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Sunday, February 26, 2017

Grieving The Addiction In Recovery

Grieving Addiction RecoveryFor people in recovery, feeling our feelings is extremely uncomfortable. The use of alcohol and/or drugs was our main coping mechanism to eliminate uncomfortable feelings. It is often stated in recovery settings, “feel your feelings”. Yet, how is that manageable without alcohol and/or drugs? 

One of the biggest mistakes we can make in recovery is to deny the unsettling emotional state in which we find ourselves. As in our active addiction, we dismiss our feelings or try to stuff them. It is common to view our feelings as unjustified, unreasonable, or even unimportant. Even more common in recovery is to avoid or deny our feelings.

One thing is for sure, our feelings do not go away. They will return in a haunting way to remind of us we need to address them. In sobriety, especially early sobriety, our feelings come flooding back, and it’s hard to navigate through them. However, it is vital to be gentle with ourselves as we sort through these feelings honestly and courageously.

So, where does grief play a part in sorting through these feelings? “When we give up an addiction, we give up more than alcohol and/or drugs. We give up a confidant and a friend; a constant companion and comfort; as well as a means of navigating (however ineffectively) through life”.  

Even though in sobriety we begin to feel physically, emotionally and spiritually better, we will still feel an overwhelming sense of loss, and even sadness as we process our feelings and progress in recovery. By not processing these feelings, it is easy to fall into depression in sobriety that can inevitably lead us back to active addiction. Addressing and moving through grief and loss is a huge part of the process in recovery. It is important to engage in a healthy way to bring closure to lives in addiction.

Similar to losing a love one to death, the relationship we have with our addiction is deep, intimate and entangled. It is a real sense of loss that must be approached and processed in a healthy way so we can find peace and have closure needed to start a healthy life in recovery.

We all have a uniqueness to how we grieve, yet there are some universal ways in which we grieve. The stages of grief are universal, yet the length of time one need to move through these stages are individual to that person, and their situation. It is important to have patience with yourself as it is common to go through more than one stage at a time.

The Five Stages of Grief 

It is a very common feeling to initially be in denial of our addiction, and that recovery is necessary. It is also common in early sobriety to deny our emotions are getting the best of us. We absolutely do not want to feel our feelings, or even acknowledge that we are having the feelings. Rather than share what we are feeling, we will isolate or pretend the feelings don’t exist.

In recovery we may experience one of two types of anger; raged-filled anger or stuffers. We are either continuously angry, or pretending we are not angry. We are people that want to have it our way, and will do what it takes to get our way. When we give up alcohol and/or drugs, anger, even among the meekest of us, is unavoidable.

Most of us has lived in our active addiction in some state of bargaining. We would consistently try to control our alcohol and/or drug use to appear as normal user. However, when we find that recovery is necessary, we will still try to bargain, looking for loopholes where can still use alcohol and/or drugs without a calamity that will inevitably destroy us.

The sense of complete hopelessness and sadness is common for us to experience in early sobriety. Some of us cannot image a life without alcohol and/or drugs. Even worse, what would the future look like? This is the phase where we can experience some depression and despair. Don’t fret. This phase will not last. With honesty, and becoming open to work through this phase with a professional or a peer in recovery will be the great revealer that what we are feeling is normal.

At last! We come to the phase in our journey where we experience a freedom like none other. We accept we are an addict, and active alcohol and/or drug use is not an option for us. Life begins to come together for us. We are honest about our addictions, and begin to live peacefully and in harmony without alcohol and/or drugs. We have found the gift of acceptance!!!

Beyond the “Five Stages of Grief”, the journey can continue by exploring the, “Four Gifts of Grief”; forgiveness, love, gratitude and farewell. The gifts of grief allows the pain to pass, and we can to let go and live a life of beauty and serenity in our acceptance.

Gwen Henderson, MA
A Person in Long-Term Recovery
Group Facilitator
Canyon Crossing Recovery

Tuesday, February 14, 2017

Cognitive Behavioral Therapy for Treatment of Substance Use

cognitive behavioral therapy Cognitive Behavioral Therapy (CBT) is an active, collaborative, short-term treatment method that aims to reduce unhelpful patterns of thinking and behavior that may exacerbate or even contribute to mental health issues and substance use.

