Harm Reduction

In the addiction community, there are two types of “recovery.” One is abstinence-based (completely abstaining from all drugs and alcohol) and one is harm-reduced based (drinking or using in moderation, or at least, in a safer environment than one is used to). Coming from a background in 12-Step, I always firmly believed in abstinence only. I never once believed an addict could use in moderation because, in time, they would eventually relapse. I actually still do believe this to an extent, however, not as passionately and vehemently as I used to. I think it’s different for everybody. My husband, a former cocaine addict, went to rehab once and never went back. He’s been clean from drugs for almost 20 years. He doesn’t believe he could ever use cocaine in moderation, hence being clean, however, he has used marijuana and alcohol since getting out of rehab when he was in high school. It didn’t lead him back to cocaine, nor did it turn him into a habitual pot smoker or alcoholic. As for me, I believed I needed to abstain completely from my eating disorder because it was too easy for me to play around with ED behaviors. After all, my husband doesn’t need cocaine to live, but I certainly need food to survive.

With that said, what I’m engaging in right now is harm reduction. I’m not abstaining from eating disorder behaviors, but I’m limiting them in hopes of maintaining my good health and emotional well-being. My ultimate goal is to still lose weight, but I can’t pretend like harm reduction fixes everything. I may not be constantly bingeing or weighing, I may not be constantly isolating or snapping at my husband, but I am still hiding a scale in my pajama drawer and eating almost 1,000 calories below my agreed caloric intake when I said I was beginning recovery again back in November of 2011.

I’m practicing harm reduction, the very same thing I preach to my clients to avoid. Is an alcoholic who moderately drinks really in recovery? Is an OxyContin addict who kicks his habit by visiting a methadone clinic every morning really in recovery? Is a heroin addict who goes into a clinic that offers clean needles really in recovery? Or are they just masking problems under the fact that they are “managing” their addictions? After all, if our lives really are good, there should be no reason to continue the self-destructive behavior, even if it is in moderation. Is harm reduction just an easy excuse to continue to get high or drunk? And given the fact that addiction is apparently genetically pre-disposed, can someone really use their drug of choice in moderation or will their brains eventually take over and do them in again?

I don’t believe what I’m doing is right. I believe to be truly free and happy, I must surrender all ED behaviors. But at the same time, I can see myself living the rest of my life like this. As long as I maintained my weight (Goal of 14 range BMI), ate enough to limit binges, felt relatively normal and happy, and no longer had compulsions, why not? Logically I know why not, but that’s what my brains says every day when I’m questioning when this will all end. Will I die from this? Will I survive until I’m 80 like this? Will I ever feel as connected to OA like I did a year ago? Will I ever go back? Will I ever eat normally again? Will I ever go into treatment? For today I’m practicing harm reduction, and it’s something I don’t necessarily agree with. How is that even possible? I guess as long as it keeps my eating disorder alive, I will agree to anything.

EDIT: Also want to add in that this whole relapse started with a safe, healthy diet. I lost weight slowly and safely. So in my own way, I was “using in moderation” and eventually relapsed. Harm reduction, as nice as it sounds, just doesn’t work, at least for me. As I said before, I think to be truly “free,” I need to abstain completely, or as best as I can.

I’m Sorry, I Just Can’t

It’s Friday night. I have two options: I can go home or I can go to my regular 12-Step step study. I choose option two because I haven’t been in two weeks; I have to keep up appearances or else people will wonder what’s going on.

I no longer feel the need to go. I’ve worked the same damn steps multiple times; I can only write down the same resentments and defects so many times before it just becomes a chore rather than a tool. There are things I need to surrender, but they aren’t pressing enough for me to do so. So I sit down, tune myself out, and hope the hour and a half group goes by quickly.

The first two members share on Step 6, commenting on their negative characteristics and what they are doing to eliminate them. I catch glimpses of words like “selfish” and “dishonesty” between thinking of what babble I am going to say once it’s my turn to share. I haven’t done the homework for the week; it’s pointless. I know my defects and I know what I must do to get rid of them; I don’t need to analyze them over the ten blank questions that lay in front of me.

Each member takes about ten minutes; I already know I’ll take under three.I come up with brilliant comparisons and 12-Step lingo that will make me seem like I am doing better than I really am, although half the members will most likely see through my exaggerations. As they say, you can’t bullshit a bullshitter.

A third member shares and I get bored. I try calculating calories in my head. I am currently running off of 460 for the day, leaving 190 left over for home. I can’t calculate correctly in my head so I openly scribble numbers on my paper trying to see which foods I can eat later. We are low on options but 190 calories is a lot. I could have eight slices of turkey meat. I could have a Carnation Instant Breakfast drink. Hell, I could have a half cup of ice cream with 50 calories to spare. But I settle on one and a half cups of rice cereal with a half cup of milk. I tally the calories on my step work, making sure everything fits.

