I had found recovery sooner since I ended up wasting so many years. At the same time, things happen the way that they were supposed to. I have to believe that deep down. I have had to get myself away from language like "mistake" and "wasted time." Some people came in and out of my life during those years. I learned a lot. Even if counseling didn't end up being my career of choice, the experience and knowledge will stay with me forever. 

I feel like I am on a good path right now. I am still happy with my current job and, of course, I love school. My school is very challenging, and I am missing that in-person component. One of the best things about my practical nursing program was the people I met. A few of those folks are life long friends. I think people bond very quickly in nursing school. We have to have each other's back. It's hard enough to know everything we need to know. I have met some folks, and we chat online and via text. It's not quite the same, but I will take what I can get right now! I hope to continue to revive old passions that I may have forgotten about. Hospice nursing is still a forerunner. I know that transplant is still an option as well. I do plan on just a little bit more schooling when I am done....I'll keep you posted on that.

Hope everyone is staying healthy and happy!
J