The therapeutic value of Keep It Simple
By Jeff Vircoe
The Akron surgeon probably knew the therapeutic value of the term as well as anyone.
But when Dr. Robert Smith offered Keep It Simple as prescription for the good health of one Bill Wilson, he probably had no idea how profound that little slogan would become.
Keep It Simple was one of the most frequently used slogans by Dr. Bob. On record, he offered it up on the railway platform when Bill left Akron to return home to New York after the summer of 1935. He used it again during his last talk to the membership at the 1950 Alcoholics Anonymous International Convention in Cleveland. And, he encouraged Wilson to pay attention to the simplicity message the last time the two cofounders of A.A. spent time together, just weeks before Dr. Bob died in November 1950.
Sixty seven years later, in countless meeting rooms around the globe and in thousands of treatment centres like Edgewood in Nanaimo, B.C. (part of the Edgewood Health Network) the slogan Keep It Simple is still considered a fundamental slice of the recovery pie.
Apparently, addicts need that simplicity. It makes sense.
“Drug addiction is a complex illness,” reads the first page on the National Institute on Drug Abuse (NIDA) website.
As one of the world’s leading researchers into the health aspects of drug abuse and addiction, NIDA is about as scientific in its definitions and vocabulary as any organization. Its credibility is impeccable. With articles on diagnostic methods, pharmacology, and use of heady terms like endogenous and cardiac arrhythmias, organizations like NIDA help scientists and doctors, treatment centre counselors, and you and I to figure out the mechanics of what is wrong and what is fixable with our brains. Yet, with scientific language about as exciting as watching grass grow, it’s not exactly Keeping It Simple. So, by telling readers that, first and foremost, “drug addiction is a complex illness,” NIDA’s intro speaks volumes.
If drug addiction is a complex illness, it probably goes without saying that addicts are complex people. But are they?
Not necessarily so, says one woman with a decade of working with and studying addicts.
“I believe there is not a huge difference, sometimes, between the life problems that addicts face and the life problems that somebody without active addiction faces,” says Dr. Christina Basedow. “One of the main differences that I see is the amount of obsession that is given to those types of problems. So I wouldn’t say that addicts necessarily complicate things, but I think the obsession that comes as part of addiction complicates things.”
With a PhD in Psychology, Basedow is the supervisor of the continuing care team at Edgewood Treatment Centre in Nanaimo. Her team of counselors treats patients in extended care – a typically three-month phase of treatment which follows two months of inpatient residential treatment. In extended care, patients continue with the group therapy in which they’ve been extensively involved in inpatient treatment. But, they are also transitioning back into work or school, volunteering, and attending 12 Step meetings in the community. It’s a transition back to the outside life awaiting them: bills, relationships, jobs, kids and health issues. You know – life. Everyone’s got problems, and everyone has their own way of navigating through them. But, by the sheer nature of addiction, the level of obsessiveness with which addicts roll into recovery makes dealing with life, well, complicated.
“There’s a belief that addicts think that ‘normal’ people don’t have all of these [life] issues,” says Basedow, “and they think, ‘There is something wrong with me – there’s something different and I’m sick.’ But, really, it’s not that ‘normal’ people don’t have issues. It’s just that they don’t obsess to the nth degree about them.”
With a decade of experience studying and helping addicts, Basedow explains how the addict can’t necessarily help him- or herself when it comes to how they process information.
“Addiction has definitely got a brain disorder component. We’ve seen that. If you look at it from a hereditary perspective or a thought process perspective, the cognitive distortion perspective, there’s definitely something that’s dysregulated in the brain when it comes to active addiction, especially when someone is using. It can re-regulate when we get into recovery. But, in the active phases of addiction, there is absolutely a cognitive dissonance component and a brain component to it.”
The idea of interfering in the crazy-making, obsessive, compulsive mind of an addict means hope is available, but it requires a complete overhaul of how addicts approach their lives. A rerouting of the brain patterns and responses to issues. The 12 Step movement offers one way. Psychotherapy offers a way. Medication management, diet and exercise, pet therapy, religious programs – many suggested avenues appear on the map toward recovery.
At Edgewood, what has been found to be successful is taking an honest inventory of what has been going on in active addiction, studying the story told by the addict brain and comparing it to the facts. So, a lot of time is spent on assignments like Step One, and on questions like how have chemicals placed your life or lives of others in jeopardy? Have you lost self respect due to chemical usage? What is it about your behavior that your spouse-friends-family object to the most? Questions like these, truthfully answered, can start the process of rewiring the complicated web of half-truths, full on lies, or imaginary instances with which many addicts have been living in their un-simple world.
Dr. Basedow says the assignments and plenty of group therapy are about getting to the truth and changing the story.
“It’s about sorting out what the story is that this person has been telling themselves sometimes from childhood onward, what has kept the lies alive, what has kept them disassociating or kept them complicated or kept them using. Re-narrating the story into something that’s a lot more simplistic. It could be something as simple as, ‘I had a lot of stuff happen in my childhood, and some of them were really traumatic. And, because of that, I didn’t connect with people. And, because of that, I told myself that I was unworthy and unlovable. And, because of that, I was …’ It’s about asking, ‘How do I re-narrate all of these thoughts that I’ve had into a story line that has led me to use?’”
“That’s why we use group therapy, because, then, more people than just one can help re-narrate the story and confront the masks you wear and the different types of stories you’ve created for yourself and the way that you keep yourself away from people. And, just the lies you’ve told yourself, whether it’s the victim stance or whether it’s a different type of role.”
Once the honesty aspect – the truth about our situation – is established within us and with others, then recovery can grow from a spark into a life filled with ups and downs.
Keep It Simple means understanding that life is not always up or down.
“When you get into recovery, everything feels different. You’re not using a substance of process or choice. And because you’ve used it to regulate your emotions for so long, you don’t know that this flood of emotions, this roller coaster, is a normal part of early recovery, and the problems that people in early recovery are facing are not abnormal. People out there [who] don’t have substance abuse issues are also struggling with things and also don’t know how to cope. They just don’t pick up [an addiction] to get through them,” says Basedow.
Perhaps no item provided by Edgewood staff to patients is as useful as the Aftercare Plan. A one-page document which describes in simple detail a list of items to follow each day to maintain the spark of recovery embedded in treatment, the Aftercare Plan keeps things in a simple order.
Meetings. Sponsorship. A home group. Aftercare. Exercises to look after physical, spiritual and mental health. Nothing too complicated, the Aftercare Plan is Keep It Simple in action.
The willingness to enact their plan is on the addict.
If you’ve spent money and time on feeding your addiction and it led you to a point of devastation and you or your loved ones chose to spend money and time getting help, including treatment at one of Canada’s most widely recognized centres, then Keep It Simple means carrying on the process of recovery, bumps and all.
“I think there is solid therapeutic value in Keep It Simple,” says Basedow. “Really, what we are saying in Keep It Simple is don’t trust your mental obsession. Don’t trust the constant reoccurring thoughts as your brain is rewiring itself. Don’t trust that all of those ideas are good. Don’t trust that [you] should act on every impulse. Don’t trust that [you] should re-engage with every person that [you] thought that maybe [you] shouldn’t have. Basically, don’t act on impulse is what keep it simple is all about. Keep it grounded. Keep it connected. That’s the whole purpose, really.”