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Thursday, April 19, 2018

Relapse Prevention


Relapse is not a sudden process that happens without warning. Most addicts and alcoholics in recovery that are at risk for relapse experience predictable and progressive warning signs that typically cause so much distress that self-medication with alcohol or drugs seems like the only option. This is often not a conscious process and can happen subtly and slowly over time. These warning signs can develop automatically and unconsciously. Since most recovering individuals have never been taught how to identify and manage relapse warning signs, they don't notice them until the pain becomes too severe to ignore.

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. A renowned cognitive behavioral therapist, Gorski has a wide range of experience and expertise in the chemical dependency field. Through extensive research he has identified specific predictable relapse phases and how to intervene when one recognizes that he or she is on the path toward relapse.
The phases and warning signs of relapse according to Gorski include:

• RETURN OF DENIAL
• AVOIDANCE AND DEFENSIVE BEHAVIOR
• CRISIS BUILDING
• IMMOBILIZATION
• CONFUSION AND OVERREACTION
• DEPRESSION
• BEHAVIORAL LOSS OF CONTROL
• RECOGNITION OF LOSS CONTROL
• THE RELAPSE EPISODE

During the return of denial phase, the addict or alcoholic typically is unable to recognize honestly what he or she is thinking or feeling. This phase leads to avoidance and defensive behavior characterized by the individual not wanting to address anything that may lead to painful or uncomfortable emotions. As a result, he or she begins to avoid people and situations that would challenge an honest look at the self. The individual may become defensive when asked direct questions about wellbeing. Common symptoms include distortions in thinking and the beginnings of compulsive and/or impulsive behaviors. Following a period of denial and avoidance, the individual often finds him or herself building up toward a crisis situation as they begin to experience more and more life problems resulting from extreme denial and avoidance. The individual may begin to experience minor depression and have difficulty seeing realistic solutions to life problems. If left unaddressed this inevitably leads to a phase of immobilization.

During the immobilization stage, the addicted individual becomes incapable of initiating proactive action. They may be going through the motions of day to day living, but they tend to feel helpless to solve problems and may begin to spiral out of control. Thinking becomes clouded and the individual grows increasingly confused and distressed.

An inability to think rationally characterizes the next phase of confusion and overreaction. The dependent individual naturally becomes frustrated with self and others growing increasingly irritable, over reactive, and easily angered. Ultimately, the individual can sink into a depressive phase without proper help and intervention. During the depression phase, the individual may have difficulty managing simple daily routines. Thoughts of suicide, drinking, or drug use begin to arise as a means to cope with the depression. It becomes more and more difficult to ignore or hide the severity of the depression at this point. The dependent person progressively loses the ability to control behavior and regulate emotion.

Once the individual has reached the behavioral loss of control phase, he or she is unable to control behavior and continues to lack awareness of being out of control. Life becomes increasingly chaotic as problems pile up. The individual may stop attending 12 step or treatment meetings or completely reject help altogether at this stage.

Ultimately by the time the individual reaches this stage in the relapse process, their denial erodes and he or she begins to recognize the severity of the problem, how unmanageable life has become, and how little control he or she has at this point. This awareness can be incredibly painful and frightening. By this time, the individual has typically become isolated from his or her support network and may feel as though there is no one to turn to. Self-pity, thoughts of drinking and/or using, dishonesty and manipulation, and a loss of self-confidence characterize this relapse phase.

During the option reduction phase, the person tends to feel trapped and completely incapable of managing his or her life. Drug and alcohol use often seem to be the only options to manage feelings of pain and loneliness. The individual may believe that nothing can help him or her and has typically lost all behavioral control. At this point they have discontinued participation in all treatment and 12 step involvement and may be overwhelmed by resentment, loneliness, and frustration.

Ultimately, these progressive relapse phases result in a relapse episode if left unaddressed. This is when the individual begins to use alcohol or drugs again, usually struggling to regain abstinence. Feelings of shame and guilt characterize this phase when attempts to stop or control use fail. Eventually all control is lost and problems rapidly progress. 

This relapse progression can be summarized in the following way: 

THE RELAPSE SYNDROME

 INTERNAL
--Thought Impairment
--High Stress
--Emotional Impairment
--Sleep Problems
--Memory Problems
--Coordination Problems

EXTERNAL
--Denial Returns
--Crisis Building
--Avoidance and Defensiveness
--Immobilization
--Confusion and Overreaction

 LOSS OF CONTROL
--Depression
--Loss of Behavioral Control
--Recognition of Loss of Control
--Option Reduction

It is important for the dependent individual and loved ones to recognize signs and symptoms of relapse early on so that appropriate interventions can be applied. Some common warning signs and behaviors to look out for might include negative thinking, poor self-care, increased conflict, feelings of fear and anxiety, neglecting spirituality, internalizing emotion, not asking for help or listening to suggestions, isolation, complacency, and self-destructive behaviors and attitudes.

