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Friday, April 28, 2017

Gender Specific Addiction Treatment

gender specific addiction treatmentThere is no denying the benefits of substance abuse treatment when the individual applies what they learn while in treatment. However, for the addict in early recovery, the challenge of staying focused on themselves and applying the tools they learn is immensely difficult. This arises for several reasons. It could be they are not interested in recovery, or that they have an intense fear of facing the reality of who they have become. However, there is another distinct reason, that is more common than one might believe. Studies show that the number one thing addicts cross addict to in early recovery is romantic relationships.

There are several reasons why an individual may chose to distract themselves with a romantic relationship while in early recovery. The first is the most obvious one. People with addiction have repeatedly gone against their moral compass while intoxicated. They would do things while intoxicated that they would have never done if sober. When the addict sobers up most come to reality with the actions they have taken while in their addiction. Taking a hard look at oneself is not an easy thing to come to terms with. Therefore the addict in early recovery will chose to engage in a romantic relationship for the sheer purpose of focusing on another person instead of focusing on themselves. This is obviously inherently selfish, as well as unhealthy. In order for someone to successfully recover from addiction they must repeatedly take a hard look at themselves, and be willing to continue to amend their behaviors.

Another reason is because addicts, by default have a low self-esteem. Due to this, the addict will become involved in romantic relationships, because they derive a sense of validation and worth from the relationship. Building a sense of self-esteem and self-worth takes time, and is not an easy task. There are many things the addict must face and overcome to do so. Since people with addiction tend to avoid their problems and want instant gratification, they will usually try to find another way to achieve their goal - which almost always ends up in avoiding the problem, or dismissing it outright. Therefore it is not surprising that the addict in early recovery will use romantic relationships the same way they used substances. Substances provided a way for them to avoid dealing with reality, and to escape pain. It is the same with unhealthy relationships in early recovery. They will use the relationship as a source of self-worth, thus avoiding both the true work needed and the pain of growing. This is particularly dangerous because they do not do the necessary therapeutic work needed to recover from addiction. Furthermore, the addict in early recovery tends to have enmeshment issues, and will often times establish their identity based on another human being. 

Hence why gender specific programs are becoming more and more of a mainstay in the treatment industry. If an individual chooses to attend a gender-specific program, they will not have the opportunity to distract themselves with a romantic relationship. These programs also offer a more comfortable environment for the individual to become vulnerable with both their peers and staff. For example, not many men care to open up and be emotional around women, because it might make them feel week. Or vice versa. Not many women would feel comfortable talking about abusive relationships they have had with men, in a room full of men. Gender specific treatment not only removes the distractions, but also allows the individual to learn how to form true friendships with their fellows, and gives the addict a safe place where they feel comfortable opening up and being their true self.

Monday, April 17, 2017

Motivational Enhancement and Behavioral Strategies for the Treatment of Substance Use Disorders

motivational enhancement substance abuseResearch on emotion, cognition, and motivation in recent years has demonstrated the closely related interacting nature of these constructs as a means of better understanding addiction and improving clinical modalities of treatment. There is growing evidence for the existence of disruptions in emotional, behavioral, and motivational processes that exist in a variety of mental disorders including substance use related disorders. It is important to consider the relationships among cognition, emotion, behavior, and motivation as well as the neurobiological processes involved when developing and implementing effective behavioral and psychological treatment methods.

Substance use disorders have gained increasing clinical attention in the study of cognition, emotion, behavior, and motivation, and considerable research has focused more specifically on the motivational factors impacting the etiology and treatment of substance use disorders. More recent research has focused on ways in which to enhance motivation amongst individuals seeking substance use treatment, sustaining positive change, and avoiding relapse following the completion of treatment. Lack of motivation frequently characterizes individuals early in recovery from substance use disorders and is typically used to explain the failure of individuals to comply, follow through with, and complete treatment.

