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Tuesday, October 25, 2016

Boundaries in Relationships

boundaries in relationshipsBoundaries establish a system of what is acceptable and what is not acceptable in our lives and in the lives of those around us. Boundaries in relationships are essential and are of great importance in order to contain healthy communication with your partner, and for maintaining healthy balance in all areas of your life. This is especially important when someone is in recovery as it is by nature that addicts and alcoholics operate as extremists and when in a relationship, it is very easy for the other person to become a “higher power,” or for priorities to get skewed as relationships (especially new relationships) are exciting and feel good. It’s also a part of a healthy relationship where open communication, honesty, and boundaries are essential rather than making assumptions and not being honest which is an easy set-up for resentment.

While in addiction, boundaries can easily be blurred or nonexistent which allows for others to manipulate, take advantage, or even put you in harm’s way. This also leads to codependence which continues to feed one’s addiction. Codependency entails poor boundaries as a codependent person tends to feel responsible for other people’s feelings and problems or blame their own on someone else. Taking this into consideration, while setting boundaries in relationships, it is vital to recognize your own feelings as you must differentiate yourself from the other person. Boundaries also help to determine which responsibilities in a relationship are yours, and which ones belong to your partner. When you take responsibility for your part in the misunderstanding or conflict, and your partner is able to take responsibility for their part, resolution of the problem at hand becomes much easier.

When these lines of responsibility are clear and respected by each person, emotional intimacy has a strong foundation to grow upon. Some of the basic steps for learning to set boundaries are to recognize and acknowledge your own feelings, recognizing how your boundaries have been crossed, and how you need to go about setting a boundary. It is also important to get grounded as it is common for those in relationships with poor boundaries to fear backlash from the other person, or to feel guilty.

The next step is to voice your boundary and make it known to your partner. In this case, if backlash does occur, it is evident that the other person does not respect the boundary you set and rather than engaging in the argument and focusing on the backlash which subconsciously is telling the other person that you are not grounded and confident in what you want, it is best to simply just walk away and take care of yourself.

Boundaries in romantic relationships are critical, because as opposed to other relationships, partners inhabit each other’s most intimate spaces, including physical, emotional, and sexual. Communication is key because when couples are clear about the boundaries for their own relationship, the relationship can be stable and continue to grow in a healthy manner that will allow the relationship to flourish.

Monday, October 17, 2016

Benefits Of Long-Term Substance Abuse Treatment

benefits long term substance abuse treatment Long-term substance abuse treatment, once thought a luxury, is quickly becoming overwhelmingly obvious to be a necessity if one hopes to develop an alcohol and drug-free lifestyle that is not only sustainable, but joyful and fulfilling. Many experts today prescribe to the disease concept of addiction. Alcohol and drug addiction is a disease that affects the mind, body, and social abilities of the individual, all of which require individualized attention and care if the period of sobriety in treatment is to transform into a lifestyle. The individual who refuses or does not receive appropriate treatment and develop recovery often face the same consequences: jails, institutions, and death. The fact that long-term treatment increases one’s ability to achieve sustainable sobriety has become so evident that many therapeutic courts across the nation have mandated their programs to be 12-18 months at minimum. The outcomes focused on by the court systems are mainly decreased recidivism, or a decrease in repeat offenses that brought individuals to the drug, alcohol, and family court systems in the first place.

Long-term treatment has proven effective in application by data collected not only by the courts, but psychiatrists, psychologists, and substance abuse counselors as well. What seems to be most effective in this approach is that it allows for therapeutic change from the biological, psychological, and social perspectives, and facilitates a transitional phase back into societal roles and norms. In the past, the one-stop 28-day treatment was nothing more than a “spin-dry,” merely to remove the individual from the stimuli, but accomplishing very little with regards to re-entry to life, it’s many pressures, and the coping skills required to face those pressures. The challenge does not stem from getting a person sober, but keeping them sober. Short-term programs were helpful in having a person “dry up,” and maybe allow for a brief evaluation of any underlying mental health or medical issues, but fell drastically short in continuum when compared to long-term treatment programs. Once these individuals leave a short-term treatment, they return to the many challenges that most of us face in a day: work, school, bills, familial obligations, deadlines, and commitments, with the same limited coping skills they entered the treatment center with in the first place. In addition, they frequently return to the same social circles which often promote drug or alcohol use, or an inevitable path to relapse. On top of all of these challenges, the majority of addicts will experience up to two-years of post-acute withdrawal, a time of emotional and mental instability that exacerbates relapse motivation and challenges dedication to continue with recovery. This is a period when prescription medication management, psychotherapeutic support, and sober living support, are crucial. It is within this time frame that many addicts will self-medicate via relapse if not properly treated.           