Healthy responses and interventions for these warning signs include having an established routine, engaging in positive affirmations and thought stopping techniques, utilizing conflict resolution skills and assertive communication, recognizing irrational fears, applying anxiety management techniques, having a daily spiritual routine, practicing healthy expression of wants and needs, reflecting on behaviors, taking suggestions, attending meetings and remaining involved in treatment, raising awareness of motives, and having positive rewards for successes throughout the recovery process. 

Most addicts and alcoholics in recovery will find themselves somewhere in the relapse phase process at some point in their recovery. It is important to be aware of the phases, warning signs, and common symptoms of relapse so that the individual can intervene before relapse occurs. Intervention and redirection are possible with support, awareness, and skills training. Relapse prevention planning and related therapies can help the dependent individual to recognize his or her unique relapse warning signs so that he or she can create a comprehensive plan to address each phase and related behavior. Having this knowledge and proper coping skills can empower addicts, alcoholics, and loved ones as they continue on their path toward recovery.


Marie Tueller, MEd, LPC

Thursday, April 12, 2018

A Successful Recovering Addict

Success addiction recovery
Long-term sobriety is an extremely challenging thing to accomplish and maintain. Many addicts can maintain initial recovery and even stay abstinent for several months or years but ultimately relapse into old behaviors and drug use. For an addict, returning to the use of drugs is a maladaptive form of emotional coping. For a long time drugs were this individual’s solution to the pain and stress of life. It takes time and consistency to create new habits and ways of approaching the world around us. For addicts developing community and being rigorously honest in relationships is also crucial to maintaining these new rituals. A foundation in 12-step programs along with creating a new and exciting life are also factors that impact ones capability of maintaining long term sustainable recovery.

For many people taking the first step into recovery can feel like an impossible challenge. Vulnerability and open communication are not things that come naturally to someone who has been lying, and manipulating in order to get their needs met, because of this people often feel alone and lost. A helpful tool in taking that first step is attending drug and alcohol treatment. In rehabilitation facilities there is structured support and community to help the individual comfortably re-integrate into interpersonal relationships. Emotional pain and past trauma is often presents a high risk for relapse when not dealt with, in rehabilitation centers clients are offered therapy and support from licensed professionals to help them attain emotional regulation and healthy coping skills. Research shows that long-term treatment and after care have the highest success rates for maintaining sobriety. 

Creating a strong foundation in 12-step based programs is also integral to continuous and fulfilling recovery. Developing deep and committed relationships with other recovering addicts allows individuals to create community and support for themselves, which is crucial in moments of self-doubt and weakness. Addiction is a disease of silence and shame, so when people allow themselves to be vulnerable and continue to work on healthy honest communication their chances of remaining abstinent are vastly greater than when isolating. Lastly one of the most impactful ways to effect meaningful and consistent change, is for the addicts to create a new life for themselves, that they fill with creativity, relationships, hobbies and passion. A life that they love living.

Rebecca Kaplan-Rahimzadeh

Thursday, April 5, 2018

Enabling: Helping or Hurting?

Recognizing addiction in a loved one is often a painful experience frequently leaving the loved one and/or family members feeling lost and helpless. Many will turn to denial and attempt to rationalize the addict’s behavior while others will try to control and change the behavior. While these attempts to cope and “help” the addict typically stem from a genuine desire to support him or her and relieve distress, they often create more chaos and harm within relationships and the family system.

This is a common scenario in family systems and in relationships where one or more person suffers from a substance use disorder. Loved ones believe that they are helping when in fact they are enabling the addiction and ultimately causing the problem to become worse. How loved ones respond to the addict or alcoholic’s behavior is crucial in supporting their path to recovery.

Enabling can be defined as:

• Standing between a person and his or her consequences.
• Doing for someone something he or she should be doing for him or herself.
• Engaging in actions that ultimately perpetuate someone’s problematic behavior.

