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Friday, July 28, 2017

Working and Living 12 Step Recovery

working living 12 step recoveryIt is a gift and a challenge when a person who is in their own 12 step recovery also gets to work in the field of addiction with other recovering addicts. From my perspective, it can be challenging to separate my own recovery from the work I do on the job. As a clinician, my focus is on the clients I work with and making sure they learn how to stay sober and use the 12 steps of Alcoholics Anonymous to support their recovery. Since I have my own experience as a recovering alcoholic, and I have a very good understanding of how the 12 steps can help a person stay sober, it is easy for me to pass this information along in a way that the clients can easily understand.

When a client talks about how “12 step programs don’t work” or that they feel as if they have tried the program and found it wanting, I can easily point out several success stories and self disclose my own long term recovery to help them see a living example of success based on the 12 step principles that we at Canyon Crossing are encouraging our clients to embrace. This is the gift I can give to my clients since I’m working a program of my own.

The challenge comes, when as a clinician, I can’t separate my own program from the program that I am asking a client to integrate. When I think, “I did it this way so they should too”, I need to take a step back and remember that every person has their own journey with the 12 steps and my clients will have their own journey that may not look exactly like mine. When this occurs I can use the Al-Anon 12 step program to practice detachment. Al-Anon teaches a person how to love the person and separate their disease from the person they are. It also teaches how to lower your expectations and meet a person where they are instead of wanting them to be where I think they should be.

I am a better clinician because I have integrated my own 12 step program into my life and live by the principles of the AA and Al-anon program. I am also very satisfied in my work because I’m doing something that I believe in and doing meaningful work is very important to me. I also practice my program outside of work in order to stay as healthy as I can be which enhances my ability to work with the women who need positive supportive role models of recovery.

I’m new at Canyon Crossing and have been working in and around the field of addiction treatment since 1986. I am a trained EMDR therapist and am presently enrolled in a master’s degree program to become a Licensed Marriage and Family Therapist. I find that a 12 step foundation enhances all of my education and allows me to be the very best clinician I can be, but working in the field of addictions does not take the place of the service work I need to do in my own program. It is a gift to work with this population and I enjoy sharing my own experience, strength and hope while maintaining my professionalism.

Janet E. Bontrager
Primary Therapist/EMDR

Saturday, July 15, 2017

Somatic Experiencing Interventions for Healing Sexual Trauma

somatic interventions sexual traumaThe first part to healing trauma within the body comes with identifying where the emotion is being experienced within the body. Recognition is the start to healing. The client needs to feel safe within the therapeutic relationship and learn how to transfer that feeling of safety into their everyday life by using self-soothing techniques. Dr. Peter Levine, Ph.D is the originator and developer of Somatic Experiencing and the director of Somatic Experiencing Trauma Institute, says that it is important to give tools for emotional regulation and self-soothing for those who have experienced trauma, so that they do not become dependent upon the therapist for soothing and an inner sense of safety. The first step is becoming attuned to our feelings and the place we are feeling that emotion within our body.

The first exercise is putting your right arm under your left arm pit and the left hand on the right shoulder, then taking a moment to feel what is going on inside of your body. Shut your eyes and allow yourself to feel and fully experience the moment. The benefit of this practice is to help the person become aware of the idea that the body is the container of all the sensations and feelings of each person. A good time to put this exercise into practice is when a flashback is happening or when someone has been triggered by a smell, word, sound, taste, or touch. When one realizes that the body is the container, and they can feel safely soothed and contained within, then the emotions will not be as stimulating or overwhelming as they have been before.

Squeezing your muscles or tapping all over the body can be helpful in a person’s sense of boundary because in trauma - especially sexual trauma - there is a hole in someone’s boundary not having a sense of where they begin and end. This hole comes from the powerlessness and loss of control and protection of their entire being. The aim for the therapist is to initially touch the client with their presence. According to Seigel (2015) “presence is a way of keeping trust alive and keeping connections strong and communication wide open (p. 250).” Presence is cultivated by allowing whatever arises to come and gives flexibility to move with the client in the path that they need to go without judgement or predetermined manipulation in a specific direction. Presence is simply being fully in the moment with the client, feeling with them, observing while being aware of their nonverbal reactions and responding accordingly. With a client of sexual abuse the person has lost their autonomy, the ability to govern themselves or maintain internal emotional homeostasis, thus a partnership of the counselor client relationship is crucial for the client to gain back their own autonomy. The root meaning of therapist is “fellow traveler on a journey” this is the essence of the healing that takes place within the relationship of the counselor and client. It is a process that must be taken together, but gradually the tools are building up the client to govern their own inner emotional state.