Long term treatment not only allows for the stabilization of biological consequences of use, but also allows for time to develop volition; the ability to make healthy choices, and autonomy; the ability to establish and maintain independence. In long-term treatment, the person learns not only to begin to reestablish healthy habits with regards to self-care, but also begins to learn cognitive skills that help identify emotions – emotions that at one time paralyzed them, but now may be used as strengths in creating positive lifestyle changes through positive behaviors, which create positive outcomes. Individuals learn how to develop healthy communication, healthy assertive skills, the assigning and maintenance of healthy boundaries for self and others, the many dynamics of interpersonal relationships, and how to make positive changes within those relationships.           

There are many families out there who will continue to ask the question, “Why did this have to happen to our loved one,” in reference to having paid the final price for addiction: death. These families may have experienced many bouts with lapse and relapse, treatment center after treatment center, and spent a considerable amount of money. I have spoken to families after such a tragedy, and they all say the same, that they would gladly go through it all again and spend until they had nothing left to spend if it would bring their husband, wife, father, mother, son, daughter, brother, or sister back. I have yet to hear a family complain after a loved one has completed nine months, or even 18-months in treatment, seeming to be relieved of their alcohol and drug addiction, and say, “I wish they wouldn’t have spent that much time in treatment.” In closing, this message not only serves the alcoholic and drug addict that may still be suffering, but their families as well. Always remember, “They didn’t get addicted overnight, nor will they recover overnight.”

Thursday, October 13, 2016

Women and Borderline Personality Disorder: Filling the Void

borderline personality disorder womenBorderline Personality Disorder (BPD) is a severe, chronic, disabling, and potentially lethal psychiatric condition. It is often characterized by pervasive feelings of emptiness that, in turn, provoke reckless and impulsive behaviors aimed at filling this internal void. Individuals who suffer from this disorder have extreme and long standing instability in their emotional lives, as well as in their behavior and self-image. This is a relatively common psychiatric disorder affecting 2% of the general population, however a staggering 75% of BPD individuals are women. Without treatment and support, most BPD individuals are unable to achieve sustainable recovery. Women, in particular, who suffer from BPD require gender responsive treatment that honors the unique needs and complex experiences of this population.

The instability of emotion, behavior, and self-image characteristic of BPD have devastating and sometimes deadly consequences. Individuals with BPD have repeated and frequent difficulties in their relationships and work lives, often experiencing alternating extremes of anger, depression, and emptiness. The borderline person tends to view past and current relationships as characterized by hostility and experiences pervasive social dysfunction and attachment disturbances. Quite frequently they have suffered from serious trauma including sexual abuse, physical violence, neglect, and psychological abuse.

To be borderline is to have little sense of identity. At its extreme it may mean having to turn to others for cues in order to know when to eat or drink, work or rest, or even laugh or cry. It may mean intensely embracing a person, idea, or thing one day and having no use for it at all the next. Descriptions of themselves often tend to be confusing, conflicting, vague, or unidimensional, lacking depth and feeling. They frequently define themselves in terms of how others see them. For example, their interests, values, mode of dress, and mannerisms may shift as the nature of their relationships change.

This discontinuity is further magnified by an accompanying fragmentation of emotion. Borderline individuals may alternate between being flooded with emotion and being numb to all feeling. In addition, whatever feeling-state predominates at the moment seems to last forever, and the BPD individual can scarcely recall ever feeling differently.

When applied to relationships, this same fragmentation of emotion and identity causes BPD individuals to view their relationships with an intensely black and white quality of feelings. This means that the borderline may experience their last encounter with someone as characterizing the entirety of that relationship. For example, if they parted on angry terms, then the BPD individual might only recall the other person as a heartless villain, wishing bitterly for revenge. Borderline individuals also tend to imagine themselves as deliberately persecuted by those who have merely let them down, placing themselves in a constant state of victimhood.

Complicating this fragmentation of relationships is the likelihood that the borderline’s sense of personal value depends entirely upon the current state of their relationships. When borderline individuals lose a relationship they often lose their inner sense of value that accompanied it. Since abandonment brings with it emptiness, it is avoided at all costs. These defects in identity and self-structure leave borderline individuals with a chronic and overwhelming sense of anxiety or dread and contribute to problems in self-regulation, self-control, self-soothing, low self-esteem, and a sense of personal inadequacy.

Typically, borderline individuals ward off their inner turmoil and unstable self-concepts through compulsive activity and self destructive behavior. This seems to reassure some borderline individuals that they are alive and have feelings. All too frequently, 69% to 75% of individuals with BPD resort to self-destructive behaviors such as self-mutilation, alcohol and drug use, behavioral addictions, serious over or under eating, and suicidal acts to escape from their emotional turmoil or to end dissociation. Often these behaviors serve as futile attempts to fill an internal vacancy, to satisfy a chronic and insatiable hunger.