Families and loved ones often enable the addicts and alcoholics in their lives by:

• Getting stuck in the defenses
• Denying there is a problem
• Minimizing the problem
• Avoiding discussions about the problem
• Blaming others or lashing out with anger
• Joining in the rationalizations/justifications that their children create
• Taking over their responsibilities
• Continuing to provide financial support
• Helping to resolve legal problems
• Promising rewards for abstinence
• Suggesting a physical fitness program or a job change
• Threatening to kick them out
• Provoking arguments/nagging
• Avoiding getting help for themselves

In order to stop the cycle of enabling, it is important for not only the addict to receive help, but for families and loved ones to get their own support. Learning how to say no and set boundaries with someone who is active in an addiction is challenging and can often be frightening. Loved ones can benefit greatly from counseling, support groups, and coaching on how to practice self-care and set healthy boundaries with the addict in their lives.

Healthy functional boundaries create a system of limit setting that protects a person from being a victim and contains a person so that he/she is not offensive to others. They help to protect a person’s reality in relationships. They also allow for meaningful exchanges, healthy self-expression, and vulnerability. Addiction violates our boundary systems and requires loved ones to reestablish healthy boundaries in order to stop enabling behaviors that contribute to the chaos and harm that occurs within addicted family systems.

A healthy family with functional boundaries:

• Communicates honestly, directly and thoughtfully
• Supports and affirms one another
• Maintains trust through reliability and consistency
• Practices respect for each other and for others
• Shares a sense of order and responsibilities
• Shares leisure time and a positive sense of humor.
• Teaches traditions, values and right from wrong
• Shares attention among members in a balanced way
• Respects appropriate boundaries among each other
• Values service to others
• Is flexible under stress
• Resolves disagreements without damaging words
• As a system that is open to other people and new ideas
• Admits problems and seeks help from others
• Has a sense of optimism for the future

When working on establishing healthy functional boundaries in order to stop enabling behaviors within an alcoholic or addicted family system, it is almost always recommended that the entire family receive support and help while doing this work. Furthermore, it is important for family members to remember the “3 C’s” of addiction when breaking dysfunctional old patterns: “I didn't Cause it, I can't Cure it, and I can't Control it.” Family members and loved ones of alcoholics and addicts can practice these principles with support, coaching, and guidance. With help, it is possible to break the cycle of enabling and thereby create a foundation in recovery for the entire family unit.

Marie Tueller, MEd, LPC

Wednesday, March 28, 2018

Spring Cleaning: Letting Go of the Old & Bringing in the New

spring cleaning recoverySo you are not using drugs or alcohol anymore, now what? Maintaining abstinence from drugs and alcohol is a huge transition for addicts, however, just like addiction is much more than the drug itself, abstinence alone won’t support sobriety. The entire foundation of the diseased system must be rebuilt and the addict must under-go a social and emotional Spring Cleaning.

In active addiction, an addict’s foundation consists of people, places, and things that enable the addict to continue their use without disruption—friend’s or intimate partners they use with, dealers, places they go to pick up, places they go to get/be high, the food they eat, the clothes they wear, the way they talk, the people they associate with. The addict’s foundation is also formed by the way they are in relationship to their family and loved ones—mom becomes the one they lie to, dad the one they have to avoid, sister the one who will cover for them, etc.; lying, manipulation, and lack of boundaries become second nature. All these components make up a way of living for the addict that becomes synonymous with using drugs.

In sobriety, although abstinence is the first and arguably the most important building block, all the other components of a “high” life must change in order to support a sober one. That means that new habits must be formed in all aspects of the addict’s life—social, spiritual, environmental, intellectual, physical, and emotional.

Shifts in these behaviors are embedded in most treatment programs and in the 12-step approach as well. Sober supports and A-teams are put in place to surround the addict with people who value and understand the importance of abstinence and sobriety and who can engage with the addict in engaging in sober recreational activities. The recovering addict cultivates a new relationship with their Higher Power, for some for the first time, inviting a trust in something greater than themselves into their everyday life. Environmentally, addicts are encouraged to develop relapse prevention plans which help them avoid place and things that remind them of using or, if unavoidable, develop a plan to stay safe while exposed to those triggers. Intellectually, recovering addicts radically learn how to think differently—how to challenge their negative beliefs, reality test their thoughts and implement new, strength-based ways of thinking. Addicts in early recovery also benefit from re-engaging their minds which have been sorely under stimulated during active addiction. Physically, it is important for addicts to learn how to tend to their bodies which they have caused harm to. This means learning to nourish themselves with food and finding an exercise routine that keeps their bodies engaged. And, lastly, emotionally. In order to support new recovery, addicts must learn to feel in a new way. In addiction, addict’s had a negative feeling and simply got high. In early recovery, addicts must learn how to care and soothe themselves and ask for help from those around them. Addicts do not have the luxury of “being emotionally checked out,” they must implement self-care and time to connect with their emotional internal world on a daily basis.