The term active indicates that the work accomplished in session is aimed at making an immediate difference the client’s life, through the implementation of problem-solving. Collaborative means that therapist and client work together, and each take responsibility for the contents of the sessions. Short-term means just that- the sessions are time-limited and usually last less than 20-sessions.

So why is CBT an effective treatment of substance use?

CBT helps to provide insights as to what drives the compulsion to use substances to cope with life, or the challenging thoughts and emotions life may induce. In this method, the substance use itself is not necessarily focused on as the problem, but the underlying issues are, as they create a constant feeling of not being okay, which often leads to self-medicating through drugs, alcohol, sex, gambling, and other compulsive, addictive behaviors. If the aim of therapy focuses solely on removing physical dependence from substance use, a relapse may soon follow, as the person needs to not only understand why they use, but develop healthy coping methods and strategies for staying sober in the future.

Earlier it was mentioned that CBT is active. In relation to substance use treatment, this means that therapist and client work together to identify the thoughts, feelings, as well as circumstances that a client frequently experiences before and after using. This helps to identify patterns that may contribute to the feeling of wanting or needing to use, as well as identify ways to prevent risky situations. Specific triggering thoughts can be identified, and once that happens, the person may develop other ways to reduce or eliminate those thoughts and emotions. For example, maybe the person feels that their reality is too painful and that they cannot cope without numbing themselves with drugs or alcohol. With CBT, the person may first be able to come to a better understanding of the situation, and then develop skills necessary to cope. There are a multitude of reasons people may have turned to drugs and alcohol to feel better, but through the skills training of CBT, they may develop healthy ways to replace old, outdated coping mechanisms that only provided temporary relief and ultimately lead to exacerbation of problems.

CBT has a very structured, hands-on approach. Every session includes a specific agenda that is set by both the therapist and the client. Part of this agenda includes specific techniques that are used to reduce the negative thoughts that drive negative behaviors. Common methods utilized are: cognitive restructuring, automatic thought reduction, thought-stopping techniques, situational diversions, mindfulness and meditation, and motivational enhancement. In addition, the goals are based on what the client identifies rather than just the therapist, lending to a sense of personal contribution to the sessions and increased feelings of self-reliance and confidence.

The behavioral portion of CBT indicates that just as behaviors are learned, they may be unlearned. Once specific maladaptive behaviors, such as drug and alcohol use, have been identified, plausible alternatives for coping may introduced, and unhealthy behaviors can be replaced with healthy ones.

Monday, February 6, 2017

“The Lotus Blossom: From Survivor to Thriver”

women addiction trauma
A Blog on Women, Addiction, and Trauma
By Marie Tueller, MED, LAC

The relationship between trauma and substance use disorders among adult female populations is complex and requires a unique approach to treatment. An alarmingly high proportion of women with addiction and substance use issues have histories of trauma including childhood and adult sexual abuse, physical assault, neglect, emotional, verbal, and psychological abuse, and domestic violence. It is therefore essential that treatment interventions for addicted women embrace a perspective that highlights the undeniable connections between substance use and trauma while recognizing the survivor’s fundamental resilience over pathology. 

Here are some alarming facts about women and trauma in the United States:

¥ About half of all women in the U.S. will be exposed to at least one traumatic event in their lifetime.

¥ Women are more vulnerable to sexual assault and childhood sexual abuse than men.

¥ Nearly 1 in 5 women (18.3%) in the United States have been raped at some time in their lives.

¥ Women experience PTSD at two to three times the rate that men do.

¥ Lifetime estimates of PTSD are 9.7% for women and 3.6% for men

Even more shocking is the increased prevalence of trauma among women who suffer from substance use disorders:

¥ 80% of women seeking treatment for addiction report a lifetime history of sexual and/or physical assault.

¥ Women with PTSD and substance use disorders present with higher rates of other mental illnesses that can complicate treatment and prognosis.

¥ The rate of PTSD in the general population of women is about 11%, for women in substance use treatment the rate is 30-59%.

The high incidence of trauma among addicted women undoubtedly shapes the nature of treatment approaches and interventions applied to women seeking relief from both addiction and trauma related symptoms. For women suffering from addiction and trauma, it can be extremely difficult to maintain abstinence because trauma related distress and emotions continuously trigger the compulsion to drink, use, or act out in addictive behaviors. In the context of trauma, addiction arises NOT simply as a pleasure seeking strategy but as a primary survival coping strategy to self soothe and self regulate. For the trauma survivor, addiction can become a way to function and feel safer in the world.