As noted, a disproportionate percentage of individuals within the population of diagnosed BPD patients are women. There are a variety of cultural, social, and gender related factors that place women at greater risk for receiving a diagnosis of BPD. Violence, trauma, abuse, sexual assault, self esteem, gender specific socialization, discrimination, conflicting social expectations, lack of resources, combined with environmental, biological, psychological, and genetic risk factors are a few of many explanations for the tragic overrepresentation of women among those diagnosed with BPD. 

For women with Borderline Personality Disorder, they must cope with a galaxy of feeling that surrounds female socialization and the blend of longing, need, sorrow, and constraint that underlies it. The BPD individual’s yearning for others and her fragmented identity may be intensified by her awareness of its depth and the volume of need it inspires when compared to societal norms often based upon solely male experiences. These women must struggle for ways to cope with being too full of emotion, too hungry, too needy, and with the compulsion to release those feelings while also punishing the self for having them in the first place.

Gender expectations and aspects of female socialization do not make it easy to find available options, possible ways to cope and to express how empty and hungry and fearful these women feel. Many turn to drugs, alcohol, and countless other behavioral addictions in an attempt to find reprieve. For the self-mutilator suffering from BPD, she may cut to make the pain at her center visible, lacking any socially acceptable methods for release. The anorexic starves to make manifest her hunger and vulnerability.

For women with BPD, struggling to cope with the effects of trauma or substance use, a hostile environment, a rapidly dissolving sense of identity, or conflicting social expectations, this can be devastating and, in some cases, next to impossible without long term comprehensive treatment and support. Many BPD women, without help, continue to blame and hurt themselves, remain speechless, or engage, instead, in a pantomime of sorrow and chronic self destruction, an act that can be seen in everything she does if viewed through the right lens. Caroline Knapp, author of Drinking: A Love Story and Appetite, reflects on this very phenomenon with poignant insight,

“Women wanting to eat and slapping themselves for giving in. Teenage girls mastering the art of negative self-scrutiny. A skeletal body forcing itself to run and run. An arm with more scars on it than you can count. This is endlessly sad, this steady, quiet pummeling of the self, women borne along on a river of unwept tears….Way beneath these sensations is an ancient, aching emptiness, a gaping hole so vast you think it could kill you, a longing for comfort…a desperate, driving sadness that comes from feeling unloved, the longing it evokes to be fixed, to be held and needed and valued, to be proven lovable at last.”

The cluster of symptoms that make up the complex and enigmatic diagnosis that is Borderline Personality Disorder are nothing more than an expression of a deeper, voiceless, inarticulate, and pervasive hunger. It is the cavernous void that drives countless women in to the depths of addiction, obscurity, self annihiliation, and untimely death. And yet beneath these symptomatic expressions of need exists a uniquely human (though not uncommon) longing to discover that she is in fact whole and valued…and a fragile hope that through the process of healing she can, at last, be filled.

Thursday, October 6, 2016

Eating Disorders Within Recovery

eating disorders addiction recoveryEating disorders can be a primary catalyst in seeking relief through drugs and/or alcohol. With the consideration of an eating disorder being any range of psychological disorders which are characterized by abnormal or disturbed eating habits, it is safe to say that eating disorders center in the mind-just like alcoholism and drug addiction. Through personal experience and knowledge gained from working in the field of addiction and recovery, it is my belief that the desire to control is one of the primary characteristics of an eating disorder- just as the desire to control is predominant for many people seeking recovery and a better way of life. Although there are common characteristics among those in recovery, the struggle with an eating disorder presents a unique and, at times, difficult challenge. One, for example, cannot choose abstinence from food like one can from drugs and alcohol. This makes the treatment of an eating disorder trickier and more difficult.

Considering that nutrition provides the sustenance for life, the key is to get mental health support whether this be behavioral therapy that will help slowly shift attitudes and behaviors around food, body image, and size, or traditional talk therapy to help resolve underlying issues. A huge part of this process is stabilizing one’s emotions and coming to accept who they are especially in relation to their body image. Getting in touch with those emotions and learning to separate them from body hunger cues is a vital first step. Continued cognitive behavioral therapy and practicing self love and acceptance is an effective means of living in recovery from an eating disorder. Of course, just like any other addiction or disorder, it is necessary to acutely address the addiction/disorder head on with a hyper-focused treatment module in place. This is especially true for eating disorders and it is highly recommended to attend an inpatient facility while continuing with an effective aftercare plan and different way of life afterwards.

For those struggling with an eating disorder you may feel like you’ll never be happy or satisfied until you lose weight, and that your worth is measured by how you look. The truth is that happiness and self-esteem come from loving yourself for who you truly are-and that is only possible with recovery.