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Thursday, January 18, 2018

Family Dynamics in the Recovery Process

family dynamics recovery processThere is a saying that addiction is a family disease, and this couldn’t be more true. Any person who is in relationship with an addict is negatively affected, whether it be emotionally, physically or financially. A person in active addiction creates absolute chaos in their personal lives and the lives of those around them. Maladaptive Addictive behavior includes lying, manipulation, theft, intense emotional dysregulation, unexplained anger and endless other destructive things. Families tend to develop their own maladaptive behavioral and communication patterns in turn with the addict. These patterns often involve codependent and enabling behavior. The family will give into the addict’s manipulation in the form of giving them money, a place to stay, and cleaning up problems the addict carelessly creates instead of allowing the addicted individual to face the natural consequences of their actions. This behavior not only allows the addict to live in their sickness, it also keeps the family unit hostage to the chaos and pain the addict creates.

It is natural for a family to want to protect their loved one from pain. Many families are motivated by the fear that without their help their loved one will face the ultimate consequence of addiction, which is death.

It is easy to understand why a family would continue to enable their loved one, however these behaviors and dynamics generally continue once the addict has stopped using drugs. This is partly because addicts are master manipulators and partly because these dynamics become so deeply engrained it can feel impossible to change.

It is important for the family to be actively involved in the addict’s treatment. A lot of damage has been created and there is generally very little trust, if any, left in these relationships. Families need to learn how to communicate openly and honestly with each other, this includes expressing resentment, making amends for past wrongs done, and sharing how each persons behavior impacts the family as a whole. The family members and the addict need to be willing to examine their own behavior and take accountability for their part in the dysfunction. Learning how to set and hold boundaries on both sides of the relationships is another important part in healing the dysfunction and pain that has occurred. 

It’s also helpful for families to seek outside support in the form of individual or group therapy, or 12-step based programs such as AL-ANON, which is a program of self-discovery for loved ones of alcoholics and addict. This also helps families build a support network of their own to continue healing.

Thursday, January 11, 2018

Emotional Wellbeing in Recovery

emotional wellbeing recoveryResearch has demonstrated that psychological factors play an important role in physical health and overall wellness, particularly when it comes to recovery and the treatment of addiction related issues. Studies have demonstrated significant measurable relationships between cognitions, emotions, and immune functioning; indicating that happier individuals have healthier functioning immune systems, engage in healthier behaviors, have more energy, and better coping skills to manage challenges that are common to early recovery. Additional research also suggests that having a sense of meaning and purpose reduces the risk for countless diseases and provides individuals in recovery strength and motivation. There is substantial evidence that psychological health and emotional well-being are closely linked to physiological health factors and more sustainable recovery.

Social support, friendships, humor, and love also have documented positive impacts on health. For example, positive social support and friendships have been associated with greater resistance to disease of all types, lower rates of heart disease, and lower mortality rates. Social support can also speed up recovery processes and encourage health-promoting behaviors. Laughter and humor are other factors that enhance emotional well-being and health. Experimental studies have shown that laughter can increase certain antibodies that help to fight off infection while lowering blood pressure. Similarly, some researchers have proposed that music can increase positive mood and thereby lower stress hormones, decrease blood pressure, and increase endorphins - all of which provide relapse prevention techniques for the addict in early recovery to continue to develop and implement over time.

Conversely, current research suggests that the presence of certain negative emotions such as depression and anxiety are strong predictors of overall poor health status, increased substance use, and increased relapse rates. When it comes to experiencing trauma, addiction, mood disorders, and other difficult emotions, appropriate emotional expression is important for the maintenance of good health and wellness. Both verbal and nonverbal expressions such as art and writing can have significant therapeutic value. One study showed that after writing about a personal traumatic experience, individuals exhibited marked improvement in physical health indicators including reductions in blood pressure, better immune system responses, decline in visits to the health center, and reduction in distress. It is clear that attempts to control or suppress negative emotions can have an injurious impact on overall health, while healthy emotional expression produces improvements in overall emotional and physical health. Similar studies have supported the efficacy of utilizing verbal and nonverbal expressions to process cravings for drugs and/or alcohol, obsessions, and urges to use and/or act out in process addictions.