In order to address the complexities of motivation that exist for individuals suffering from substance use disorders, it is important to embrace new concepts of motivation. Motivation is important for change, it is multidimensional, it is dynamic and fluctuating, it is influenced by social interactions, it can be modified, and it can be enhanced by specific modalities of treatment. Through the integration of these basic tenets of motivation, we can broaden our understanding of motivation and addiction as well as approaches to behavioral and psychological treatment modalities that promote positive sustainable change. Research has shown that motivation-enhancing approaches to treatment improve participation and positive treatment outcomes for those suffering from substance use disorders. 

Behavioral modification and motivation enhancement therapies can be especially effective in using positive reinforcement to promote engagement by rewarding goal directed activities which in turn can lead to positive changes in cognition and emotional processing. These treatment approaches specifically focus on the interactions between cognitions, emotional processing, and motivational constructs. This is further supported by neuroimaging that has shown marked improvements in brain functioning related to cognition, emotion, and motivation in individuals who have received motivation enhancement and behavioral based therapies.

As psychological treatment approaches have matured, theories and relevant research findings that incorporate motivation enhancing strategies and motivational methods have become increasingly utilized in a variety of settings. There is a growing shift from a focus on client deficits and limitations to a greater emphasis on identifying and enhancing client strengths and competencies as primary principles of motivational counseling. Such approaches focus on affirming the client, enhancing self-efficacy, offering support, and encouraging positive change in order to enhance positive emotion and motivation.

Because motivation and personal change are intimately linked, effective treatment must not only consider the psychological constructs of motivation, but also how to create optimal conditions for positive lasting change. The stages of change model provides a helpful framework within which to conceive various levels of motivation for change. These stages include: pre-contemplation, contemplation, preparation, action, and maintenance with each stage characterized by varying states of motivation, cognition and action oriented behaviors. The study of cognition, emotion, and motivation provide important insight into how people change, barriers to change, and individualized approaches to change allowing treatment providers to tailor services to the unique needs of the individual. Identifying an individual’s particular stage of change provides a context within which to conceptualize goal directed behavior, cognitions, and motivation. Change is a process characterized by various states of multidirectional motivation and varying levels of readiness to change that must be taken in to account when designing a treatment approach.

A popular treatment approach utilized to enhance motivation particularly amongst substance use populations includes motivational interviewing strategies. Theses strategies often act as interventions to initially engage clients in treatment as a means of instilling motivation at the outset of treatment. This treatment technique has also shown to increase motivation throughout the course of treatment for individuals suffering from substance use disorders. While motivational interviewing shows promising results, it is important to note that it is most effective when coupled with maintaining an empathic and supportive motivational style.

Through linking the emerging views of motivation, cognition, and emotion along with motivational enhancement based strategies, behavioral modification, the varying stages of change, a practitioner can design and implement appropriate treatment approaches that target the specific deficits characteristic of substance use disorders. Through the combination of motivational techniques and behavioral strategies, one can create an innovative approach to enhance motivation, increase emotion and behavioral regulation, and diminish unhealthy cognitive biases thereby promoting goal achievement and enhancement in self efficacy.

Motivation is what propels individuals to make changes in their lives. Unfortunately, this construct is often deregulated in individuals suffering from addiction and psychological dysfunction in addition to the prevalence of cognitive biases and deficits in emotional regulation. It is clear that these psychological constructs have an interactive and reciprocal relationship in the etiology, manifestation, and maintenance of substance use disorders and that it is difficult to distinguish their respective influences. Nevertheless, basic research on these constructs and integration of related theory informs more effective and more comprehensive approaches to the treatment of psychopathology and substance use disorders. Professionals must consider the interactive relationship between behaviors, cognition, and emotion in order to enhance motivational processes along with the application of existing theoretical frameworks and therapeutic interventions. When such approaches are taken there appears to be much promise for the overall efficacy of a variety of motivational enhancing therapies that challenge cognitive biases and promote sustainable positive change for individuals recovering from addiction.

