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"Working the program" of Teshuva: Lessons from Addiction Treatment

Updated: Dec 30, 2020

Each year as I sit to chart my resolutions for the Jewish New Year, I tend to grow frustrated as I discover, yet again, that my list so closely resembles the one I penned the year before.

I never would have imagined I would receive a transformative lesson on how I could more fully embrace my own Teshuva (spiritual growth) process as a therapist at an in-patient treatment center for substance abuse disorders.

Here are four of the major insights that I have gleaned from observing the “rehab” process first-hand:

1. What “verbalizing” the problem looks like

Soon after an individual enters rehab, he sits for an assessment and asked to share glimpses into various domains of his past and present life. The list of substances used, prior sobriety attempts, snapshots of major life events and challenges – his full history shared.

Using this assessment, the client and therapist work together to find the key areas that need to be worked through in hoping to make and sustain progress toward sobriety. A step-by-step guide for moving forward in treatment is then formulated. Clear and specific therapeutic goals, assignments, and target dates for each are charted out from the very beginning.

The tireless, all-encompassing effort toward renewal and growth embraced by those dedicated to recovery can offer inspiration during our own designated period for spiritual rehabilitation.

In order to create authentic change, there are obstacles and core issues that must be addressed. Individualized work that must be done to avoid a return to old behaviors. And it all starts by formulating a purposeful, clear blueprint that takes his full picture into account. 

In hoping to make lasting, permanent changes, have I taken the time to methodically and fully spell out the fuller “history” of my past year? Have I assessed and developed clear and targeted goals so that I can form a thorough and measurable plan forward?

2. What putting forth effort to change looks like

Sitting in any therapy session, it is abundantly clear that individuals differ tremendously in their levels of insight into the severity of their problems. The same is true for their degree of motivation, and how ready they are to take concrete action towards real change. Some lean in their chairs, arms crossed and say "I can stop using whenever I want and don’t need help”; “they all think I still have a problem but I am fine now.”

But when asked to elaborate on how and where things have changed, they have only vague answers to offer.

There are then those individuals who are embracing this program head on. They share the damage that has been caused to themselves and others and the remorse felt over doing so. They acknowledge the tendencies, thought patterns, and behaviors they are battling against. They share which of the “12 steps” they are on, or current treatment assignment working through. And they express determination to continue progressing forward despite the very real obstacles they face.

Much of what occurs throughout a client’s day is noted. Willingness to engage during therapy sessions, behavior during groups, even tone and body language- all come together to paint a picture of how well a client is progressing toward his sobriety goal. During this critical period, it is not lip service, but concrete shifts in conduct and attitude that reflect whether or not he is willing and ready to grow.

Looking at my list of the goals I have set out for myself, I wonder where I stand in terms of my own willingness and internal readiness to make these changes.

3. What making a plan for lasting change looks like

Obtaining basic sobriety is nowhere near enough. Over the course of treatment the individual is continually asked to reflect upon the main "triggers" for his substance use. He is asked to identify, in painstaking detail, the scenarios, thought patterns, emotions, or relationships that could continue contributing to this cycle if not addressed.

Clear responses are expected to questions such as: What coping skills have been gained for managing a craving? Who does the person have to turn to for support if he should become "triggered"? Numerous clinical groups and individual sessions therefore revolve not just around understanding the past, but formulating a plan for maintaining boundaries with the "people, places, and things" that have been found to lead him to spiral backward.

The client is told time and again to never rest on progress that has been made. That he must continue to be on guard. This "relapse prevention plan" is seen as the key toward long term maintenance of sobriety. And having a crystal-clear picture of his personal "triggers" and vulnerabilities is a key part of the process.

Have I taken an authentic, sincere, brutal look at the underlying "triggers" that keep me vulnerable to these specific behaviors?

Before completing the treatment program, every angle of his prevention plan is reviewed and questioned to ensure that there are no gaps or vulnerabilities overlooked. It is this plan that is regarded as his armor and protection from reverting back to his old patterns. In this real battle with such a dangerous threat lurking, all potential scenarios need to be strategized, and contingency plans set well in advance. “Winging it" and careless optimism do not have a place when there is such a real fear of harm.

As I enter my day of judgment, have I taken stock and formed a specific “relapse-prevention plan,” or am I comfortable relying on more vague intentions toward change? Have I taken an authentic, sincere, brutal look at not only my wrongdoings, but also the underlying "triggers" that keep me vulnerable to these specific behaviors?

4. What immersing oneself in a program for change looks like

Walking in the halls of rehab, one hears murmurs from the AA “Big Book,” words of encouragement exchanged between peers, hushed whispers of therapists consulting on how to address an issue that has arisen. They're a community of soldiers (or as one client put it, ninja masters) fighting tirelessly for the mission of achieving and maintaining sobriety, being cheered on by fellow peers and caring staff members.

From their 8:00 AM “goal setting” group where they reflect on today’s specific tasks, to their 8:00 PM “wrap up” where they reflect on and share progress-- they are living and breathing a process of growth and change. Daily therapy sessions, AA meetings and “working the steps,” daily reflections and clinical assignments frame their day.

Standing here, I can’t help but feel I am inside a battle ground. For a month or more, these individuals challenge themselves. They spend their days thinking, learning, and sharing. They call each other out when someone isn't being honest with themselves. They push themselves past the brink of their comfort zones. In seeking and fighting for change, going through “treatment” isn’t a peripheral part of life- “working the program” has quite literally become their lives. The rest of life does not go on until they have gone through this process with every fiber of their being (and enlisting a team of professionals and support systems along the way). They are in this.

Getting a glimpse into this world opened my eyes to the meaning of real lasting change.

Substance abuse is a uniquely destructive, severe, and complex problem that is unimaginable to those not ensnared by it (the nature of which well beyond the scope of this article to explore). Nonetheless the tireless, all-encompassing effort toward renewal and growth embraced by those dedicated to recovery can offer inspiration during our own designated period for spiritual rehabilitation.

Taking stock and setting concrete goals for renewal is not relegated to the recovery world; they are the primary goals designated during the 40-day period from Elul and leading up to Yom Kippur. Our tradition recognizes that every Jew needs to annually immerse himself in an in-depth reparative process.

As I sit surrounded by people who are so fully immersed in their program of rehabilitation, I wonder about my own efforts for change and growth during this period.

I have admitted that at some point I have hit a spiritual bottom. I have recognized the need to change and grow, but have I truly committed to put in the necessary work to make it happen?

Have I spent time creating a “treatment center” of my own making, taking a pause, a leave of absence from day-to-day life in the hope of accomplishing meaningful progress in this list of goals? Have I built a “support system” and sought to surround myself with mentors or peers to seek support, accountability, and encouragement? Have I sought opportunities for genuine inspiration and motivation to keep progress alive? Have I made a contingency plan for each goal to give myself a real chance at permanent transformation?

Our Sages have designated a period for reflection and transformation. They, too, have designed a powerful, “evidence-based program” for identifying and replacing our behaviors and patterns that are not in line with who we want to be, or what we want for ourselves. They have not only designed and mapped out a full therapeutic program, but also scheduled the therapeutic period. For this “rehabilitative” process to be effective it entails a commitment to the full program that has been mapped out. As these inspiring individuals seeking recovery have modeled, renewal takes effort. Time must be carved out to sincerely assess ourselves, to map out a targeted plan of action, and form a concrete contingency plan for the “triggers” that will undoubtedly push me to spiral backward after Rosh Hashana and Yom Kippur have come and gone.

I hope that this year, by taking time to more fully “work a program,” next year’s resolution list will change along with me.

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