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Navigating the Obstacle Course

"I Have a Voice in the Back of My Head Saying 'I Need Help'!"

October 2004

Navigating the Obstacle Course
I was let go from my job and so for the summer I have been living on my unemployment check. With no job, I've been leading a "party boy" lifestyle, sleeping late and going out at night 'til dawn. Being HIV-positive and over 40 years old, I know I should protect my health, but my days are pretty much gone by the time I finally get out of bed. Naturally I drink way too much, take drugs, and have a pretty wild sex life. I also need to look into getting more consistent medical care and finding a way to pay for it, but dealing with all that is a big downer. So tonight I'm going out to party, drink, smoke, and "get down" with somebody. But I still have a voice in the back of my head saying "I need help"! So where do I start?

A Response to this Composite Case Study

Someone like yourself who wishes to gain control over an unstructured life must find ways to break down the areas in your life into smaller parts. If your fears have gained control and are directing your behavior, it can prove to be very difficult to be productive. Fear often rules us, so that instead of dealing with issues of concern we may try to run away from our problems by allowing ourselves to use alcohol or drugs or to act out sexually. To self-medicate with substances or to have quick sexual interactions does, of course, give people some temporary escape. However, the real problems don't fade away. In fact, they become compounded, and the ability to deal effectively with the true issues can become more problematic with time. Please remember that seldom does your emotional and physical health improve without some kind of intervention. Map out small steps and start the ground work for achieving emotional and physical stability. Here are some steps that hopefully will help you get started.

Motivation and Accountability

For anyone who is attempting to escape their problems by leading an unstructured life, it is always important to remember that you must be accountable for your own behavior and to understand you must be motivated to change your behavior. Your world may seem to be overwhelming now, but taking very small steps with a true motivation to change will lead in time to big steps and in many cases to big changes in your life. In order for change to take place you must begin to build a stable foundation by first taking responsibility for your situation and truly wanting to change your behavior.

Facing Your Fears

Navigating the Obstacle Course
The fact that your are HIV-positive and not getting consistent medical care is a major reason that you should be telling yourself to get up, get out of bed and make a doctor's appointment. By staying in bed, you are not dealing with the important issues in your life. In fact, you are putting off doing the very thing that would actually give you the most control and power in your life. Right now your fears are in control of your life and are fueling your self-destructive activities.

The bottom line here is for you to develop a road map that you can use to improve your situation. This would be a general guide and you would have to "buy into it" by adding the personal changes in your intervention plan that would make it work for you. It is important for you to remember that you are the expert about what you can and can't do in your life. Don't attempt to do everything all at once, but do attempt to complete a planned task daily. Having a sense of structure, including clear goals, is basic to everyone's life. Spend the time to think out what you want and need. Then write it down into daily and weekly goals that you will complete in that time frame.

Writing Down Your Goals

Create a list of short and long-term goals on a sheet of paper. Short-term goals should be listed along with completion dates, for example: one month, three months, six months. Long-term goals are those that will take a year or longer and need to be revisited every six months and re-evaluated when progress isn't being made. By making a list, you are giving yourself structure and a map on what you expect to get done in a time-limited matter. Once finished, place it on your refrigerator and attempt to follow it. On a separate list make what you will accomplish for the current week and the following week. Every two weeks complete another list and follow it. Then look at your list daily and keep the appointments you have listed!

The very first step would be to make an appointment with your medical doctor and take responsibility for your own emotional and physical health. A caring, concerned, and HIV/AIDS-knowledgeable medical doctor is a great foundation. Go in for the appointment and get the facts. That would be the first step to gaining control of your fears -- by gaining the education and information you need to take charge of your physical health. If you don't like your doctor or feel he or she is not medically competent, then look for another opinion from a qualified doctor. Connecting with a good medical doctor that you trust and believe in is essential.

Accepting Help

Navigating the Obstacle Course
Consider HIV/AIDS case manager services to help you map out what services and assistance you will need. It can be overwhelming for you or anyone to deal with the medical concerns on top of all the normal and natural stressors that people deal with daily. Having a case manager to assist you in gaining access to the services you need can be a great help. You may need additional medical care, assistance with paying bills, counseling for your substance abuse, and help with other medical issues in your future. By working with a good agency that pairs you with a competent case manager, your can start to gain control over your medical concerns.

You should also consider support groups, which provide structure and offer direct pay-offs. Although substance abuse groups are available to all people, for many they don't offer tangible rewards. Consider support groups that include free meals or snacks afterwards with social time, interesting locations, and possible travel reimbursement like Metrocards. Those little extras really do help and may prove to be the additional benefits you need to encourage you to go to your needed groups, which over time may provide you with the structure and health benefits you need. People who don't have structured lives and who lack short- and long-term goals are ungrounded, and this provides the fuel for their current depression and substance abuse.