Marie Tueller, MEd, LPC

April 14, 2017

Monday, April 3, 2017

The Benefits of a Healthy Diet & Exercise in Early Recovery

benefits diet exercise addiction recoveryThere is no denying the mental and physiological benefits of a healthy diet coupled with exercise. These benefits are universal to everyone. However, what about the impact of these on someone who is in early recovery from alcohol and/or drug addiction?      

The effect that substances of abuse have on ones body are highly detrimental from both a physical and mental aspect. Chronic alcoholism can leave someone with a severely damaged liver, kidney trouble, and elevated blood pressure; not to mention a significant chemical imbalance in the brain. However, in today's world professionals are encountering more and more cases of poly substance abuse. Often times it is a combination of drugs. It could be alcohol and amphetamines, or amphetamines and opiates, and the list goes on and on. When these combinations of substances are abused in large amounts over an extended period of time the damage is severe. Couple that with the fact that individuals who are in active addiction have poor eating, sleeping, and hydration habits, and it's a breeding ground for both mental and physical deterioration.    

When individuals enter into rehabilitation programs there are several processes one goes through. The first and most critical phase is the medical detox. During this phase an individual is monitored by medical professionals who administer certain medications to keep the individual both comfortable, and medically stable as they go through this phase. After this an individual will often transition to a rehabilitation program. There are many rehabilitation programs, but they all have one thing in common: to treat the person suffering from addiction and help them gain the tools they need in order to maintain sobriety outside of treatment. However, it is well known in the field that addicts are some of the most stubborn people there are. Often times they will have a negative perspective, and present as resistant to treatment. This resistance to treatment could come in many forms, it could be depression, thus making it difficult for the individual to respond to treatment. It could be a low self-esteem and the individual believing they are not worth recovery. It could be just plain out defiance. All of the above are not solely caused by chemical imbalances in the brain, but these imbalances either caused or exacerbated by drug abuse without a doubt influence this resistance. 

This is where exercise and a healthy diet come into play. It is becoming more and more apparent based upon research that these things have a profound impact on the individual in recovery. Exercise will do many things for the recovering addict. First and foremost, it will cut in half the time needed for the brain to balance itself out. For example, studies show that in individuals with an opiate addiction, the brain recovers in twice the time when they exercise three to four times a week for thirty minutes or more. What about the individual who suffers from addiction to substances such as amphetamines, or alcohol that can cause the person to have depression? Studies show the same outcome- if the depression was caused by drugs, and not biological factors, intensive exercise multiple times weekly will help the individuals brain to balance itself out, and often times within a period of six to nine months. Of course not every one is the same and sometimes medications are definitely needed. 

Now lets look at a healthy diet. It has been documented that over time when addicts adhere to a healthy diet there are less reports of fatigue, depression, a higher sense of self worth and well being, and an overall more positive outlook on life. Not to mention higher energy levels and better sleep.  A healthy diet is shown to help liver function, cardiovascular function, cognitive ability, as well as help regulate the circadian cycle. It is so important for addicts to have a good diet. So many suffer from poor life skills, that they will go days without eating, and when they do eat it is usually processed foods, with little or no nutritional value. These poor eating habits are proven to through hormones out of wack, as well as tamper with brain chemistry. Combine that with early recovery, and the already incurred chemical imbalance and the individual is going to have a harder time than they would on a healthy eating regiment,  

Combining healthy eating and exercise for the addict in early recovery is paramount. It is not about getting in shape, or a summer body, or looking good. It is about helping the body adjust and heal itself, it is about giving the individual life skills, it is about helping them set personal goals for themselves and attaining them through discipline and dedication. If you are considering a rehabilitation program, make sure it has some sort of exercise and diet planning involved! Whether it be a gym, hiking, mountain bike riding, or sports. Whatever it is, it will help your loved one stabilize, and preserver on the road to recovery!