In early sobriety, there are a couple reminders that will help an addict make sure their foundation will be a supportive one. First one, Opposite Action. If you notice that you are about to engage in a behavior you did while in active addiction, do the opposite. If you want to isolate, call a friend. If you want to procrastinate an assignment, make an action plan. If you want to cover up a lie with another one, get honest. Chances are your addict brain has turned on and is trying to convince you your old way of doing things will be just fine. Fight it. Do the opposite.

The second thing to remember is it is a lot harder to stop doing something, than it is to start doing something new. If you find yourself stressing out about not talking to an old using friend or struggling with not eating candy—replace it with the thing you want to be doing. Call you new friend or sponsor instead. Get excited about something you want to eat that you love. The more I say “I want to stop smoking,” the more I am thinking about smoking. If I instead say to myself “I want to take care of my body. I’m going to chew this nicotine gum instead,” I allow my brain to shift toward the goal rather than the undesired behavior.

Last trick—before you make a decision in early recovery find three people you trust to tell you the truth and whose recovery or life you admire and ask them their opinion. If they are support you, move forward. If one person doesn’t, use it as a signal to stop and rethink.

The tools will help an addict as they begin to rebuild their recovery foundation from the ground up and bring in a whole new set of habits to support a new and improved life.


Carmen Cartterfield, MA

Wednesday, March 21, 2018

Self Care in Sobriety

self care sobrietyAround the tables in Alcoholics Anonymous meetings, it is often said, particularly to newcomers, that AA is a selfish program. Newcomers are encouraged to realize "You don't do it for your wife, husband, or children. You do it for yourself." For many of us, this feels strange and uncomfortable. Throughout life, most of us are taught not to be selfish. We are taught to share, to be kind to others, to put others first, to show compassion, empathy and generosity. Yet, when it comes to directing this type of love and understanding inward to ourselves, it often feels rather unnatural.

In our addictions, we often become so accustomed to self-loathing that the concept of self-love feels foreign and far removed. The wreckage of addiction can be severe, to say the least. When we get sober, we are commonly plagued with feelings of guilt, shame, regret, and are appalled by the atrocities we’ve put ourselves and others through. We may have even continued drinking and using to avoid these feelings and facing our truths and even as a form of self-abuse. It can be very challenging to replace self-loathing with self-love, but to attain sustainable recovery, we must!

There are many ways to cultivate self-love, but a simple way to become accustomed to extending love towards yourself is through self-care. By practicing self-care, you learn to be kind to yourself, take care of yourself, connect with self-worth, and simply realize how much better it feels to be nice to yourself!

There are many facets to self-care, as we are multidimensional beings. The whole person is comprised of physical, mental, spiritual, emotional, and social aspects. When we think of self-care, we need to think of taking time to nourish each of those aspects.

For physical self-care, think of being gentle and caring with your body. Eating nutritious food, getting adequate physical exercise, rest, and sleep, will help provide energy needed for recovery. Mental self-care can be attained by engaging in activities that stimulate your brain, such as puzzles, books, or stimulating conversations with friends or colleagues. Spiritual self-care looks different for everyone and can be found in prayer, meditation, yoga, wilderness, or really whatever helps you feel connected and grounded. Emotional self-care involves talking about your feelings, releasing negative emotions, setting boundaries, and often finding an expressive outlet such as music, art, or dance. Social self-care is essential, as relationships are highly important aspects of our lives. Taking time to attend meetings, nourish existing relationships, and reaching out to others all lend to social self-care.

Self-care looks different for everyone but involves the same principles. It is a vital part of the recovery process and can help with attaining self-love, which not only feels great, but is a huge part of relapse prevention.

Heather Smyly, BS

Wednesday, March 14, 2018

Amends

amendsThe Webster dictionary defines amends as: compensation for a loss or injury; and some related words are: correct, rectify, reform, remediate, and remedy. So, lets face it, when we come into a treatment facility or recovery program we all have a lot of things to amend. Some of the things that need to be amended are hurts we have caused, harms we have done, and ways we have behaved toward ourselves and others that we wish we hadn’t. There is also a need to amend the way we live our lives. Making amends can feel insurmountable at times and we become overwhelmed with the mountain of wrongs that we have done and become buried in a mountain of regret and shame. It is very important to remember that the first amends that has to be done is to ourselves and the way we are doing that is by staying clean and sober. We need to amend the way we see ourselves and that begins with self examination. After this we can forgive ourselves and begin to live productive lives.