One negative emotion in particular that is associated with declines in emotional, mental, and physical health is regret. Several research findings indicate that intense feelings of regret are often associated with more health problems particularly among the elderly. Similar to regret is the feeling of “life longing” or a sense that life is somehow incomplete. The emotions that accompany this experience of longing can result in significant decreases in health and well-being if left unaddressed. 12 step based approaches typically address these feelings of resentment, regret, and remorse as part of comprehensive program of spirituality, relapse prevention planning, and positive fellowship.

Marie Tueller, MEd, LPC

Thursday, January 4, 2018

Signs Your Loved One May Be Addicted

signs loved one addictedPopular stereotypes of drug addicts involve the person being unemployed, engaged in criminal activity, male, minority, homeless, disheveled, dirty, and basically standing out like a sore thumb in mainstream society. However, many drug addicts are in fact very difficult to identify and will not possess many, if any, of these stereotypes. The shame of addiction and stigma associated with being an addict can act as a powerful barrier to someone coming forward to ask for help, causing them to do whatever it takes to keep up appearances and avoid their addiction being revealed. Many people still think of addiction as a moral failing, in spite of overwhelming evidence that has proven addiction to be a “primary, chronic disease of brain reward, motivation, memory, and related circuitry” (ASAM). These stigmas can cause shame and embarrassment for the addict, and cause them to retreat further into secrecy around their addiction.

That being said, how can you find out if your loved one is addicted to drugs or alcohol? I would venture to say if you are asking yourself this question right now, chances are you’ve already witnessed behaviors in your loved one indicative of substance use, and your instincts may be right. I’m certainly not advocating contempt prior to investigation, but the fact is we are dealing with a cunning, baffling disease that will cause the user to minimize, deny, rationalize, and stop at nothing to hide the problem. Sometimes, all you will have is a “gut feeling,” and that feeling may be enough reason to take a closer look at what is actually going on with your loved one.

If your loved one is chronically addicted to drugs or alcohol, this means they are at the point where they must continue to use in order to function in their daily lives. This also means they desperately need help, as they’re at the point that they can’t stop on their own, even if they desperately want to. Even at this advanced level of addiction, a person may not display overtly obvious signs that they are using. Often, they may be able to continue working and maintaining relationships for a period of time without a problem being detected. However; it us usually only a matter of time before they start experiencing consequences of the substance use that affect them physically, legally, socially, and in their relationships.

Overt signs your loved one may be using drugs or alcohol include agitation and irritability, intense mood swings, periods of either sleeplessness or seeming to sleep all the time, slurred speech, “nodding out,” injection marks, glassy or blood shot eyes, and enlarged or constricted pupils. Other obvious signs might be if valuables or household items are missing or if the person seems to always need money in spite of earning enough money to self-sustain.

Periods of depression, anxiety, and euphoria are also common symptoms of substance use. The individual will fluctuate between craving, using, coming down, and contemplating their life situation - all of which greatly impact a person’s mood.

Other, more subtle signs could include: smell of drugs or alcohol, use of fragrances to mask the odor, changes in appetite, drowsiness, increased tolerance of drugs or alcohol, impaired or fixed concentration, and decreased coordination.

Another hallmark sign that a loved one is addicted to drugs or alcohol is that they will likely make themselves scarce. Where they once participated in family and social events, they may now avoid these interactions, as they interfere with the person’s using and also provide more opportunity for their habit to be discovered.

If you suspect your loved one is struggling with addiction, please get help immediately. You don’t have to confront this situation without support, as there are trained professionals that are well-equipped to offer guidance, intervention, and placement in treatment. Remember, you are not alone! Alcohol and drug addiction is more widespread than it has ever been, with the reasons people become addicted as varied as the population that struggles with this disease. DON’T beat yourself up trying to analyze every detail from your loved one’s past and identify why they started using or where you went wrong. That’s a rabbit hole you have no business going down right now, as it won’t help matters whatsoever. DO get them help and let the trained professionals take it from there!

