Some Assembly Required blends a wonderful matrix of clinical and personal observations about the process of addiction and recovery. It discusses the commonalities between Western psychological theories, certain psychotherapeutic approaches, twelve-step recovery, and Taoism and Buddhism, and provides a comprehensive review of psychological and physical interventions for chronic pain. Dan articulates the complex interplay of thoughts (in the forms of negative self-talk, catastrophization, resistance, and self-judgment) and feelings (such as shame, guilt, anger, fear, depression, and anxiety) associated with his conditions, consistent with what I have observed in many patients who suffer from co-occurring pain and addiction.
As Some Assembly Required conveys, there are cognitive-behavioral and mindfulness-based ways to reduce both physical and emotional pain. Basically, if you think differently about your pain and/or you act differently in response to your pain, you have less pain. This is an important component of our pain recovery model at the Las Vegas Recovery Center and Central Recovery Treatment. Pain recovery is about balance. It involves the way we think, how we cope with feelings, how our body is functioning, and our spirituality. The net result is that people have relationships that are enhanced and much greater involvement in positive actions and behaviors. Nonmedication treatments are really all about movement: exercise, release of tissue adhesions through massage, yoga, chi kung, Reiki’s nontouch, energy work, and acupuncture.
What we see consistently in our program is that people give up opioids, and they go from a state of depression, despondency, and disability to a state of freedom they didn’t think was possible. It is possible to recover from the co-occurring conditions of chronic pain and addiction and live a better life. It can be very tough to get there, but it’s the closest thing to miracle work I’ve ever seen in my thirty-two years of clinical practice.
Some Assembly Required will be of benefit to anyone who struggles with addiction and chronic pain, as well as the professionals who treat them. It is a story of hope and success in the face of disabling illnesses: addiction and chronic pain.
Mel Pohl, MD, FASAM
Vice President of Medical Affairs
Medical Director
Las Vegas Recovery Center
There are many people who have directly and indirectly contributed to this project and my heartfelt appreciation extends to all of them. The task of formalizing this list of acknowledgments is inherently intimidating by virtue of the inevitability of certain omissions. There are many thanks to give.
To Nancy Schenck, Executive Editor of CRP and editor for this project, whose guidance and friendship is a great gift. Clearly, one of the reasons I was brought to Las Vegas was for her to be part of my life and my recovery.
To my other talented CRP teammates: Valerie Killeen, Managing Editor, and my walking partner at work, as well as a walking example of professionalism and humility; Helen O’Reilly, Senior Editor and human dictionary; Daniel Kaelin, Editorial Coordinator and permissions guru; Eliza Tutellier, Assistant Editor, who did a wonderful backup edit for this book; and Patrick Hughes, Sales and Marketing Manager, ace book pimp, and cinematic savant.
To Bob Gray, CRP Publisher, whose efforts facilitate our mission.
To Stuart Smith, whose vision and support make this book and all the important work we do at Central Recovery Press possible.
To Mel Pohl, MD, FASAM, for composing the Foreword to this book. To be able to collaborate on projects such as this with the renowned physician who met me at my nadir is a stirring example of what is possible in recovery.
To Claudia Black, PhD, whose groundbreaking work on dysfunctional family systems I utilized with clients as an addiction treatment professional, for her kind feedback and generous support of this project.
To my most excellent colleagues at Central Recovery and Central Recovery Treatment, especially: Debbie Champine, Joni Baumgart, Doyne Pickett, Bill Peiffer, Paul Hinshaw, Travis Shephard, Tony Carter, Dave Lawrence, Greg Pergament, and Alvin Elliot.
To my informal reviewers, Margie Williams, MA, LPC, dear friend and colleague, whose path and mine have had so much in common; and Beth Kovac, my beautiful (inside and out) partner.
To my mentors in behavioral health, most notably: Wendy Yalowitz, MSW, LCSW, my first post-master’s supervisor from whom I learned so much about the art of psychotherapy; Dave Glaser, MSW, LCSW, my East Coast Grateful Dead concert-going buddy, who taught me the ropes of clinical supervision and administration; and Susan Rubin, PhD, MSW, who showed me what courageous leadership in the face of political pressure looks like, and was instrumental in helping me refine my management skills. Their guidance and support have been an enduring resource.
To Frank Szabo, for the many extensive discussions we had that clarified and enriched my understanding of recovery.
To Phil F, who loved me when I had little capacity to love myself, and foresaw this book long before I ever did.
To Jimmy S, a living example of how to walk a spiritual path, even on burning coals in bare feet.
To Alan Trist at Ice Nine Publishing Company, who immediately and generously granted my request to use Grateful Dead lyrics in chapter epigraphs for this book. I am honored to be able to quote from songs that have meant so much to me and have been so close to my heart for so long.
There is no shortage of autobiographical stories that describe the horrors of addiction. Many of these also depict people’s journeys into recovery. Some of these narrative self-portraits have been painted by those who rose from the ashes of their active addiction to find recovery and go on to become addiction counselors. The usual sequence of events is active addiction to recovery to counselor/therapist/helping professional. This story is a little different. Like no small number of things in my life, I got it ass-backward insofar as I was a behavioral health professional, working in high-level management capacities for many years, plenty of which were in addiction treatment settings—before I entered recovery.
As I moved up the promotional ladder, I transitioned from full-time direct practice as a therapist to providing clinical supervision and teaching treatment approaches and techniques to dozens of counselors, therapists, interns, and other staff. I was responsible for overseeing the clinical operations of (in succession) a residential addiction treatment center for adolescents, a hospital-based inpatient addiction treatment program for adults, and multi-program outpatient treatment services for adults, children, and families—all while I was in active addiction. In these settings, I was highly regarded as a practitioner and administrator.
Of all the twists and turns my life has taken, I never expected to be confronted by the challenges and complexities that lie at the nexus of addiction and chronic pain. As an experienced clinician with a master’s degree in social work and advanced training and credentialing in clinical hypnosis, I knew a thing or two about the connection between thoughts, emotions, and physical pain.
I had treated others’ suffering from chronic pain with unanticipated success using hypnosis. However, with the onset of my own chronic pain condition and its intersection with the addiction that had long predated it, all my professional knowledge and experience faded away. For all rational and practical purposes, it was nonexistent to me.
I allowed myself to become utterly dependent upon the prevailing conventional Western medical approach to pain management with its merry-go-round of opioid painkillers, lumbar epidural steroid injections, occasional episodes of physical therapy, and the ever-looming option of spinal fusion. I effectively assumed the position of victim. And in doing so, I submissively succumbed to the admonitions of my doctors (all extremely experienced, skilled, and well-intentioned) and relinquished sports and other physical activities that potentially put me at risk for further injury. As a lifelong