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Monday, December 10, 2012

About My Discharge Plan

Apologies if this is a boring post, but it might help you. 
   When you’re in treatment for an addiction of any kind, figuring out what you’re going to do when you leave is a HUGE piece of the process. Things are very safe here in my treatment center. I can’t engage in my eating disorder behaviors. I’m protected from Frank, but out in the real world is a different story. 
            I’m working on my discharge plan. Don’t you fret, I will not be discharging any time soon—I’m pretty sure if I tried my therapist would laugh at me. I’ll stay here until I run out of money or until I’m ready to step down from residential to partial hospitalization program (PHP). We start working on our discharge plans early so we can identify triggers, emotions, and warning signs that lead to negative behaviors. We list coping skills we can utilize other than our eating disorders; specific dietary, exercise, self care, and social commitments; self correction strategies; and support people to call or text or whatever if we feel like we might lapse. The discharge plan helps us have a vision of how our life is going to look outside of the center.
            When I discharge, I’ll have what’s called an “after-care team,” which will include a physician, therapist, dietician, and psychiatrist. Ideally, after residential I will step down to a partial hospitalization program (PHP) from 9 am-6 pm every day. After that I’ll move to an intensive outpatient program (IOP) which is about 3 hours a day 3-4 days a week. Then I’ll attend therapy a couple times a week, go to support groups, etc. That will last anywhere from a few years to the rest of my life.
            A big part of the discharge plan is where I’m going to live. Obviously figuring out where to live is an integral part of finding an aftercare team. Ideally I’ll be able to start working with my aftercare team before I leave here. The problem is I am very confused about where I should live. But one thing I’m certain of: I’m not going back to Seattle. I think my Seattle days are officially over. I liked Opal while I was there, I grew up there, my friends are there, but there’s no questioning that I got worse when I moved home. It’s no one’s fault but mine. Frank was born and raised in that house; I think I’ve binged, purged, restricted, or over-exercised in every room. The stores there remind me, the freeways, restaurants, neighborhoods—nearly everything.
            I need to live somewhere with good PHP and IOP programs. If I stay here I could live with my dad, or get my own place. Living alone is too risky in my opinion, and living with my dad might be hard; BUT if I stay here I can do PHP and IOP and therapy at Center for Change, which would be great because I already know the people here. Another option is to move to Arizona and live with big brother K and his wife J. They live in Gilbert, which is very near the Remuda Ranch PHP and IOP programs. Arizona would be a fresh start, it’s sunny, I could ride my bike everywhere and wouldn’t need a car. Also my beloved dog nephews are there!
            There’s a lot to figure out right now, luckily I have a lot of time to do it. In case anyone is interested, here is a bit of my discharge plan so far:
    • I will eat breakfast every day at a scheduled time
    • I will eat lunch every day at a scheduled time
    • I will eat dinner every day at a scheduled time
      • 1 main and 2 sides
      • Eat intuitively
    • I will not restrict, I will listen to hunger/fullness cues
    • I will be honest if I am struggling and ask for support
    • I will eat 2-3 snacks a day.
      • If I skip a snack I will do the next right thing
      • I will have variety in my meals
    • I will exercise no more than 6 days a week
      • I will not do more than 1 hour a day
      • I will have variety--running, yoga, pilates, zumba
    • I will rest on Sunday
    • For the first month I will not exercise alone
    • I will include going dancing and hiking/riding bike as exercise         
    • I will put real clothes on during the day
    • I will not stay in my exercise clothes all day
    • I will do my hair/makeup at least twice a week
    • I will get at least 7 hours of sleep a night
    • I will not stay up past 10pm on weekdays
    • I will not stay up past 11pm on weekends
    • I will wake up by 8 am on weekdays
      • I can reevaluate this with my therapist and support team 2 weeks after discharge
Alone Time:
    • I will not isolate
    • I will not eat alone, even if I have to eat a snack at a mall or somewhere public
      • I can reevaluate after 2 weeks
Warning Signs Leading to Negative Behaviors
  • Lying
  • Behaving anxiously/erratically
  • Hiding food
  • Blowing up about small things
  • Checking out/isolating
Self-Correction Strategies
  1. If I lapse, I will tell someone within 24 hours
  2. I will not water load at meals
  3. I will not compensate with restricting or exercise
  4. For 2 weeks I will have a nightly check-in with ______

How Support Members can Help
  • If I come to you and admit a lapse, don’t yell at me.
  • Help me eat the next meal or snack; do the next right thing
  • Listen; don’t try to fix it, especially not when I’m in the middle of the chaos
  • Ask me questions about what I was feeling or doing before the lapse
  • Avoid interrogating
  • Ask specifically if I have restricted/binged/purged
  • Do not engage if I start talking about being fat
I hope this post has been educational if nothing else. If you are struggling with an addiction I recommend putting something together like this when you’re thinking clearly, and post it somewhere where people can see it. Tell your family and friends so you can be held accountable. It’s scary. It’s hard. And I think it will be worth it.

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