Tiffany CarlsonLMHC, CAP

Addiction: How do I stay sober? A lot of people come to south Florida for help, but for what often ends up becoming the “Florida Shuffle.” Meaning, they are in and out of detoxes, inpatient treatment settings, halfway houses, homelessness and then active addiction again. This ends up helping no one. Not the patients, families, staff and treatment team, or insurance companies. Some people struggle with not wanting to take clinical recommendations for support such as even attempting 12 Step recovery, sponsorship, meetings and home-groups. Some people are also unwilling to try Celebrate Recovery or SMART Recovery. And this is fine! However, there must be SOMETHING or somethings that someone is doing to improve upon themselves daily. There must be support, accountability and drive. If someone is not motivated, institutions can only help to keep that person ‘clean’ for so long. So, if you want to stay sober, I invite you to write down your motivations for recovery. Your internal motivations. What will long-term sobriety afford you the opportunity to do with your life? What are you truly passionate about? Do you want a family, to travel the world, to help people? Please spend more than thirty seconds thinking about your wants and needs (outside getting high, outside the immediacy of perhaps needing a detox, and outside the external materialistic charade we convince ourselves we may need because “society tells us.”) Write it down, don’t just talk about it. You deserve that much. Once you have some concept of what it is you might hope to accomplish in your life outside the insanity of doing the same thing over and over again, expecting different results. Please establish actual support. If you do not want to attend Alcoholics Anonymous, that’s fine. But please find something for you. Simply going to a therapist once a week isn’t going to cut it. It’s a start. But you will need more. Much more. You will need friends, co-workers, family, hobbies, interests, volunteering your time and energy, giving back to the community, standing up for a cause, helping other people. Something that keeps you involved, busy, supported and accountable. Now for real stuff. Anybody, and I do mean anybody, who struggles with addiction, struggles with core underlying issues. Not just drug addiction, but gambling addiction, sex addiction, eating disordered behaviors (over eating, not eating, binging and/or purging), self-harm behaviors that may exacerbate when someone’s drug of choice is no longer accessible to them. People can become addicted to anything: the gym, working, reading, sexual partners, lying, anger, jealousy. There are chemical hooks in the brain that get released when we experience different emotions. As unpleasant as it sounds and may actually be, some people get addicted to their depression, to anxiety, to control, to the chaos of the active addiction and all its wonders. Control, as I’m sure many of you have heard before, is an illusion. We can be in “control” but only up to a certain extent. Unless you have a crystal ball that tells the future. But if we know that control is just an illusion, why do we strive so hard to get it? Why does not having control mean so much to us? How does not having the illusion of control create such hopelessness and helplessness at times? I want to talk about self-esteem, whether somebody in early recovery presents as a Narcissist or with Bipolar Depression, there is still the core underlying issues of pervasive low self-esteem, how we got it, how it’s negatively impacted us our whole lives and what we can do about it. Stay tuned for upcoming blog posts on control, self-esteem and working towards making positive changes in our lives.