Thursday, July 6, 2017

Co-Occurring Substance Use and Mental Health

co occurring substance use mental healthAn extremely high prevalence of comorbidity exists between substance use disorders and mental illnesses. What “comorbid” or “co-occurring” means is that the symptoms of two or more disorders occur simultaneously (or congruently) in the same person. The interaction between the illnesses can drastically exacerbate the symptoms a person experiences, as well as make the conditions challenging and more complex to treat. Co-occurring disorders can be quite difficult to diagnose due to the compound nature of the symptoms, as for each disorder there is a biological, psychological, and social component of the symptoms that often overlap. It is fairly common that individuals will receive treatment for one disorder while the other is left untreated. When left undiagnosed or untreated, co-occurring disorders can lead to more severe symptoms than solely mental illness or substance use, such as: medical illnesses, homelessness, incarceration, suicide, and death.

With substance use and mental health, the question that plagues providers is often similar to the chicken and the egg question- which came first? One aspect of this conundrum is certain people with mental health disorders are far more likely to experience substance use disorders than those without mental health disorders, and vice versa.

It is quite challenging to determine causality of substance use and mental health disorders for several reasons that include, but are not limited to, the following considerations:

1) Mental illnesses can prompt a person to self-medicate symptoms with substance use. Consider a depressed person who drinks alcohol to alleviate symptoms of depression. Alcohol is a known depressant, so while drinking may temporarily cause the person to feel better, the symptoms of depression remain untreated and will likely worsen, requiring greater amounts of alcohol or more frequent episodes of drinking to provide the person with some relief, this pattern being one of the criteria for the onset of alcoholic drinking.

2) Drug and alcohol use can cause individuals to experience symptoms of mental illness. Consider a person who has been using methamphetamines for days without sleep, who begins to experience active hallucinations and symptoms of psychosis.

3) Both substance use disorders and mental illnesses can be caused by exposure to stress and/or trauma, genetic vulnerabilities or predispositions, and underlying brain deficits.

4) Mood disorders in particular increase a person’s vulnerability to substance use and addiction, as well as the inverse.

How are co-occurring disorders treated? These disorders are undoubtedly served best by an integrated treatment, where practitioners address both the mental health and substance use disorders simultaneously, as well as any primary care issues that may have developed as a result of the untreated disorders and the side effects thereof. According to SAMHSA, “Combining strategies from psychiatry and addiction treatment can lower relapse rate among rehab graduates, reduce the number of suicide attempts, and foster long-term abstinence.” In addition, comprehensive, integrated treatment not only reduces cost for the individual or family, but has far better outcomes than when treating the disorders separately.

When utilizing integrated mental health and substance use interventions, the same team of clinicians will work together in one setting, will all take responsibility for the client’s treatment, and will create a very comprehensive, coherent treatment package where symptoms from all disorders are treated. In this method, the treatment approach and philosophies remain consistent, as well as the set of recommendations. This also lessens the chance for individuals to medication-seek from providers who aren’t in contact with one another. For example, consider a person who suffers from symptoms of anxiety (as related to both Generalized Anxiety Disorder and alcohol use disorder). That person could easily go to a mental health provider, report the feelings of anxiety and not the alcohol use disorder, and be prescribed a benzodiazepine. This may lessen feelings of anxiety, but it would do nothing for the person’s sobriety, and would likely exacerbate the situation as now the person has a prescription for benzodiazepines and is drinking alcohol on top of them, a very dangerous combination that can be lethal. It is for this reason pharmacotherapy is much more effective when the treatment plan addresses mental health as well as substance use.

The following are additional reasons integrated treatment for co-occurring disorders is most effective:

1) Treatment of substance use and mental health issues simultaneously may help clients address unique triggers, such as depression, panic, or mood swings.

2) Group therapy in this setting provides a more specific and stronger support system for those who experience substance use and mental health disorders.

3) Integrated treatment also aims to overcome side effects of mental health disorder, such as barriers to socialization, impaired motivation, and reduced attention.

4) Challenges with medication are reduced, as there is a drastic reduction in prescribing medication that may be counterintuitive to symptoms of substance use, but not to mental health and vice versa.

In closing, co-occurring disorders are nothing less than very complex disorders that hence, require a complex form of treatment to be most effective. Substance use and mental health combined, when left untreated, are incredibly deadly. It truly requires a team of individuals collaborating recommendations and treating ALL symptoms to help those with these disorders to enjoy a life of recovery.


Heather Smyly