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Wednesday, October 25, 2017

Dialectical Behavior Therapy in the Treatment of Addiction

dialectical behavioral therapy addictionA main goal of dialectical behavior therapy is to improve emotional regulation and reactivity to external stimuli. These skills can be especially impactful for people with substance abuse disorders, as they tend suffer from intense mood fluctuation and sensitivity. Many people with substance abuse disorders are also impacted by borderline personality disorder. DBT has been proven to be one of the most effective methods of treatment for BPD, due to its behavior and thought modification. DBT also focuses on reducing stress, learning how to manage every day life, and interpersonal skills. All of these things combined make long term sobriety more accessible.

Dialectical behavior therapy helps clients identify triggering thoughts and situations. For example, a boss being unhappy with ones work performance. The client will then assess whether this situation warrants the extreme emotional reactions they are experiencing. The client implements evidence-based thoughts to counter act their “triggering thoughts”. Clients learn and implement self-soothing exercises and coping skills to aid with emotional regulation.

Dialectical behavior therapy is an extremely effective form of therapy due to the diversity of areas in which it can be implemented. DBT can be used in group therapy, in the form of skill building, or in training groups. This is where clients can learn life skills and interpersonal effectiveness. Individual therapy is also an area where DBT can be used. Clients share personal experience and then use/implement new coping strategies in order to handle life more efficiently. Both of these methods are extremely important in the treatment of substance use disorders because clients are generally learning for the first time how to live as a responsible adult. Clients with substance use disorders also need to learn new coping skills, rather than turning to drugs or alcohol to sooth intense emotions and stress.

Thursday, October 12, 2017

Reflecting About EMDR & Substance Abuse Treatment

EMDR substance abuseFor as long as I have been working in the field of substance abuse treatment there has always been a concern that a client may not be able to stay sober if they start to deal with their deep emotional issues. There are those who say “NO WAY” and those who say “If they don’t they CAN’T stay sober”. I have found that I rest somewhere between these two extremes.

While working here at Canyon Crossing, I've noticed that someone who has been doing well in treatment begins their trauma work with EMDR, and will appear to become less stable in their recovery. When they start dealing with that old trauma (that they used drugs/alcohol over for years), they start to have more cravings; when they were not having any cravings before they started to process these feelings. This is perplexing to the client, and creates some confusion and concerns for them. It is important that the client understand that this is a normal response to digging deep and dealing with old trauma, because this trauma is a huge relapse trigger and it is better to deal with it in a safe environment instead of on their own after treatment when they don’t have the built in support that treatment gives them.

One of the great things I like about working at Canyon Crossing is that I can do this deep work with the clients. I trust that the environment they live in is secure enough to support them while they deal with resolving their trauma, cravings, and painful history. The high accountability and structure that Canyon Crossing provides is a perfect place for these women to stay sober and work through their deep history of trauma with EMDR in order to achieve long term sobriety.

Janet E. Bontrager

Monday, October 2, 2017

Risks and Benefits of Psychotropic Medications

risks benefits psychotropic medicationsIt is not uncommon for clients in treatment to have resistance towards being prescribed psychotropic medication due to such factors as side effects, risk of becoming dependent on the medication, having to take the medication for the rest of their life, etc. As a result, there is a movement towards using alternative forms of treatment (i.e., biofeedback for ADHD, holistic medicine, hypnotherapy, EMDR).”

With many illnesses, the benefits of medication must be weighed against potential risks and side effects. Ultimately, the patient must be informed of the risks and benefits and make a decision whether to pursue a medication management program or not. Part of the provider’s responsibility is to educate the patient on the pros and cons as well as possible alternative forms of treatment that do not include the use of psychotropic medication.

The decision to have a life free of the devastating effects of mental illness and addiction versus experiencing unpleasant and/or potentially life altering side effects is a decision that must be made by the patient after a thorough process of informed consent. This is when the benefits of psychotropic medications must be considered.

The success rates of being treated with psychotropic medications can often be quite high. Some studies have indicated that antidepressants can be up to 70% effective even with the first medication trial. Sometimes, patients initially experience unwanted side effects with one medication but will find relief from the use of another medication. In such circumstances, the benefits of the medication must always be balanced against the possible consequences of not taking the medication.

In the case of chronic depression, it may be necessary for one to be treated with antidepressants long term. For many, illnesses of this nature are chronic, lasting years. Research has shown that if left untreated the effects of the illness can have detrimental effects on the brain. Those who aren’t treated effectively for depression actually have lower brain volumes due to the increased number of circulating stress hormones. These hormones cause cell damage and death, while antidepressant medications have a neuro-protectant effect that prevents this type of cell damage and assists with neuro-genesis. Specifically, the antidepressant medications known as SSRIs aid in transforming stem cells in the brain into mature brain cells that ultimately replace damaged cells in the hippocampus.

In general, psychotropic medications are especially effective with biologically based disorders such as schizophrenia and, in some cases, bipolar, mood disorders, and anxiety disorders. Medications have proven to reduce the negative symptoms of these disorders, increase overall functioning, increase the effectiveness of other therapeutic approaches, and tend to be very cost effective.

