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Friday, June 30, 2017

Interpersonal Relationships in Recovery

interpersonal relationships in recoveryDeveloping healthy interpersonal relationships, both platonic and intimate, is essential in maintaining long-term recovery from drug and alcohol addiction. When entering recovery many people have little to no close relationships due to the damage they have caused while in active addiction. Often the relationships they have maintained are unhealthy, not emotionally supportive, and occasionally even abusive. Learning how to detach from these relationships is imperative for the addict, because it is impossible to heal and recover while still involved in unhealthy environments. This can be a challenge for many people because although they are taking a step towards a healthier, happy life detaching from relationships can leave them feeling alone and vulnerable. Due to the nature of their past relationships many people don’t have any idea how to form healthy relationships or what a healthy relationship even looks like. Working with a sponsor and therapist can be very helpful in this area because they will model what healthy human interaction and positive emotional support look like. There are many things that are important to acknowledge when beginning to form new relationships in recovery.

It is incredibly important in recovery that people make sure to take the time to get to know each other. Taking relationships slow and steady helps to ensure that neither party causes harm to the other and that both people are aware of the things the other needs in a relationship. It's easy to mistake excitement and validation for love, especially in recovery where people are looking for instant gratification and distraction from intense negative feelings. For this reason people often jump into relationships quickly, whether it be a friendship or romantic relationships, and later realize they have nothing in common with this person or continue their pattern of volatile interpersonal relationships. In romantic relationships this often leads to relapse, as the person has been distracted from completing any deep personal introspection and adjustment of behavior. When relationships are taken slow and given time to develop naturally, the skills of healthy communication, confrontation, and emotional support can be learned with the help of treatment providers and 12 step programs. Community and healthy connection can be one of the biggest and most valuable assets in the difficult journey of recovery.

Another important factor in relationships in recovery is to make sure that both people are focusing on their individual program. Frequently when people begin relationships they stop going to as many 12 step meetings, limit communication with their sponsors, and slack in the personal areas of their programs such as 12 step and service work. This is because the new person in their lives becomes a distraction and they lose focus on their own work. This can be dangerous because when people are focusing on external factors and distractions instead of internal work and validation they put themselves at a risk for relapse. The other part of this is for people to be able to identify when a relationship is causing harm to them and use the tools they have learned in recovery to exit the relationship. These tools include setting boundaries, communicating feelings, identifying maladaptive behaviors in ones self and others, and identifying relapse risk factors (going to bars for social events, high levels of stress due to conflict).

Friday, June 23, 2017

Treating Substance Abuse with Co-occurring Disorders

substance abuse co-occuring disordersThe definition of recovery is "a return to a normal state of health, mind, or strength". It is becoming the norm for someone who suffers from substance abuse to also suffer from some sort of co-occurring disorder. It could be trauma, borderline personality disorder, a mood disorder, self-harm, amongst other things. Due to this increasing occurrence, it is has forced the treatment industry to evolve. 

Today, treatment often requires a multi-faceted approach. Let’s take a look at trauma as our first example. If a provider only treats the substance abuse, but does not treat the trauma an individual has suffered from, that person will not be able to make a full recovery, and it puts the patient at a higher risk for relapse. The reason being is that individuals with untreated trauma tend to unconsciously recreate the trauma in their lives. This means that if someone has untreated trauma, chances are they are going to put themselves in a situation that will not only cause pain of various types, but the individual will more than likely act out in certain behaviors that are not conducive to “a return to a normal state of health, mind, or strength.” They will be engaging in situations that put their newfound sobriety at risk.

