Any crusty old-timer in AA or NA will insist that geographical change is useless or even counterproductive. Are they wrong?
Kapalua, Maui, on a blustery day. The AA and NA fellowships on the island are strong and vibrant. I was clean and sober for an extended time while living and working with my aunt and uncle on Maui; relocating to Florida and China later on in my life initiated two other periods of extended recovery without maintenance treatment.
If you’re familiar with the lore around the Vietnam War, you’ve probably heard that there were many vets who became addicted to heroin during their tours of duty only to return to the United States and stop using the drug with relative ease. (It's worth noting, however, that many Vietnam vets developed debilitating alcoholism).
Twelve-Step programs emphasize that there is no “geographical cure” for addiction. No matter where you go, they insist, you bring yourself. As with many of the contradictory axioms of these programs, there is truth in this statement. However, these programs also urge avoidance of old “people, places, and things” - a little hard to accomplish without geographical change, no?
My longest periods of recovery without opioid maintenance (suboxone or methadone) have invariably been assisted by major geographic change. On the 17-hour flight from New York City to China, I was so ill from drug withdrawal that I contemplated calling my mom as soon as I arrived to beg for an emergency plane ticket home. However, from the time that I arrived in Shenzhen, I was drawn out of myself by the need to adjust to a new environment (where I didn't speak the language, locks and toilets worked differently, and wallets were obsolete). I was energized by the desire to explore said terra nova and grounded by my responsibilities to my students. Moreover, I began learning a new language with which to reprogram and reinvent myself. (Even today, when I speak Mandarin, I find myself expressing shorter, simpler, more confident, and more positive thoughts than I typically do in English).
Under such circumstances, I was amazed to discover that - although I felt like garbage physically and was full of anxiety - my mind wasn’t torturing me with the intense, interminable cravings that would have typically besieged me; these were dampened by the subconscious knowledge that it was utterly impossible for me to get high, anyway. With the psychological hell of sudden abstinence attenuated, opioid withdrawal became little more than an atrocious, extended flu with insomnia. What's more, this was true despite my failure to practice mindfulness, attend to my spiritual or psychological health, or engage in any type of recovery program.
So, yes, wherever you go, you bring yourself. And I did eventually relapse in China. But geographical change can be a powerful alley-oop towards recovery. This is supported by the neuroscientific evidence, which reveals that a novel environment can help to weaken the neural circuitry that connects environmental stimuli to deleterious thoughts / memories, emotions, and behaviors; it also supports the formation of new loops of cognition and emotion that root us in healthier ways of responding to our environments. For this reason, in my article on factors to consider when choosing an inpatient rehab, I recommended selecting a program in another area whenever possible.
With all of the above in mind, returning to my home city due to the pandemic felt like a death sentence. When I visit my mom in my hometown and run the same hilly, five-mile route that I've been torturing myself with since I was 12 or 13, I say a breathless hello to Dylan at the top of the first hill; he was a close friend of my older brother, and he died of an opioid / benzo overdose not too long after I graduated from college. Further along my route, I pass Rachel (see pic), who was one of my best friends, who died during my second year in China, also of an OD. After the second turn on the rectangular route, there's Jodie, who overdosed shortly after Rachel; Jodie's son and Rachel's daughter used to play together. Next, following the second-to-last turn, there's Tom, Jodie's boyfriend, who passed away from the same cause a couple of years after Jodie. Finally, as I run by the three churches standing sentinel in the center of our village, I pass Nick, who overdosed in 2022. Fewer than five miles through a town of 5,000 residents, and I've passed the houses of five opioid addicts who died of OD, all of them high school classmates of mine.
My dear friend Rachel C., who died in 2018. Rachel and I went to high school together, and she became one of my best friends when I moved back to our hometown a few years after I graduated from college. The two of us used heroin together every single day for over a year, and I doubt that I would have survived that period without Rach, who was a nurse.
Rach was a desert flower that blooms at night; she showed her bravery, wit, and perspicacity most in adversity. Her mother, who was her best friend, died of a prescription drug overdose a few years before Rachel passed. Rachel left behind a wonderful daughter, and my most fervent hope is that this special little girl will break the cycle of addiction.
I miss Rach like a Type 2 diabetic misses cake and cookies; she was exactly the right person to do the wrong thing with.
My addictive experience is embedded into every single facet of my existence here, from my relationships with my friends and family to my educational and work histories to the places that I go for fun. I feel myself regressing into the selfish, deterministic, chaotic Brian of 10 years ago, and this cuts and repulses me. I live in almost complete isolation from friends and family, and - without my fiancé beside me to remind me of the best version of myself as well as what he has achieved - it has started to feel like the "new Brian" was nothing more than a pleasant dream (or worse, a persistent delusion).
I knew what I was facing when I returned from China. Because I had relapsed on prescription opioids and benzos before I left China, I began a long, slow taper off of methadone almost as soon as I arrived home. I kept myself from using alcohol or other drugs for over a year by employing all of the tools that I had learned during years of treatment and recovery - exercise, mindfulness, writing, meetings, service to others.
But in the end, after resisting the 99,999th impulse to use, a Facebook message from an old using friend pinged into my inbox at precisely the wrong time. I gave in. Even before the drugs entered my body, the relief from constant self-resistance was heavenly ("This feeling is worth dying for," I remember thinking as the fentanyl hugged me from within). The "dope" around here is garbage now - fentanyl contaminated with xylazine and probably even God doesn't know what else - and I am more conscious than ever that someone could soon be mentioning me as their deceased friend in a post like this.
I'm doing somewhat better these days, and for the time being, I content myself with attending AA as a wanderer who doesn't have a home group or sponsor. AA is unequivocally the stronger 12-Step fellowship in my area, but my experience with disclosing that I am an opioid addict to AA members here is that they back away swiftly and politely because of A) how many opioid addicts are on buprenorphine (Suboxone) or methadone, which most 12-Steppers consider substances of abuse, and B) how few opioid addicts recover even when they work a strong program. The stark fact is that there are almost no recovering opioid addicts even in the NA meetings around here (West Palm Beach, by contrast, had a sizable and energetic population of young, recovering opioid addicts who were not on maintenance).
For now, I am practicing mindfulness every day, and I am searching for a therapist with whom I can continue my work in Dialectical Behavior Therapy (DBT), which has been the most useful of the therapeutic modalities that I have experience with.
In addition, I'm trying to leverage the psychological knowledge that I referenced above. I make sure to vary my daily routine. This involves living in a different location, choosing new running routes, trying out new restaurants, and forging new friendships. Psychology supports the usefulness of these small-scale changes in disrupting deeply entrenched, negative patterns of remembering, thinking, feeling, and behaving. In effect, I am attempting to create a "place within a place" for myself, my own private hometown.
These measures are temporary. I am hell-bent on getting out of dodge, hopefully by returning to China this summer. As the 17th-century English poet John Milton famously observed, the human mind can make a heaven out of hell. However, this transformative magic is more easily accomplished in some places than in others, and the body that houses the mind must remain alive for it to do so. When the cards are as staggeringly stacked against you as they are for me in my hometown, geographical change is the safe, sensible option.
What about you all? Do any of you have experience with relocation as a facilitator of (or an impediment to) positive change related to addiction, depression / anxiety, problematic relationships, and other struggles in life? For those of you who do not, how have you created a "place within a place" for yourself?
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