When it’s my turn, I spew out some half-truths and omit other things completely. My husband and I really have been doing well. I really am trying to manage the eating disorder. I really am trying to gossip less. I smile and act like I am not totally tired and hungry and cold, and once I finish, I patiently wait for the last two members to go. I tune them out, too.

When the meeting finishes, the only man in our group who is abstaining from bulimia comes to speak with me. He’s in his 50s and has taken me under his wing. He asks me if I can commit to going to the Sunday morning meeting. I tell him I can’t commit and that I am sorry. He asks me to commit to an hour of program a day. I again say sorry, but that I can’t. I suddenly feel like I am being pressured to join a religion that I don’t agree with. I tell him that I feel like I am disappointing him. He says I could never disappoint him, but that he wants to see me get better. He says I am young and that I have my whole life ahead of me. He begins to get misty-eyed and says, “I want to see you alive to live that life.” He hugs me and I say thanks, repeating that yes, I know that this is lethal and that I know I should be in recovery. I am uncomfortable to the extreme, and I feel guilty for making a grown man tear up. I leave in haste, feeling like I just broke a man’s heart. I decide I should probably just drop out of the study.

They just don’t understand. My life is manageable. My food is decent. My health is fine. I’m not depressed. I enjoy my life. I am not running away from my problems. They are making this a bigger deal than it is.

Then why are you still trying to control your food and weight?

I don’t know.

I go home and eat my cereal. And later, even though I am not feeling like eating, I eat a bit of ice cream and peanut butter. I’m okay with this, and go up to bed.

I am the same weight this morning as yesterday, and I am okay with that, too.

Tomorrow I have the option of going to the morning meeting, but that, I am not okay with.

I am sorry, I just can’t.

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Compulsive Overeater VS. Anorectic

When I started this blog, it began as a tool of my recovery as I continued my journey with Overeaters Anonymous, a 12-step program for eating disorders. If you are a new reader, and you go back to the beginning of this blog, you’ll see that the entries I wrote in 2007 were very different than the ones I write now.

I don’t talk much about the program anymore, even though I do occasionally post 12-step work. I feel disconnected from the program, especially now that I am in relapse, but even more so because the majority of people in the meetings are compulsive overeaters. What is strange is that I felt such at home with OA and never saw the differences of compulsive overeating and anorexia. I never once thought that the people there were lazy, or fat, or struggling with a problem lesser than mine. I never once thought that maybe, on some level, those who saw me secretly resented me for being underweight and not having issues with food as they did. I never saw those things, because recovery was too important for me to let those things get in the way. If people had issues, those issues were no business of mine, and if I had issues, then I wasn’t following the OA tradition of putting “principles before personalities.”

Now that I am in relapse, I see things totally differently. I don’t like talking about my relapse. I don’t like “complaining” about how hard it is to eat normally. I don’t like saying how I feel like I’m fat. Why? Because I know most of these overweight people who struggle with binge eating disorder are probably offended in some way.

I started the first OA group on facebook and a fellow member said she wished she could shake those who were underweight in order to convince them they weren’t fat. She went on to say how jealous she was of us, and how we had nothing to complain about until we knew what it felt like to be 200 + pounds.

Without going into too much detail and breaking anonymity, I responded by stating that posts like hers are part of the reason why I don’t feel comfortable speaking up about anorexia in an Overeaters Anonymous meeting. She then responded how she understood because she “used to be anorexic” but that it still frustrated her to see underweight people complain about being fat. For an “anorexic” who “understands,” I find it hard to believe she would get frustrated at someone who legitimately felt they were fat. She justified her rant by saying how people like me make her feel like crap because she wishes she could look like us. Last time I checked, how YOU feel is YOUR responsibility. I’m also pretty sure my weight, all 80 whopping pounds of it, does not have the power to make you feel like crap.

I can see how one can get frustrated. I, too, get frustrated when the Abercrombie-wearing, big sunglass-sporting, bleach-blonde, duck-lipped teenager complains about how fat she is when clearly, she knows she isn’t. But there’s a HUGE difference between that type of person and a person who sits in an OA meeting who may be desperate for help and in need of support.