American Society of Addiction Medicine. (n.d.). Retrieved November 29, 2017, from http://www.asam.org/

Thursday, December 28, 2017

Dual Diagnosis or Co-Occurring Disorders

dual diagnosis cooccurring disordersDual diagnosis or co-occurring disorders (CODs) refers to one or more disorders relating to the use of alcohol and/or other drugs, as well as one or more mental health disorders. Examples might include Major Depressive Disorder with cocaine addiction; alcohol addiction with Panic Disorder; Borderline Personality Disorder with substance use. There is no single combination, rather there is great variability among combinations of disorders.

More than half of all adults with severe mental illness are further impaired by substance use disorders. Compared to patients who have a mental health disorder or substance use disorder alone, clients with CODs often experience more severe and chronic medical, social, and emotional problems. The existence of two or more disorders causes potential for both substance use relapse, as well as worsening of the psychiatric disorder.

Addiction relapse often leads to psychiatric deterioration, whereas worsening of psychiatric problems often leads to addiction relapse creating a dangerous cycle. Relapse prevention must be specifically designed for patients with co-occurring disorders.

Both substance use and mental health disorders are rooted in biopsychosocial systems.  Sometimes the mental disorder occurs first, which can lead the individual to self-medicate with alcohol or drugs, providing temporary relief. Sometimes, substance use occurs first, which can lead to symptoms indicative of one or more mental health related issues. Mental Health Disorders & Addiction are both dynamic processes, with fluctuations in:

• Severity
• Rate of Progression
• Symptom Manifestation
• Differences in speed of onset

Furthermore, both disorders are greatly influenced by several factors:

• Genetic Susceptibility
• Environment
• Pharmacological influences

Certain individuals have a high genetic risk for these disorders, whereas others may develop them due to environmental situations. It is also important to note that some drugs are more likely than others to cause psychiatric disorders. A common example includes methamphetamine induce psychosis or schizophrenia.

To provide appropriate treatment for CODs, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends integrated treatment for individuals suffering from CODs. Integrated treatment occurs when a person receives combined treatment for mental illness and substance use from the same clinician or treatment team. Integrated treatment helps individuals develop hope, knowledge, skills, and the support they need to manage their problems and to pursue meaningful life goals.

• Specific methods of integrated treatment include
• Screening, assessment, and referral.
• Mental and physical health consultation.
• The use of a prescribing onsite psychiatrist.
• Medication and medication monitoring.
• Psycho-educational groups.
• Psychotherapeutic groups.
• Individual Therapy Sessions.
• 12-step Based Program and/or spiritual support.
• Peer/Community Support.

When all components of integrated treatment are present, the likelihood of relapse in either mental illness and/or substance use disorders diminishes significantly. Long term recovery from the devastating effects of CODs is available and possible with integrated compassionate care.

Marie Tueller, MED, LPC

Thursday, December 7, 2017

The Influence of Sober Support Networks

importance of sober network
One of the important things to understand about addicts and alcoholics is that drugs and alcohol served a purpose in their lives. It helped the person cope with stress, trauma, and bad feelings or circumstances. It was a friend and it was always there for them. When an addict gets clean and sober they don’t have the skills to cope because they have been using drugs and alcohol to handle all the aspects of their life that they couldn’t. This concept creates a big loss in their life, and the drugs and alcohol have to be replaced with something.

What Alcoholics Anonymous (AA) learned in the 1930’s is that if the alcohol was replaced with a spiritual life, a life lived with the support of other alcoholics, and a way to come to terms with their inner selves they could stay sober. They could do something that the medical field had been unable to do with any consistent success. They needed each other and they needed a Higher Power of their own understanding. This was the beginning of what we have now come to understand as sober support networks.