In other words, to simply dismiss addiction as a “bad habit” or “moral failing” conceals the functionality of the addictive behaviors. For most women struggling to cope with debilitating trauma related symptoms, drug and alcohol use can serve as a way to numb symptoms, cope with intolerable effects, slow reactivity, manage impulsivity, distract from obsessive thinking, stop intrusive memories, combat helplessness, and facilitate dissociation. In short, substance use becomes a means of survival in an otherwise unbearable state of being. Unfortunately, this is not a sustainable (or healthy) survival strategy. Ultimately, the suffering individual requires a new set of coping mechanisms coupled with compassionate support, connection, and hope in order to begin her healing process.

Because of the powerful relationship between trauma and substance use, it is imperative that addiction treatment integrates both trauma-informed and gender-responsive interventions in order to reduce the risk of trauma-based relapse. Simply put, treatment MUST address both the addiction and underlying trauma. When the addictive behaviors are gone, all the traumatic memories, emotions and thoughts that were being suppressed by the addiction will surface. It is impossible to heal the trauma while the addiction is active, and equally as impossible for the addicted survivor to maintain abstinence in the face of debilitating trauma related symptoms without effective alternative coping skills.

Specifically, treatment of co-occurring substance use disorders and trauma related disorders must address the relationships between:

¥ The trauma and the addictive behavior
¥ The role of the addictive behavior in medicating traumatic activation
¥ The origins of BOTH in the traumatic past
¥ The reality that recovering from EITHER means recovering from BOTH
¥ Stigma and shame associated with trauma, gender, addiction, and mental illness.
¥ Cultural, social, and systemic barriers that increase risk for relapse.

In addition to recognizing the complex relationships between gender, trauma, and addiction, it is important to recognize the survivor’s need to be respected, informed, connected, and hopeful regarding her recovery process. The survivor can be empowered through self-awareness and understanding the interrelation between trauma symptoms and other issues such as process addictions, eating disorders, personality disorders, depression, and anxiety. A collaborative approach to healing that actively involves the survivor, family members, community support, and a variety of trained providers typically yields the most successful treatment outcomes.

Coupled with this integrated approach to treatment, developing a renewed sense of connection and self worth are arguably the most important elements of healing for addicted female trauma survivors. Judith Lewis Herman, author of Trauma and Recovery: The Aftermath of violence From Domestic Abuse to Political Terror, describes the powerful and restorative healing that comes from connection and the careful reconstruction of one’s sense of self:

“Traumatic events destroy the sustaining bonds between individual and community. Those who have survived learn that their sense of self, of worth, of humanity, depends upon a feeling of connection with others. The solidarity of a group provides the strongest protection against terror and despair, and the strongest antidote to traumatic experience. Trauma isolates; the group re-creates a sense of belonging. Trauma shames and stigmatizes; the group bears witness and affirms. Trauma degrades the victim; the group exalts her. Trauma dehumanizes the victim; the group restores her humanity.” 

Survivors have repeatedly described the indispensible role that connection has played in their own healing processes. Incorporating an integrated and multidisciplinary treatment approach for addicted female trauma survivors while offering opportunities for connection, safety, and self-love can reawaken that person’s sense of possibility and hope. Treatment and community based support services not only offer a path to recovery but provide survivors with indispensible opportunities for connection with other women who speak the complex language of trauma and addiction. Faith, courage, dignity, and peace, once believed to be irretrievably destroyed, can be reclaimed and renewed as the trauma survivor begins to recognize the lost parts of herself mirrored in the actions of her fellow survivors.

The resilience and transformation of the survivor as she moves through her healing process is beautifully paralleled by the lotus blossom’s growth cycle. Like the trauma survivor, the lotus flower begins as a plant growing deep below the surface of dark and murky waters. The plant must fight to make its way to the surface in order to reach sunlight and eventually blossom. The lotus flower mirrors the addicted trauma survivor’s recovery process and reminds us that healing and growth are possible no matter the depth of our despair or the darkness of our past. If given the right support and environment, the victim once trapped in dark isolation, can thrive in the brilliance of love and connection. With help and support, anything is possible. And as the once fragmented victim breaks through the surface, she eventually learns that not only has she SURVIVED the darkest of times, but that she is THRIVING above the surface of deep and muddy waters.