If I could go to Eating Disorders Anonymous or Anorexics and Bulimics Anonymous, I would. But unfortunately, I don’t have the luxury of living in LA or San Francisco where all those meetings are held. So until then, I will continue to attend OA. In the end, we ALL have issues with weight and food regardless if we are underweight and restricting, overweight and bingeing, or a mixture of both. I may not understand what it feels to be overweight. You may not understand what it feels like to be underweight. But regardless of what weight we are, we are all judged in one way or another. Being overweight sucks. But being very underweight isn’t a party either. Please don’t tell me you wish to be like me. An eating disorder is an eating disorder, and regardless of what we look like, we ALL feel like SHIT in the end.

Edit: BRILLIANT! She went on to say how anorectics don’t overeat (as in, AN ANOREXIC WOULD NEVER UNDERSTAND WHAT IT’S LIKE!). I kindly let her know that I binge quite often. Her response? “But you only overeat because if you don’t you will die! I am fat and don’t need to overeat but I do anyway!”

*face palm to the highest degree.*

My Flaws (Step 4)

So I’m working on Step 4 of the 12 steps. The first part is to write about my flaws and then come up with assets that refute those flaws.

My list was pretty extensive and included being afraid, avoidant, careless, conceited, deceitful, dependent, dishonest, envying, exaggerating, forgetful, impatient, insecure, justifying, lazy, pessimistic, procrastinates, and rationalizing.

With these though, I was able to think of assets that refuted them. For example, in terms of my dishonesty, I’m actually quite honest when doing step work and writing in here, not being afraid to tell the truth about who I am or what I do.

However, there were four flaws that I literally could NOT think of assets to, so I’m assuming those are the ones I need to work on most:

Gossiping
Inconsiderate
Self-destructive
Selfish

Gossiping: I talk way too much about people behind their back, especially at work. When someone is talking crap about someone that I don’t like, I don’t hesitate to join in on the conversation. When I know something “juicy,” I seldom keep it to myself and tell it to anyone I know who would appreciate the information.

Inconsiderate: I rarely take other people’s feelings into consideration.  My husband often surprises me with little romantic things and I never do. When people ask me how I am, I often answer and forget to ask them how THEY are doing. I often zone out when people are talking to me about something I don’t care about (even if they DO care). I don’t put my clients first nor do I really care where they go after they graduate from my program. I don’t send birthday cards to those who send me one.

Self-destructive: I almost didn’t even circle this one, but then I figured restricting my food intake and severely limiting my vegetable and fruit intake is doing damage to my body in the long run. The emotional toll it takes is pretty high as well. I’m angry/irritable more days than not.

Selfish: Putting my life in danger is selfish and unfair to my loved ones and potential children. I often get upset when our money is spent on unnecessary things but don’t think twice when I buy binge foods or new shoes or make-up. All of my actions are usually for my benefit.

Even when I was in hardcore recovery, I still struggled with these behaviors. But when I was in recovery, I had a better grasp of what was reality and could stop myself when I recognized the behaviors. In my eating disorder, I fully give into these things and don’t think twice. It made me feel like shit when I couldn’t think of an asset to go with these four flaws, but at the same time, at least I recognize them in this mind frame (seeing them as negative) vs. the ED mind frame (not giving a fuck).

They say you can’t fully work the steps unless you are abstinent from your eating disorder. That’s probably true. When I ask myself, “Can you stop yourself from being inconsiderate?” I think so, but at the same time, I’m more likely to be considerate of others when I’m thinking straight and not irritable from starving. I’m more likely be concerned with others when I’m eating healthy and taking care of my body. I’m more likely shut my mouth when I can be secure with myself and not needing the constant attention of others. And that is all easier when I am content, present, and well-fed.

So can I continue with the steps while I’m still restricting? I can try, but I’m not so sure how beneficial it will be, especially because I’m only really on Step 3 in my heart. Step 1, admit you have a problem. Check. Step 2, came to believe in a Higher Power. Check. Step 3, surrender. I’ve got nothing for you there.

Step 3 for me would be to eat three, moderate meals a day and to surrender my weight.

I keep saying, “Well, I’ll surrender my weight once I hit below 78 pounds.”

Which goes completely against what surrendering actually means.  Surrendering means no conditions or terms, and unfortunately, I can’t do it yet.

Finally Back in the 70s

It’s hard sitting in 12 step meetings with the notion you have given up on changing your ED behaviors. Because then you sit there and say, “Okay, I am working a recovery program, but around what if it’s not the food?”

I ate a cupcake, cookie, and ten almonds yesterday so by the time the meeting rolled around my mind felt fried. I couldn’t put thoughts together and the thought of having to open my mouth and speak made my heart race. I was afraid I wouldn’t eve be able to put a coherent sentence together. I was so weak and tired from not eating that all I wanted to do was sleep.

