Maintaining Recovery through Connection: Expert Tips from an Addiction Medicine Physician on the Holiday Season
The holiday season can be a difficult time for those in recovery from drugs and alcohol. Whether it be the loneliness of isolation or the pain of unresolved family issues, a mix of temptations, triggers and stressors can conspire to challenge even a longstanding recovery. Fortunately, there are many effective ways to manage the complexities of addiction recovery during the holidays. The following conversation with Dr. Sally Combest, CleanSlate Regional Medical Director, will equip you with tools for a healthier, happier holiday experience.
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Dr. Sally Combest
Could you please introduce yourself and explain your path to addiction medicine?
Dr. Combest: I’m the Regional Director for all CleanSlate facilities in Arizona, Wisconsin and Kentucky. I’m board certified in addiction medicine, and have been with CleanSlate for over five years. I got here via a path most wouldn’t expect. I’m originally board certified in anesthesiology, which I practiced and taught for over 20 years. During my time in academic medicine, we had to address the growing issue of addiction among physicians. At least at that time, anesthesiologists had the highest incidence of opioid use disorder among all medical specialties. I encountered doctors who wrecked their lives and careers, barred forever from anesthesiology. I wondered how people who have studied and worked so hard end up in that position. This was before a lot of the current data about addiction and the brain was known. I was fascinated, and I transitioned over that way.
In your experience, what are the main challenges that individuals in recovery face during the holiday season?
Dr. Combest: Despite the cultural sense that the holidays are this wonderful time of year with family, food, gifts and cheer, for many of our patients the holiday time exacerbates the issues that they’re struggling with in their day-to-day life. They might be separated from their loved ones because of the challenges that their substance use disorder has created. It can bring up a lot of things that cause people increased stress, depression and sense of isolation.
When they’re homeless or estranged from their family, it can feel as if the whole rest of the world is celebrating family get-togethers or getting on planes to go back home to visit and reconnect. Being isolated from that cultural phenomenon can really drag up a lot old wounds from family relationships that have not yet been adequately worked through and healed. So it’s a time of distress for many patients with substance use disorders.
What are some effective strategies to help individuals in recovery prepare for the holiday season?
Dr. Combest: The first is simply recognizing that not everyone is going to have this happy holiday spirit. This involves an awareness that many of our patients may not be in that same holiday mood as we are, and keeping our private lives more separate from our professional interactions.
We also need to be very supportive, understanding that our patients may need more support than they’ve needed recently, even if they don’t recognize it themselves. They might need to come in and see us more often—not because they’ve returned to use, but because they need that human connection more when they’re struggling in their private lives.
For a patient with substance use disorder, stress—whether it’s emotional or physical—can result physiologically in more cravings. They may not understand why, despite doing well and being stable for six months, suddenly they’re thinking more about using or experiencing intrusive thoughts about using. That’s on us to help our patients understand that stress can lead to cravings. We address all of this proactively in our patients, so that we can help prevent that backslide to using.
How important are support systems during the holidays, and what role can family and friends play in aiding recovery?
Dr. Combest: Support systems are absolutely important, and the role of family and friends depends on individual circumstances. Some people still have family and/or friends who are quite supportive. Other people really have no one, except maybe other people who use. Of course that can be quite a trigger for patients who feel kind of down in the dumps. We’re creatures of habit, and if there’s emotional distress, they’ll want to relieve it in familiar ways.
So we need to help them find support wherever they can get it, whether it’s CleanSlate, a sponsor, family member, friend, a NA or AA meeting or an online recovery meeting—whatever support that’s available.
One thing we could do better here is educate our patients that coming in to see us is not a sign of failure or weakness. It’s a sign that this is a time that you could use added support. And let’s think about doing that before you struggle and have a return to use.
There was a patient once who would come in to CleanSlate and sit in the waiting room to connect with his touchstone in recovery. He didn’t have an appointment. He just wanted to come in because it was a supportive environment. Everyone knew him and treated him with respect and kindness. He didn’t have a sponsor, but he would come into the waiting room and hang out, chat with the medical receptionist and talk with other patients who were there for their appointments. Then when he’d refueled his spirit enough, he’d head on out and continue with his day.
If this is what one of our patients need, that’s fine. It’s going to be very individualized. And again, it’s on us to point out to patients that the holidays can be challenging, and ask them what we can do to help them prepare. Some people are going to be excited for the holidays. So patients’ needs are variable. But it’s an important conversation to have regardless.
What are your top tips for preventing relapse during this potentially stressful time?
Dr. Combest: Again, it’s a matter of educating patients on the risk of holiday stress, and educating them that their own experience is worthy of discussing, determining their needs during this time and finding ways for them to connect with people who are important to them. Connections are very, very important to the human experience.
Many of our patients, especially in those earlier times, may be experiencing homelessness, loss of family, marriage and jobs, and they really have no connections whatsoever. So we help them connect in some way—to us, to meetings, or a recovery program online, etc. And we help them build their confidence to reach out and meet other people and not be stopped by a fear of rejection.
Some of them isolate because all they know are other people who use. So they isolate to protect themselves from the risk of using with those people, but there’s no one else in their lives. Our job is to help them connect with us and others. Connection is essential.
How do you help individuals in recovery practice self-care during the holidays?
Dr. Combest: It all depends on where they stand on the hierarchy of needs. Are they experiencing homelessness? Then they need a shelter and other physical needs met. So we first decrease the added physical stress of the winter time. Some centers, for example, do coat drives. We also help patients understand the importance of sleep and diet, to meet fundamental physical needs, like avoiding malnutrition. Finally, with respect to physical needs, we ensure that they’re adequately medicated to physically suppress those cravings to use.
Regarding their spiritual needs, we try to help them find solace, comfort and strength, and connect them to some spiritual organization that doesn’t have stigma and understands how to interact with people with substance use disorders.
Along with physical and spiritual needs, we help them meet their emotional needs through human connection and experience. How can we get patients connected to a community that supports them? 12 Step programs as well as sober living and recovery houses for a 24/7 living environment are great resources that might be underutilized at times.
Ultimately, recovery needs to come first in self-care. Everything else follows from that. Things get so much easier in rebuilding your family, relationships, jobs and ability to house yourself. Everything becomes smoother when your recovery is stable. Staying in recovery is the foundation of your life—however that looks for you.
Without revealing any identifying details, can you share a success story of someone who successfully navigated the holiday season while in recovery?
Dr. Combest: There are hundreds of stories across CleanSlate, but the one that stands out to me is the man I mentioned above who would come in to the clinic and sit in the waiting room. It’s a very vivid image in my mind. This started during the holidays. It was a place to get out of the cold, and we also gave him a coat. He continued to come after that, as he felt the need. We were his community. We were his support. Other clinics have hosted Thanksgiving meals for patients to come in and share. They break bread together as a community and begin slowly to connect.
As you face the holiday season, remember that you’re not alone in your journey of recovery.
If you or a loved one is struggling, reach out today (833) 505-4673 to get the treatment you need.