When is it time for a change When there’s a lot going on in your life: the house, the pets, children, relationship(s), family, health, job and/or job(s), juggling the finances, the drama. It adds up. America is a country not known for its bountiful holiday and vacation pay or time. So how do we exercise self-care? And more importantly, how do we know when it’s time for a change? In the field of psychotherapy, burn out if a very real thing. This is most certainly something that happens in every field, whether you are a pediatrician or a barista. Too much of the same thing can get old. Most importantly, too much stress and pressure or increased feelings of being overwhelmed are sure to bring mental, emotional and physical fatigue. When you ask yourself this question, what emotions come up for you: are you working to live and living to work? If you love what you do, that’s amazing. There are several people who have not had the opportunity or lacked follow through for completing the education to get into a field they were passionate about. Or on the flip side, you might have dredged through copious amounts of years and schoolwork and feel completely unsatisfied with where you landed and perhaps are looking for a 180-degree change. Maybe you were lucky enough to inherit the family business but finding that you’re constantly trying to live up to expectations that you’ve never had for yourself. At the very least, you are like everyone else – floundering around, looking, hoping and waiting to find something that sparks your interest, still “waiting to grow up.” If you feel overworked, under paid, underappreciated, drive over an hour to work each way, have been constantly looked over for promotions or raises, lack connection with your co-workers, don’t have any co-workers and are completely lonely, or a plethora of reasons that you are unhappy with your job: it’s time for a change. The same thing could be said about your apartment complex, the neighborhood you live in, your in-laws, your family unit, relationships, and so on. The core question is: how do these issues in my life make me feel? If it’s a consistent, palpable, negative feeling-state, it’s time for a change. I think the problem may lay, not in questioning if we want things to change, but knowing in our heart of hearts that YES we do want a change, we just aren’t sure how to go about making it happen. Maybe you need to quit your job and humble yourself by taking something demeaning (for a temporary time period) because if you show up to work one more day you might either cry or throw a computer (I get it). Maybe you need to humble yourself and get a roommate to help with some of the bills? Maybe you’re deciding on wanting to go back to school or having children. Maybe you’re ready to take the leap and get married. If you feel it’s time for a change but are afraid to pull the trigger, remember that if you end up super ill-fated you could always try to go back to the way things were before. However, I don’t think that will end up being the case. Sometimes people leave jobs or relationships on good terms – they just fell out of love with one another but are amicable and have no animosity. Or their job is monotonous and doesn’t challenge them enough. Chances are, if you are chronically unhappy, something in your life needs to change. If you are someone who’s constantly tried to change your external factors and find that no matter how much you try to change outwardly, you are still missing something… then it might be time to look inside yourself. Change can be wonderful, helpful and even though at the time may be unexpected, can transform us into who we need to be for that next stage of our lives. I invite you take an emotional inventory of the key components in your daily life (relationships, food, hobbies, pets, children, house, employment). I want you to really spend some time correlating your feelings to your daily nuances. What makes you happy, where do you feel fulfilled, what is your purpose? Try to hone in on things that tend to derive positive emotional-states and in another column, write down the typical stressors you experience throughout the days and see how they match up. Some might be necessary evils such as doing laundry, or paying bills, but other might be more ominous. If you can try to weed out the unnecessary, trivial, mind-numbing or depressing things, you could be in a better mental state. If you need to learn to set stricter boundaries, then that might be another conversation. Either way, being open to change and mindful of what works/what's not working - is a beautiful place to begin.