The next example we can look at is some sort of co-occurring mood disorder alongside the addiction, such as bi-polar disorder. The same principle applies, if a provider treats the substance abuse, but not the mood disorder the individual will not be able to make “a return to a normal state of health, mind or strength.” People who suffer from addiction already suffer from extreme emotional swings due to the chemical imbalances in their brain. Couple that with bi-polar disorder and there is an extremely volatile situation that could quickly lead to relapse. In situations such as this it is paramount that they be under psychiatric care while being treated for their substance abuse. If the individual is not stable, how can they even benefit from substance abuse treatment? They won’t even be able to take in and apply what they are learning, nor will they be able to pursue the introspective practices necessary for substance abuse recovery. In the long term situation, an individual is at great risk for relapse if their mood is not regulated, because they run the risk of self-medicating with addictive substances.

If your loved one suffers from addiction with some sort of co-occurring disorder there are several things to look for when seeking treatment for them. Make sure the facility is adequately equipped to treat whatever co-occurring disorder is going on with your loved one. Ask specific questions pertaining to their treatment of the co-occurring disorder, and what the intensity of the treatment is. Furthermore, with someone who has a co-occurring disorder, it is absolutely vital they receive long term care. Substance abuse is a complex enough issue, couple it with a co-occurring disorder and treatment gets even more complex and intricate. Thirty days is simple not long enough to fully, effectively treat the issues at hand. A thirty day inpatient facility is a good start to get the ball rolling, but after care in a long term program is vital for recovery in situations with co-occurring disorders.

Saturday, June 10, 2017

Trauma Informed Care

trauma informed careThe awareness of trauma and stress related disorders and the importance of developing sound treatment approaches for these disorders has grown in recent years. It is essential for practitioners and agencies that deliver substance use and mental health treatment to enhance their understanding of the complexities of trauma related disorders and how to treat them. Furthermore, it is important that care providers deliver efficacious and empirically evaluated forms of treatment.

Trauma and stress-related disorders are among the most prevalent disorders treated by mental health professionals. Within the general population, a lifetime trauma incidence of 40% to 90% has been reported, and the overall lifetime prevalence for PTSD ranges between 7% and 12%. Needless to say, practitioners must ensure that they have the competency, training, and support to effectively treat trauma-related disorders.

Many studies have reported the efficacy for the psychological treatment for PTSD in conjunction with psychopharmacological treatment of PTSD. These studies have shown that psychological treatment is more effective in reducing symptoms of PTSD than medication alone. These studies have focused on several different modalities of treatment in order to determine which approaches seem to be most effective. Among the most researched and effective treatments for PTSD are trauma focused CBT (TFCBT), EMDR, Exposure based therapy, and Cognitive Processing Therapy. These approaches are widely used by practitioners in the treatment of trauma related disorders.

TFCBT combines trauma-sensitive interventions with cognitive behavioral techniques, family approaches, and humanistic principles. EMDR is a treatment approach that facilitates the accessing and processing of traumatic memories and seeks to bring these memories to a more adaptive resolution. Exposure therapy involves gradually exposing the client to the feared object and/or situation without any danger as a way to overcome stress-related symptoms. Cognitive Processing Therapy (CPT) is also considered to be a best practice model. CPT is an adaptation of cognitive behavioral therapy and incorporates trauma specific cognitive techniques to assist clients in moving past erroneous beliefs and maladaptive thoughts.

While applying evidenced-based treatment approaches to trauma services is absolutely necessary, there are additional things to consider when working to develop a trauma informed approach to treatment. To become trauma informed, practitioners and agencies not only need to be aware of evidence-based and efficacious forms of treatment, they must demonstrate an understanding of and competency in working with trauma exposed clients. Training of all staff within an agency as well as ongoing training for practitioners is essential in order to deliver sound and effective services. Ongoing supervision, training, and an emphasis on creating an environment of safety, trust, choice, collaboration, and empowerment are necessary components of creating competency and effective treatment of trauma related disorders.

When delivering treatment for PTSD, physical and emotional safety are the foundation for effective therapeutic work. This includes providing a safe physical environment, education, and information about the pervasive effects of trauma. Trust is an essential part of emotional safety when treating trauma. This includes establishing and maintaining appropriate boundaries, honoring confidentiality, consistency, clarity, and predictability. These components are absolutely necessary when delivering trauma treatment and creating a safe environment in which to procure services.