The primary categories of psychotropic medications include antipsychotics/neuroleptics, mood stabilizers, antidepressants, antianxiety medications, stimulants, narcotic and opioid analgesics, antiparkinsonian medications, and hypnotics. These medications have shown to have the following positive effects when treating mental illness: stops or reduces psychotic symptoms, produces mood stabilizing effects, relieves anxiety, decreases suicidality and other self-harm behaviors, prevents psychotic states, reduces depression, can produce calming and relaxing states, increase attention span while reducing impulsivity, can control acute pain, can aid in substance use detoxification, can treat neurological disorders, and assists with sleep disturbances. These are only some of the many potential benefits of psychotropic medications.

For many, medications are appealing because they often produce quicker results than alternative treatments. For those who are significantly and chronically depressed, sometimes the trajectory of “feeling better” through alternative treatments isn’t fast enough and they are at risk for suicide or other dangerous behaviors while experiencing significant impairment in functioning. Medications can often provide faster relief and stabilization for those who present as a danger to themselves or others. Medication can help these individuals live better longer lives with fewer effects that can cause detrimental consequences.

This is not to say that there aren’t significant risks associated with the use of psychotropic medications. In 1990 a survey was conducted to explore the general public attitude toward psychotropic medications. The survey found that the majority of the population views psychotropic medication with suspicion for the following reasons: 1) they can cause unwanted side effects and dependency, 2) their effects are restricted, i.e. they only treat the symptoms of the illness and not the cause, and 3) they can be ineffective, having either no effect or effects of a doubtful or temporary nature.

For some, medication may be a way to find quick relief without having to do “the work” that is required to not need medication. It’s simply easier to just take a pill than it is to change certain behaviors, thought patterns, and maladaptive coping mechanisms. What many patients do not realize is that medications often only treat the symptoms of the illness and not the main cause. Alternative approaches such as therapeutic interventions and psychosocial treatments address the cause of the illness thereby producing lasting change and relief; however these approaches tend to be more costly, time consuming, and require work.

Medications often produce unpleasant and even dangerous side effects including but not limited to mania, psychosis, hallucinations, depersonalization, suicidal ideation, heart attack, stroke and sudden death. Frequently, psychiatrists cannot predict what side effects a patient will experience due to the fact that it is unknown how exactly many of the medications work. In fact, many psychotropic drugs have been exposed as chemical toxins with the potential to significantly harm and/or kill those who take them.

Due to the potential risks associated with medication management treatment, the American Psychological Association actually recommends that, in most cases, alternative interventions such as psychosocial therapy should be the first intervention that is considered, especially for children and adolescents who tend to be much more susceptible to the adverse side effects of medication. Clearly, such interventions are much safer and, often, more effective than the use of psychotropic medications. In fact, when medications are deemed to be necessary they should be used as adjuncts to behavioral and therapeutic treatments.

Due to the many risks and unpleasant side effects of psychotropic medications, it is important to consider alternative forms of treatment for mental health issues. Therapeutic interventions and psychosocial treatments provide guidance, support, education, and positive coping skills to manage and treat mental illness. Therapeutic interventions should be given consideration as a first option to treat mental illness. While they tend to take longer than psychotropic medications for improvements to be noticed, they have solid grounding in empirically based research and are safer than medications.

Some empirically based alternative forms of treatment include, but are not limited to, behavioral therapy, cognitive behavioral therapy, EMDR, holistic treatment, psychotherapy, biofeedback, and dialectical behavioral therapy. These treatments utilize tools that can increase positive behaviors, correct negative thoughts, heal past trauma, facilitate a return to normal functioning, teach healthy ways of interacting, develop a deeper understanding of one’s self, and skills training such as emotional regulation and distress tolerance. Research has found support for the use of these interventions as first-line modes of treatment. Through various controlled trials and meta-analysis, researchers have observed sustained significant effects on behavioral problems, mood disorders, and other mental health issues as a result of using these alternative forms of treatment.

Other forms of treatment such as yoga and meditation are being explored as interventions that can lead to improvement in overall mental health. Yoga practices incorporate mental, physical, and spiritual healing to develop self-awareness, grounding, calm the nervous system, and build balance, flexibility, and strength. A few studies involving control groups have demonstrated yoga’s overall benefit on positive self-regard, perceptions of wellbeing, and emotional regulation skills. Yoga has further been identified as a tool for treating trauma. In fact, the Trauma Center at Justice Resource Institute has developed a form of yoga for traumatized youth in inpatient and residential treatments. 

While psychotropic medications certainly can be beneficial for those suffering from mental illness, they are not without their risks. One must carefully consider potential side effects and long-term effects of medications before making a decision regarding an appropriate course of treatment. A thorough analysis of potential benefits versus potential risks must take place in addition to careful consideration of alternative forms of treatment. In many cases, such alternative forms of treatment, while slower to produce results, can lead to lasting change by treating the core causes of the patient’s condition rather than simply relieving the symptoms.

Marie Tueller, MEd, LPC