When it finally got to my turn, despite feeling everything above, words did manage to explode out of my mouth and tears ensued. I told them I had no problems now with Step 1 (admitting a problem) and Step 2 (believing a Higher Power can help me) but Step 3 (turning everything over, or in other words, letting go of the ED) was a whole different story.

I feel tugged in different directions. I feel like the more I make myself vulnerable, the more I betray my eating disorder. It wants to be thoroughly protected and every time I go and speak in a meeting, it’s like I am slowly getting pulled away from the depths of something that already has a firm grip on me.

This morning a bulimic man from the meeting called me and told me he has been where I am now. Not wanting to give up the behaviors. Everything he was saying was making perfect sense, but all the while I could hear my ED telling me not to listen…because if I listened and took what he said to heart, I may actually get closer to wanting recovery again.

My eating disorder can’t have that.

Especially since I am finally 79 pounds again.

That will most likely change this weekend, but just the fact that I haven’t seen that number since Thanskgiving weekend? I am happy. My new work schedule almost makes it easy to eat less. I am actually excited for the week to come to see if I can continue this weight loss.

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Eating Disorder Dynamics

So there are two interesting dynamics going on with my eating disorder :

1.) The fact that I am a substance abuse counselor.

I don’t like telling my clients I am in “recovery” from addiction because then there is this notion that I am a strong person who has the ability to stay “clean and sober.” (Clients do not know I had an eating disorder an assume I am in recovery from drugs or alcohol.) Clients suddenly look up to me which makes it ten times harder to make any mistakes. It’s almost as if I can’t be human or else they will use that against me in order to fuel their own addictions — as in, “If YOU can’t be perfect, how am I supposed to be?” It’s the same when students balk when they see their teachers in a bar or when patients see their doctor’s smoking. Nobody likes a hypocrite, am I right?

I also don’t like telling people in the 12-step community that I am a substance abuse counselor. Similar to my clients, if the 12-step community knows I am a counselor and that I have relapsed, I’m afraid they will think, “You’re a counselor, shouldn’t you KNOW better?” or “How are you supposed to help all those people when you can’t even help yourself?”

So there lies the interesting dynamic — an addict who is an addiction counselor. How does that even work? It doesn’t work very well unless the recovery is strong.

2.) The fact that I want a baby.

A big part of my eating disorder is about staying child-like and young. It’s about not having to grow up and become a woman. And yet one of my biggest wishes is to get pregnant. And yet it’s never going to happen with my eating disorder. Someone my size probably wouldn’t be able to carry a baby to term (if I could even get pregnant at this weight). And let’s say I do get pregnant — getting pregnant means “getting fat.” The one thing I want most will make me the one thing I want least — fat. Everything about getting pregnant is the direct opposite of everything my eating disorder brings to the table: Getting pregnant and having a child is about womanhood, responsibility, growing up, eating right, caring for someone else other than yourself. Having an eating disorder is about staying child-like, being afraid to grow up, not eating at all, and being completely selfish.

And there you have it.

Step Study — Step 2

Step 2 — Came to believe that a power greater than myself could restore me to sanity.

1.) Did I make insane decisions as a result of my addiction (eating disorder)?

Yes. The decision to lose weight under what is normal would be an “insane” decision to normal society. Granted I haven’t accomplished being grossly underweight, the want alone to be skeletal is irrational. The amount of food I eat a day could be considered insane, and the things it leads me to do are insane: bingeing, hoarding food, stealing food, eating uncooked food, eating food that is too hot, hiding food, etc. I’ve also gone back and forth on several online blogs/diaries on whether or not I’ve had a problem, I’ve posted half-naked pictures of myself in order to gain attention, I’ve weighed myself and treated the scale like my drug of choice, I’ve gone to insane measures to use the scale, I’ve had irrational thoughts like, “How much would I weight if I shaved my entire body?”,  I’ve completely put having a baby on the back burner in order to continue my eating disorder behavior.

Step Study, Step 1, Part 2

7.) What trouble have I had as a result of my anorexia?

I don’t think my anorexia has caused any trouble, honestly.  If I had never said anything to anyone, my husband would have never noticed, my work wouldn’t have intervened and made a big deal out of it, and I wouldn’t be in the situation I am now of trying to “be” in recovery. Now, I will say it was causing me emotional stress, but that’s more because of the guilt of not telling my husband I was weighing and restricting my food. Now that it is out in the open, I don’t feel as guilty weighing and restricting. I think I’ve convinced myself that it’s not really a problem and that I was throwing things out of proportion.

8.) Is there something I think I cannot get through without “using” (starving, restricting) that will be too painful that I will need my anorexia to survive?