Self-Esteem through Self-Compassion I worked on self-esteem for several years before I came across this concept of self-compassion. For a long time, I would hear people say “if you want self-esteem do esteem-able acts.” And that sounds great if it works for you. For me, it only worked in theory. I needed something more. I could maybe help someone else and feel good about it in the moment or immediately afterwards, but I found that this feeling didn’t stick. This was because of how pervasive and pathological my low self-esteem issues had been my whole life. I looked goofy as a kid, glasses my whole youth and adult life, never feeling like I belonged in one single crowd in high school, often acting as a chameleon going from one group of people to another until I got bored or felt as if I had worn out my welcome. What I was really struggling with was self-acceptance. I hadn’t accepted myself for most of my life. I, like most other people, fell victim to beliefs, thoughts and feelings from the outward messages I was receiving in my reality. I wasn’t tall enough, I was too skinny, I didn’t have a big enough chest, I wasn’t smart enough, I was too smart, I have no talents, I’m showing off, don’t have an opinion and do as your told, you better stick up for yourself because no one else will. Everywhere I went, I was receiving conflicting messages. From school, my teachers and peers, my family, the friends I thought I had or the people I affiliated myself with, ultimately my job, my boss and employees, social media, television and ad campaigns, movie stars and heck, sometimes even my neighbors. There I was, everyday of my life, going through all my actions and trying to stay afloat, not feeling like I belonged, not feeling accepted, and not feeling good enough. It’s a wonder I was even able to finish school or stay at a job long enough to save money!? How is one to go about experiencing healthy relationships when we can’t even love ourselves? I felt judged, ridiculed and low at every turn. I didn’t feel like I had much support, and even if someone did have a kind word to share, I mostly didn’t believe them. This self-esteem turned into depression very quickly, which was accompanied by several poor impulsive decisions. My perception had now become my reality. It was a self-fulfilling prophecy: No one thinks I’m good enough, let’s show them exactly how bad I can really be. It wasn’t until I discovered the concept of treating myself like I would treat a good friend. Kristen Neff, PhD describes self-compassion not as a way of judging ourselves because we’ve reached some sort of goal but relating to ourselves kindly. I soon learned that I could fail at something, or not fully complete something, and not be a complete loser. Knowing this intellectually is one thing, it can look good on paper; however, real life application of believing this is another realm. I began to believe that I wasn’t a horrible, stupid, loser person if I didn’t have what other people had, if I didn’t look how other people looked, and I wasn’t accomplishing what other people were accomplishing. Don’t get me wrong, I still experience setbacks, I’m a human and imperfect by nature. I began to allow myself to change my views on certain things, such as my view of the world and my relationship to it. I had been a separatist towards myself without even realizing I was doing it. I began working to think less critically regarding my beliefs that kept me segregated from people, life and experiences. Beliefs that kept me afraid. Self-compassion talks about the shared human experience, that suffering is part of life, and that we can commiserate on all having struggles. I allowed myself to look at others as people, just like myself, instead of the enemy who wouldn’t understand me. I slowly changed my perception from ‘how am I different’ to ‘how are we all the same.’ And this concept, this process alone, allowed me to begin facing my fears and slowly let my walls down. It allowed me to become more open-minded to friendships, supports, opportunities, and most importantly, the concept that I’m not some alien lifeform who doesn’t belong in humanity. I am just as deserving of love as anyone else is. A final portion for understanding self-compassion is mindfulness. Neff describes this as “being with what is in the present moment.” This message stands out to me, because for so long, I perceived mindfulness as being some sort of higher consciousness that you could only reach as a monk living on top of a mountain. I had finally found a definition of mindfulness that I could relate to. This concept of mindfulness meant that no matter how bad, or crappy of a feeling I was experiencing in that moment, I could embrace the fact that this was how I was feeling. I was encouraged to do so. (Again, embracing and accepting what is, is not the same as acting out impulsively when we don’t’ get our way.) Mindfulness allowed me the opportunity to sit in an experience, positive or negative, and absorb it. Learn from it, enjoy it, appreciate its dichotomy and allow it to pass just as easily as it had flown in. Self-compassion assists my self-esteem because it reminds me that I don’t need to reach some sort of goal (money, car, fancy clothes, expensive house, white picket fence) to be happy or contented. I can appreciate the fact that I am trying, and whatever I have accomplished in my life, is to be celebrated. I have condemned myself for too long, and now I have a way of relating to myself kindly without being famous, a supermodel or millionaire. Although it would be nice to have those things, I know that I can be happy in my own skin without them. Because I am enough.

Tiffany Carlson holds a Master's in Mental Health Counseling from Nova Southeastern University and completed her internship at one of the top substance abuse treatment programs in Florida. Ms. Carlson is a licensed mental health counselor, certified addictions professional and Florida Qualified Supervisor. Ms. Carlson has been in the industry nearly ten years with emphasis on addictions, dual-diagnosis mental health such as bipolar, anxiety and depression as well as experience working with the persistently mentally ill population and children with developmental disabilities. Ms. Carlson has, over the past five years, worked in a clinical directorship position at multiple treatment facilities as well as clinical supervisor and program director, developing curriculums as well as running family program weekend intensives. Ms. Carlson employs evidenced-based practices such as Cognitive Behavioral Therapy, Dialectic Behavioral Therapy, Brief-Solution Focused Therapy and Rational Emotive Behavioral Therapies with her clientele that can be most effective with pharmacotherapies.

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