When a person can learn to ask for help from another alcoholic/addict they have learned a vital skill that will save their lives when things get hard. And, things get hard the minute they are sober/clean. Because they have relied on alcohol/drugs to cope, it will take an outside source to introduce new ideas and skills to use to cope with life. A support network consists of sober individuals who are also learning how to stay sober/clean or who have been sober for a long time and are willing to share with the newcomer how they stayed sober. A sponsor can influence a newcomer and teach them what it takes to stay clean and sober by sharing their experience strength and hope. An AA group or Narcotics Anonymous (NA) group will become a safe place to find support. Treatment centers are a good start and will educate the newly clean/sober individual about sober networks and how to use them to be successful. A sober support system will also be a place of accountability in order to learn how to show up for themselves and others.

In my experience I have seen little success for the addict/alcoholic that doesn’t fully integrate a 12 step (or other of their choice) support network. I have seen addicts replace their drugs with food/relationships/work and their lives become unmanageable because they have resisted using a support network. Most of them either live miserably or relapse on their drug of choice. Without a support network they don’t have a place to learn how to cope with life without their drug. A sober/clean life is better than any addict can imagine alone but with a sober support network the possibilities become endless.

Janet E. Bontrager B.A. Primary Therapist

Thursday, November 30, 2017

Medication Assisted Treatment

medication assisted treatmentThe opioid crisis is in full swing, and is not showing signs of slowing down any time soon. As a result of this epidemic sweeping our nation, healthcare providers have been scrambling to come up with new ways to treat the issue. One of the solutions healthcare professionals came up with is Medication Assisted Treatment, or MAT for short. This method of treatment certainly has its benefits, but it can also have severe drawbacks, if not used appropriately. MAT is a method of using medication to treat opiate addiction, and other disorders, in the course of rehabilitation. For this article we will focus on opiate treatment.

One of the main medications used to combat the opiate epidemic is Suboxone. Suboxone is what’s known as an agonist. Suboxone binds to the same receptors in the brain as opiates like heroin, and oxycodone. There are two separate schools of thought for administering Suboxone. The first, is that it is used in a short taper to help ease the individuals detox symptoms from opiates. This is particularly beneficial because most addicts have a great fear of opiate detox, as it is excruciatingly painful. Often times, an opiate addict wont even attempt to get clean because of the detox symptoms; and providing this as a method of detox greatly eases the symptoms, thus motivating the individual to enter into recovery.

The second school of thought, is long term suboxone maintenance. This essentially is the idea that if someone is on suboxone long term, it will keep the individual from wanting to abuse opiates. The reason behind this thinking is two fold: first suboxone simulates the effects of opiates, thus cravings are reduced. The second, is that due to subxones method of action, it is very hard to become intoxicated on opiates whilst on it. However, the main drawback of this type of treatment is that so many providers use it as a sort of band-aid. They give the patient the medication, and send them on their way. This is not an efficient form of substance abuse treatment - because it does not treat the underlying causes of the addiction. No actual treatment of the addiction is involved. If curing the opioid epidemic was as simple as taking a medication every single day, it would have stopped long ago. Due to no actual treatment of the addiction, many individuals on suboxone maintenance will simply stop taking the drug, and begin abusing their opiate of choice again. Long term suboxone maintenance, however, can have its place in opiate addiction treatment. For example: If an individual simply cannot stop relapsing, suboxone combined with actual addiction treatment can be a powerful combination. The reason being is that the individuals cravings can be somewhat managed long enough for them to actually engage in the treatment of the addiction. Once the individual is stable, the provider can then begin slowly tapering them off the medication. It should be noted that since suboxone acts the same way as an opiate does, there are detox symptoms from it as well, when it is used long term.