Cultural awareness and competency are also important to consider when utilizing various techniques to establish trust and safety. For example, practitioners must have knowledge of culturally appropriate nonverbal cues and norms that enhance safety and trust within that particular culture. Agencies and practitioners must be aware of culturally appropriate interventions and ways in which to communicate trust and safety in a culturally sensitive manner.

A competent treatment approach and a trauma sensitive environment also places value on client choice and one’s ability to have a voice in his or her recovery process. Emphasizing choice and supporting the client’s unique voice, allows the client to assume an active role in his or her treatment. This involves mutual collaboration between the client, practitioner, and/or agency in which a cooperative relationship is built based on the value of each individual’s unique experience and expertise. The practitioner’s experience and expertise are not valued over the client’s unique experience and expertise, rather both engage in a mutual exchange of respect and trust.

Finally, empowerment is a key component to effective trauma treatment. This concept argues that clients should be actively involved in the planning, delivery, and evaluation of services. A practitioner can empower clients by providing resources, information, education, and engaging them in interventions. It is important to build on a client’s strengths and his or her inherent resiliency as a means to empower him/her in the recovery process.

In addition to implementing evidence-based treatment, and adhering to principles of safety, trust, choice, and empowerment, trauma informed practitioners and agencies must be aware of the specific challenges and risks associated with trauma treatment. These challenges include but are not limited to personal attitudes, resistance, developing appropriate policies and procedures, and the potential for staff members to suffer from vicarious trauma. Trauma-informed clinical and staff support has been recognized as a primary protective factor for trauma reactions experienced by providers. Specifically, trauma sensitive coaching and staff support must include the same principles necessary for effective trauma treatment: safety, trust, collaboration, choice, and empowerment.

As awareness continues to grow regarding the complexity and pervasive effects of trauma, it is imperative for practitioners and mental health agencies to develop an understanding of and competency in trauma informed practices. This not only includes ongoing training and the implementation of evidence based practices, but a sensitivity to and awareness of the key components that comprise an effective therapeutic relationship based on safety, trust, collaboration, and empowerment.

Marie Tueller, MEd, LPC
June 8, 2017 

Sunday, June 4, 2017

The Importance of Accountability in Recovery

accountability in recoveryIndividuals who suffer from addiction, more times than not, have no idea about being responsible for their behaviors and choices in life. When someone enters into recovery, it is paramount that they recreate themselves. Their previous way of living has been ineffective, and has caused chaos and harm in their own lives as well as the lives of others. Addiction centers in the mind. Therefore the importance of teaching these individuals to change the way they view things, and thus them changing their own behavior, is crucial for long term recovery.

The issue with addiction is that the substances being abused are only the tip of the iceberg. What about the lying, stealing, manipulating, and other destructive behaviors that accompany addiction? Many people are aware getting the drugs and alcohol out of the system is only the beginning. If it where that simple there would be no need for treatment centers or recovery programs. Recovery is about taking responsibility for one's actions, both past and present. In order to do this the behaviors mentioned above must be confronted, and the individual must learn that behaving in their previous manner will get them nowhere in life and will more than likely lead them to relapse.

Bringing about this change is not easy, but it starts with learning to hold oneself accountable. Since the individual entering recovery has no idea how to do that, it is important that others around them do so until they learn personal accountability. This is where long term treatment comes into play; especially a facility that believes accountability is crucial to one's long-term recovery. The process usually involves their peers as well as the staff confronting the behaviors in a direct, yet therapeutic manner. If someone is simply told they are not behaving appropriately, but is not explained to why, nor given an alternate method of handling the situation the individual will not internalize the importance of changing themselves.

When an individual learns personal accountability, they are able to handle life successfully. They no longer engage in harmful behaviors, they are able to have effective meaningful relationships with others, and they are able to face situations in an appropriate manner, handling them without the need to rely on others.