A few weeks ago, Sasha and I went to see an addiction medicine psychiatrist in the Chemical Dependency Recovery Program subspecialty of the Psychiatry Department at the hospital where I work. This appointment was made shortly after I discovered the humongous stashes of chocolate and the leftover wrappers that I found in his room one day. I suspected that he may have great difficulties resisting temptations for sugar, especially chocolate. I explained Sasha's complex medical history including his HO and my attempts to help him with oxytocin. I told him that I believed he behaved in a way that resembled a "carb/sugar addict" and I wondered if an opiate antagonist like Naltrexone might help reduce his urges for sugary foods. After some discussion, Dr. L agreed to provide him with a script for Naltrexone and advised me to try it after optimizing the effects of oxytocin first.
I'm not sure if we have truly optimized oxytocin's therapeutic effect at this point but I do think Sasha may be ready to be tested with increased freedom around food. As I mentioned in my last posting, I fully expect him to have huge hangups about food- how could he not have a bizarro relationship to food with his own obsessive focus on it AND with our hyper-intense micromanagement of his food?? It seems that the next step would be to actually give him some liberties in order for him to learn that 1) food is plentiful and available if needed and 2) there is no need to hoard it or eat in excess anymore and 3) it will be possible to trust oneself and one's body to decide when and how much to eat which could then 4) eliminate the need for the food police to provide external "food security" since "food security" would become an intrinsically felt experience.
I am well aware of how long it could take for Sasha to overcome his deeply engrained anxiety about food given his five year history of feeling intensely hungry and focused on food whilst his parents and other adults imposed strict control and restrictions on what he was allowed to eat and when he was allowed to eat. It's amazing he is as good natured as he is given this very harsh lifestyle he was forced to follow... Needless to say, his food police have also been deeply conditioned to feel high vigilance and anxiety about Sasha's food seeking. It has been a tortured relationship, indeed, that we have had with food in our home!
As I anticipate this transition we plan to make, I am filled with trepidation. I have lived in this paranoid "police state" for so long... despite my loathing for this locked up kitchen and hypervigilance around food, it is familiar and even comforting in a weird way. I can relax in my home with Sasha because I know the food is locked up. I cannot relax with Sasha in someone else's home because I don't know what Sasha will do around the food.
Now that he is on the oxytocin and believe we are seeing how it helps to normalize his appetite, we badly want to trust him. If I could wave a magic wand, I would wish myself the ability to totally trust him and to just let down my guard completely when he is around food. Sigh. If only it were that easy. I have already learned my lesson about the need to ensure some level of security so that he isn't able to go completely whole hog before he's ready (like have access to a 24-hour grocery store's candy collection) so I will be sure to keep up a certain amount of protection even as we transition to more freedom... similar to having a net for trapeze artists, just in case they fall. So I'm not naïve to the challenge of this transition and I know there's no easy way to make these changes, only hard work. The work we will need to do will involve a gradual letting go of control around Sasha and food. I expect that we will start with a relatively manageable task like leaving the fridge unlocked right after meals (after he has eaten and feels full) for an hour or two and then expanding the time. For myself, I know one of the biggest challenges will be to keep my eyes open and my mouth shut if and when I see him taking more food that I think he should have. He may end up overeating or hoarding extra food in the beginning (I will probably still insist that he not be allowed to store or eat food in his room since it is a household rule that we eat only in the kitchen and dining room). I can only hope that over time, he will realize that he doesn't need to hoard or eat extra food since he is no longer having to live with such a feeling of scarcity and lack of control. I must tell myself to be patient with him during this transition!
So far, my plan is to write up a gradual exposure hierarchy with Sasha and his therapist and to have Sasha practice being around these new situations in which he will have more access to food. We will start out very slowly to give him a chance to make food choices with his own discretion...we will test out the waters and I will get some Ativan (kidding, sort of) to calm down my inner Kitchen Bitch...(after all, the Rolling Stones sang about the need for this in their song "Mother's Little Helper") And if Sasha has a really hard time resisting impulses regarding hoarding or stealing food and appears to need some additional support, we will consider adding Naltrexone and see what happens...
No comments:
Post a Comment