This journey toward amending our old ways begins in 12 step meetings, treatments centers, and recovery homes. We start by getting and staying sober and doing everything we can to remain that way. There are some promises that Alcoholics Anonymous makes to us, and these promises come after the book explains how to make amends and encourages each recovering alcoholic to make amends. The promises are as follows:

(From pages 83-84 of the Big Book of Alcoholics Anonymous) If we are painstaking about this phase of our development, we will be amazed before we are halfway through. We are going to know a new freedom and a new happiness. We will not regret the past nor wish to shut the door on it. We will comprehend the word serenity and we will know peace. No matter how far down the scale we have gone, we will see how our experience can benefit others. That feeling of uselessness and self-pity will disappear. We will lose interest in selfish things and gain interest in our fellows. Selfseeking will slip away. Our whole attitude and outlook on life will change. Fear of people and economic insecurity will leave us. We will intuitively know how to handle situations which used to baffle us. We will suddenly realize that God is doing for us what we could not do for ourselves. Are these extravagant promises? We think not. They are being fulfilled among us - sometimes quickly, sometimes slowly. They will always materialize if we work for them” (Reprinted from the book Alcoholics Anonymous (The Big Book) with permission of A.A. World Services, Inc.).

Janet E. Bontrager – Primary Therapist

Wednesday, March 7, 2018

Spiritual Deficit Disorder

Spiritual Deficit DisorderHave you ever heard of Spiritual Deficit Disorder (SDD)? Until recently, I hadn’t. What does it mean? It sounds like Attention Deficit Disorder (ADD). Is it similar to that? It turns out, it’s a bit like ADD of the spirit, when we are so distracted by life: goals, deadlines, pursuit of material goods and status, that these things take on a greater importance than our spirituality and we lose sight of ourselves and impair the connection to their spirit. A large majority of the population likely suffers from Spiritual Deficit Disorder (SDD), even those who may seem to be the happiest.

SDD is the result of constantly feeling under pressure and stress. Feelings of being overwhelmed by work, family, finances, and competing with societal expectations can all contribute to a fracturing of the spirit from the self, where physical gains become more important spiritual expansion. SDD occurs when individuals lose the connection to their spirit and are driven primarily by seeking validation of that which is external.

Symptoms of SDD can include: substance use, process addictions, fatigue, irritability, resistance to awakening in the morning, self-doubt, feeling “not enough,” lack of passion, lack of meaning and direction, boredom with work or educational pursuits. All of these symptoms can take a toll on the body, relationships, family, and career, and can even manifest in chronic disease.

No matter how successful a person is, if they suffer from SDD, they feel empty inside, like they are missing something. That feeling of missing something can cause further stress, creating a perpetuating cycle of feeling “not enough.”

So, what is the remedy for SDD? It turns out, it’s pretty basic. We need to slow down and attempt to reconnect with that which is most important to us. If look carefully at what we are prioritizing in our lives, compared to that which is most important to us, odds are they may not even be on the same wavelength. With direct revelation, our hearts of hearts will let us know the truth of our realities. But we can’t even make that discernment until we slow down and take a moment to analyze what we are doing with our time. It’s the persistent, invasive, nagging thoughts and habits that really drive us to separate from our hearts, spirits, and well-being.

But how do we slow down when there’s so much to do? Here are a few ideas:

1) Breathe. When you breathe deeply from your diaphragm, you automatically invite your body to relax, to let go, and to surrender into the present moment.

2) Stay in the present moment. When you become distracted, try to gently bring your awareness back to your breathing and take some deep breaths.

3) Take time for yourself! Try to find at least 10 minutes a day just for yourself. Do this with absolute consistency. Participate in a hobby you enjoy, take a bath, enjoy a sunset, take a walk in nature, gaze at the stars, listen to music, meditate. Just do something for yourself for 10 minutes every single day. 

4) Express gratitude. When you wake each morning, think about and even say out lout that which you are grateful in your life. Pay attention to what you are grateful throughout the day. Close your day in gratitude and review what you were grateful for throughout the day before going to sleep.

Spiritual Deficit Disorder is a serious ailment which, if left untreated, can cause serious impairments to health, relationships, and overall well-being. The good news that the remedy for this disorder can be fairly simple, it just requires attention to the matter, a desire to change, and consistency in practicing change.

Heather Smyly, BS