The second medication commonly used in MAT with the opioid epidemic is Vivitrol. Vivitrol is an agonist- meaning it is a blocker. It blocks the opiate receptors in the body, making it very difficult to become intoxicated on opiates while it is in the system. It is a once monthly injection as well, so taking it daily, or suddenly stopping the medication to abuse opiates is not an option. Vivitrol is a valuable tool, in that it is not an opiate like suboxone, and it is time released, so the individual does not have the option of simply stopping, and using opiates. However, it too is not a cure-all. Like suboxone, it has it’s place, so long as the individual is receiving actual addiction treatment alongside of it. Since it is not an opiate, there are no withdrawals from the medication, and it is not a substitute like suboxone. All of these make it the more desirable option when it comes to using MAT in the treatment of opiate addiction.

In conclusion, MAT in the treatment of opiate addiction is certainly beneficial, however, it is not a cure all for the addiction. If you or your loved one is interested in MAT, be sure to get informed, and seek treatment in addition to the medication.

Disclaimer: The information presented her is only for informational purposes. This is not in any way shape or form medical advice. Before making any decisions, always consult a licensed medical professional.

Thursday, November 9, 2017

Family Therapy

family therapyFamily therapy is a relatively new form of treatment, first introduced in the 1950’s. Based on the assumption that psychological issues are the result of unhealthy interactions with others, Freud’s psychoanalysis and Roger’s client-centered therapy launched individual therapy in a whole new direction that included the influence of familial relationships, eventually giving birth to family therapy (Nichols, 2017). Carl Rogers believed that individuals are born with the innate drive towards self-actualization, but this drive is subverted by the desire for approval, which leads to conflict (Nichols, 2017). Actual founders and significant pioneers of family therapy are among Virginia Satir, Carl Whitaker, Jay Haley, Lyman Wynne, Ivan Boszormenyi-Nagy, and Salvador Minuchin (Nichols, 2017).

In working with families or individuals, therapists will at times encounter situations that involve domestic violence and/or sexual abuse. If the therapist has any suspicion of abuse of children, the elderly, or any vulnerable population, the therapist has a “duty to warn,” or a duty to report these suspicions to the appropriate authorities immediately.

In assessing a family for treatment, the therapist should be mindful of culture, as well as how assumptions related to culture may be driving forces behind some of their problems, particularly when it comes to gender roles and assignments (Nichols, 2017). If working with a culture outside of their own, the therapist would best serve their clients by developing cultural sensitivity, through educating themselves as to the experience and traditions of that culture (Nichols, 2017).

The first interview of the family is aimed at developing a hypothesis of the contributing factors of the presenting problem, as well as building a therapeutic alliance (Nichols, 2017). In the early phase of treatment, major conflicts will be identified, the hypothesis will be refined, and family members will be challenged to identify their own roles in the family problems. When one person is presented as the specific problem, the family therapist will challenge the linear thinking by finding out how other people are involved, and what roles they may have played in the manifestation of the problem (Nichols, 2017). In this phase, it is important for the therapist to be aware of both process and content, for as much can be learned by how people talk to one another, as can be learned by the content of the message (Nichols, 2017).

The middle phase of treatment will be aimed around helping family members develop more constructive ways to interact with one another. Here, the therapist will take a less active, observant role and encourage interaction amongst family members. This helps family members learn to use their own resources to work together, rather than relying solely on the therapist (Nichols, 2017). Once the presenting problem has improved, the family understands what was and wasn’t working, and has a fundamental knowledge of how to avoid similar problems in the future, the therapy may be successfully completed (Nichols, 2017).

Family therapists tend to think in terms of circular causality, rather than linear causality, by examining the interactive cycles of relationships. Instead of thinking solely in terms of cause and event (linear thinking), family therapists consider the influence people have on one another in a cyclical focus (Nichols, 2017). It is truly a dynamic process that looks beyond personalities to patterns that connect them and how family problems may be a product of the relationships that surround them (Nichols, 2017).

Nichols, Michael P. (2017).  Family Therapy: Concepts and Methods.  (11th ed.). Pacific Grove, CA: Brooks/Cole. ISBN 9780134300740