Gaining Control Over Your Sleep

Sleep is an important element of anyone's health. However, escaping from the world by sleeping late, wasting the day, and then staying up late without structure only fuels depression and reinforces destructive habits. Research indicates that individuals who develop structure can adapt very quickly and accomplish goals in days and weeks that would normally have taken months or not have been accomplished at all.

The first step is planning your activities for the next day, before you go to sleep. Set the alarm clock and provide positive reinforcement throughout your day to keep you going. For example, go out to your favorite diner for breakfast then follow your planned structure with supportive appointments at agencies coupled with medical appointments. In the afternoon have coffee at your favorite coffee house or meet up with a friend.

Searching for Supportive People

Stay away from negative people who may "bring you down." Always remember that one must be accountable for the friends they make. You always have the power to cultivate friendships with people who are attempting to make positive changes in their lives. The old saying that "misery loves company" is very often true. People who see the world in a negative light can attract that negative view in the people they meet, since it is a common trait they both share. Work to find people who are upbeat and optimistic, and seek out groups that are attempting to see themselves in a positive, productive light. Since you have problems with alcohol and drugs, stay away from drinking and drugging buddies and don't go to clubs or other places where people use. Instead, attempt to do structured activities that will provide you with possible social outlets. Surround yourself with people who are attempting to gain control over their lives and stick with them rather than other people who have lost control over their lives.

Finding Fun and Pleasure

Develop areas in your life that you truly enjoy so that you have the power and control to structure daily in your life. Do you enjoy roller blading, ice skating, snow skiing, swimming, basketball, or volley ball? Painting, music, theatre, movies? Draw from your own experiences and take a chance on developing a new hobby or sport that truly can provide an enjoyable activity daily or weekly. You need to have components in your life that bring you pleasure and that can also help to structure your life. Not only does pleasure and productivity lower stress, it can give you a greater sense of fulfillment in your life.

You can also volunteer your time in an area that you enjoy. If you like animals, seek out volunteer jobs with the Humane Society or the ASPCA. If you are interested in culture, check out museums, theaters, and non-profit programs. If you are already have connections to an organization or a religious body, think about becoming more involved. In short, consider any area that you enjoy that could benefit from your time and energy. Research continues to point out that giving back to people or society gives people a sense of productivity and also redirects them away from negative thoughts about themselves. Non-profit agencies are always looking for a reliable individual who wants to help, so you could start just about anywhere.

Exploring Treatment Options

Navigating the Obstacle Course
Consider asking your doctor about medication if you feel that depression and lack of energy is keeping you from being productive. A comprehensive medication evaluation by a psychiatrist may be an important step towards stabilizing your mood and allowing you to once again be active in your life. Your health depends on your emotional balance. If you find you still can't get out of bed or that you are continuing to engage in self-destructive activities such as alcohol, drug use, and sexually compulsive behaviors, please consider seeking help from a recommended psychiatrist who listens to your issues and concerns. Thanks to modern medical breakthrough in the areas of psychiatric medications, emotional suffering can often be helped with prescribed medication under the watchful eye of a licensed psychiatrist or nurse practitioner.

You should also consider therapy with a licensed psychologist, a trained certified social worker or licensed psychiatrist. Ask friends, agencies and medical professionals for a recommendation. Request information on brief therapy vs. long-term therapy, individual vs. group, cognitive vs. behavioral approaches. Meet with and see if you feel a connection to the therapist on the phone or in person. Chose your therapist wisely and go slow and steady.

In summary, remember that your behavior has taken sometime to get to this point. It will take sometime to get back into a structured and productive life. Take control of your HIV/AIDS by developing a plan of action. One first step is to gain control of your days. Write down the fears that are ruling your behaviors and allowing alcohol, drugs and sexual behavior to deprive your life of structure. The first step is get up and out of bed! Make a list of short and long-term goals and direct yourself toward each day with a goal-oriented list. Focus on taking one appointment at a time and reward yourself after each appointment is concluded. Remember the old saying that "slow and steady wins the race."

Good luck!

J. Buzz von OrnsteinerJ. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and writes the "Psychologically Speaking" column. He is also the host of "Ask Dr. Buzz," a Body Positive-sponsored weekly call-in radio show about HIV/AIDS issues on WWRL 1600 AM at 2:30 pm on Wednesdays.

This article was provided by Body Positive. It is a part of the publication Body Positive.
See Also
Guide to Conquering the Fear, Shame and Anxiety of HIV
Trauma: Frozen Moments, Frozen Lives
More on Coping With Mental Health Issues


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