Yes. The thought of not having a child. That’s the last thing I want to deal with and face right now. Right now I’d rather focus on myself and what I look like than have to go through the emotional rollercoaster that is fertility treatment (and for those of you who don’t know…the infertility is on his end, not mine.)

9.) Do I accept that I will never gain control even after long periods of abstinence?

I accept there are certain things out of my control — like work, having a baby, other people, etc. But there’s a huge part of me who thinks I can remain in control of my food and weight. There has been a point in my life where I was able to give my weight up to my higher power (let my body choose what weight I should be at), but at this point, I’m too scared to do that as I would like to stay this weight or under for the rest of my life.

10.) Have I made peace with the fact that I am an addict?

I go back and forth. The logical part of me knows I’ve struggled with an eating disorder since I was 15. The less logical part of me no longer sees it as an eating disorder and demands that it is a choice/lifestyle.

11.) What am I willing to do for my recovery today and why?

I don’t really feel like I am in recovery, but for today I am willing to fill out these questions and go to the step-study tonight with an open mind. I do know I need to strengthen my emotional health, and if this step-study can help me do that, then I will keep going.

12.) What is the principle behind Step 1 and am I practicing it in all my affairs?

The principle of Step 1 is to accept powerlessness over what you can’t control. I think I do a pretty good job of this in all my affairs, except the baby one. I do what I can, and the results are out of my hands. I have no control over most things in my life.

13.) Define your abstinence.

In Eating Disorders Anonymous, there IS no abstinence. No set food plan, no counting days, no “sobriety.” EDA feels that doing so is too much of an eating disorder/anorexic behavior so they focus more on moderation. Eating balanced meals for you, whatever that may be. As of right now, I like how much I eat and it’s gotten me through the week with no hardcore binges. Is it healthy? Probably not. But I feel that if I stopped putting so much emphasis on what everyone else thought of my food intake, it wouldn’t make me feel so guilty. Or maybe, in reality, I feel guilty because I secretly know it’s bad.

Ugh.

The Insanity of an Eating Disorder

I’m alone for the next three or four days as my husband is on a business trip.

Apart of me is sad because I’ll miss him, but another part of me is elated because I can totally immerse myself in my eating disorder without having to look over my shoulder. It’s already started. Today I went to CVS and bought myself a box of chocolates. I’ve never had a box of chocolates all to myself, so I thought, “fuck it — buy yourself an entire box.” It was no Sees candy or anything fancy, but the fact that the entire box is MINE makes me giddy. Stupid, right? I’ve already had like four or five pieces today. My food intake has been sporadic — I’ve had 1 and 1/2 chicken breasts, a tilapia filet, some rice-o-roni, some veggies, a can of tuna, the chocolates, some honey roasted peanuts, a cracker, a chocolate smoothie from Starbucks, a Sweet Tea from McDonalds (280 effing cals)…I also raided the fridge and got rid of old food and dumped the rest of the honey roasted peanuts in the trash. I also got rid of the boy’s leftover Christmas candy. I have two and a half packages of Ritz crackers I am bringing to work. If I don’t, I will binge on all of them while my husband is gone.

Embarrassing ED moment today is when my nine-year-old step-son goes to eat his chocolate candy balls and finds they are gone. “Where are my candy balls?” I say nothing — knowing I secretly ate them.

I was 81 pounds this morning. I always fuck up my food on the weekends because it’s easier to eat whatever is available.  My plan for the next three or four days is to eat the following:

Breakfast: 1 banana (if I don’t eat them, they will go bad)
Lunch:  9 reduced fat tortilla chips, 1/2 can tuna, 1 Tbs. teriyaki sauce
Dinner: 1 small chicken breast, 1/4 cup rice-o-roni, 1 cup broccoli, 1 cup pears, 1 Tbs. teriyaki sauce
Snack: 1 chocolate (50 calories in one tiny fucking chocolate?!)
Total estimated calories:  708 calories

As of now, there is literally no other food in the house besides the above foods and Clif bars, dried fruit, cereal, yogurt, bread, and canned goods. There’s a chance I will indulge in a Clif bar, but there’s only a couple left and I’d rather save them for my husband. They are DEATHLY though — 250 calories for one bar the size of my palm.

Step Study: Week 1

I joined a 12 Step step study. I’ll be talking a little more about it in another post, but my assignment for this week is to read Chapter 3 of the Alcoholics Anonymous Big Book and the First Step of a program of my choice. I’m choosing to go with Eating Disorders Anonymous and I’ll be reading their version of Step 1.

I also have to answer 13 questions, six of which I’ll be doing in this post: