RECOVERY TRENDS & TREATMENT

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“Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”  ~ SAMHSA/CSAT

Addiction is a socially transmitted disease therefore,
Recovery is a socially transmitted solution.

I will begin one of the most exhilarating, liberating, and exciting fours week of my life (when I enter a treatment program). Scary, yes, and filled with unspeakable emotional discomfort, but for me it’s an unquantifiable relief that I am being shown a different way to live. I am so tired of the lying, my inability to keep my word, the bullshit relationships, the hangovers, the cover-ups, and the helplessness to stop doing the things I truly want to stop doing.

- Rob Lowe, Actor and author of Stories I Only Tell My Friends: An Autobiography

FROM: DR. JEAN LACOUR

Welcome to Trends in Recovery and Treatment. We begin with introducing you to the term Behavioral Healthcare and provide a brief outline of the goals of Clinical Treatment. Then we move into a more expanded focus on the areas or domains of Recovery that align with the theories of addiction.

Popularity of some interventions has waned while new ones are being carefully considered and some are still widely embraced such as 12 Step Mutual Aid Groups.

Our Counseling Issues and Counseling Skills coursework, textbooks and public domain materials present various contemporary issues, approaches, tools, and clinical skills of addiction professionals as well as content on HIV, Domestic Violence and Ethics courses.

Check out our course on Clinical Supervision Competencies designed to increase your confidence and commitment to the critical role of quality supervision. Meets Florida Certification Board/ FCB required 16 hours for Clinical Supervision for MCAP- Masters level Certified Addiction Professional.

You can also choose from extensive coursework in Recovery Dynamics including the importance of Recovery Management and Ethics.

What’s in a name?

Behavioral Healthcare is an umbrella term and refers to a continuum of services for individuals at risk of, or suffering from, mental, behavioral, or addictive disorders. Because people with mental and substance use disorders often have more physical health problems than the general population, assistance in coordinating care across behavioral and physical health care providers can be a valuable support.

www.samhsa.gov/treatment

Addiction Treatment / Behavioral Healthcare can include:

  • Medical detoxification
  • Primary medical healthcare
  • Clinical interventions based on assessment
  • Psychotherapy: Counselors and Therapists
  • Co-occurring clinical services (mental illness and substance use disorder)
  • Medication assisted therapy

Aim of Treatment: Initial Goals for Early Recovery

  • Crises Management
  • Symptom Stabilization / Detox
  • Client Recognizes their Problem
  • Coping Skills for Sobriety

Treatment Services may include:

detoxification, inpatient residential, outpatient counseling services, family programs, aftercare programs, etc.

Typical treatment has included some combination of facilitated group work and 12-step “self-help” programs

ROAD TO RECOVERY:
BIO-PSYCHO-SOCIAL-SPIRITUAL and Developmental

  • Gender
  • Physical Illness
  • Disability
  • Genetic vulnerability
  • Immune function
  • Neurochemistry
  • Stress reactivity
  • Medication effects
  • Social supports
  • Family background
  • Cultural traditions
  • Social/economic status
  • Education
  • Learning/memory
  • Attitudes/beliefs
  • Personality
  • Behaviors
  • Emotions
  • Coping skills
  • Past trauma

Biological:

The level of physical damage to your body from substance abuse or other addictions will need to be addressed and reassessed in recovery.  But for starters, there are four areas to address.

  • Full Physical from a Medical Doctor is needed to assess your safety in cutting back from alcohol and other drugs since withdrawals can be life threatening. Get a base line on your vital signs and any underlying issues like high blood pressure or signs of diabetes, etc.
  • Medications may be prescribed by a physician to provide support and stability as you begin your steps in recovery.
  • Good Nutrition is giving your body the good food and nutrients it needs for health rather than the sugar and empty calories you put in your body during your addiction.
  • Exercise like lifting weights, fast walking, bike riding, or hot yoga to help your body release stress and readjust to being able to fall asleep. Exercise can build muscle to support your body as well as readjust your body chemistry and bring endorphins back to normal.

Psychological:

Dr. Lance Dodes, M.D. asserts that addiction’s true nature is better understood as a psychological process, akin to other compulsive behaviors, caused by meaningful emotional factors that must be explored whether by an individual personally or addressed in counseling or psychotherapy.

Dr. Dodes proposes an alternative approach to understanding and treating alcoholism and all addictions in his book Breaking Addiction: A 7-Step Handbook for Ending Any Addiction which is practical and user friendly.

He explains that the psychological function of addiction is to reverse a sense of overwhelming helplessness and that every addictive act is a substitute for more direct behavior. The reversal of helplessness is a function of addiction and the powerful drive behind addiction is rage at that helplessness. Alcoholism is treated as a displacement (substitute behavior) that can be reversed through psychodynamic psychotherapy aimed at understanding, managing, and learning about oneself so that a direct action can be undertaken as possible and appropriate for the situation. Addiction as a misguided quest for empowerment is plausible.

Whether one agrees fully with the author’s perspective is less important than the importance of understanding what it contributes to efforts to develop effective intervention with persons struggling with addictive disease, especially if they have ‘failed’ at treatment and do not fit in with 12 step groups.

This new approach provides the reader with an opportunity to make an assessment of their own lifelong tendencies and behaviors and compulsions to use.

"Breaking Addiction" is written directly to the person struggling and gives simple, descriptive and sensitive narratives about real clients to illustrate every point. Counselors who use this approach routinely report they give this book to their clients and find that they gain so much by reading it. Their therapy literally leaps forward, and they feel empowered to find personal answers and truth as they apply the thoughtful principles.

After decades of clinical treatment programs based on non-clinical 12 Step principles and practices, it can be challenging to read an approach to recovery that does not embrace 12 -Step philosophy.

Motivational Interviewing and Stages of Change:

Motivational Interviewing has five principles that focus on empowering patients and make the treatment process different from more traditional confrontational or “talk” therapies.

  • Express and Show Empathy Toward Clients
  • Support and Develop Discrepancy
  • Deal with Resistance
  • Support Self-Efficacy
  • Autonomy

The Stages of Change of the TTM/ Transtheoretical Model is based on decades of research which found that individuals move through a series of five stages (precontemplation, contemplation, preparation, action, maintenance) in the adoption of healthy behaviors or cessation of unhealthy ones.

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance

The most obvious connection between Motivational Interviewing and the Stages of Change is that Motivational Interviewing is an excellent counseling style to use with clients who are in the early stages. Pre-contemplators do not want to be lectured to or given “action” techniques when they are not ready to change. Likewise, contemplators, who are considering the possibility of making a change but are not quite ready to make a commitment, are resistant to more traditional approaches that encourage (or try to force) them to make changes for which they are not yet ready.

Through the use of Motivational Interviewing strategies, clinicians facilitate clients in examining their own particular situations, considering the pros and cons of changing, and making decisions about change. This is done in a non-threatening and supportive manner that encourages the client to take responsibility for his or her own situation.

The Motivational Interviewing philosophy, approach and methods are uniquely suited to addressing the tasks and emotional reactions of individuals moving through the first two stages of change. Clinicians have also found Motivational Interviewing to be a very effective style to use with clients in the later stages as they prepare for change, take action, and maintain the change over time. Miller and Rollnick (1991) have called this “Phase II” of Motivational Interviewing. This is the point at which the client has made a decision to change.

Read More About Motivational Interviewing: +

In this phase, the clinician’s job changes from one of motivating the client to one of advising and “coaching” as the client develops a workable change plan, anticipates barriers to change, and identifies potential support systems. Although most change strategies in this phase (the preparation, action and maintenance stages) are more action-oriented, clients are still more responsive, and ultimately more successful, when the role of continued motivation is not forgotten, and they are treated in the empathic, caring style inherent in Motivational Interviewing.

For clients in action and maintenance, Motivational Interviewing approaches can help increase self-efficacy and reinforce their accomplishments, both of which are important in sustaining long-term change.

As evidenced by the way researchers and clinicians around the world have embraced the two models, it is apparent that Motivational Interviewing and the Stages of Change are a “natural fit”. Recognizing the parallels and potential synergy of these ways of understanding and treating problem behaviors, professionals have used these models in many diverse areas of behavior change to develop client centered, personalized, motivational interventions that are sensitive to the process and processes of change (Connors, Donovan & DiClemente, in press; DiClemente, Marinilli, Sing & Bellino, 2001; Miller, Zweben, DiClemente & Rychtarik, 1992; Prochaska, Velicer, DiClemente, and Rossi, 1993; Velasquez, Gaddy-Maurer, Crouch & DiClemente, in press; Velicer et al., 1993).

Social, Developmental and Family:

If you googled the words “isolation and recovery” you would find numerous blogs and articles that address the importance of social interaction and social support in early, middle and long term healthy recovery.

Isolation and the pain of loneliness are often factors that drive a person toward addiction. Depression, anxiety and stressful situations are also factors that can affect isolation and also increase as addictive behaviors escalate. The person is obsessed with acquiring and using their drug of choice or chosen behavior and sees people as pawns to be used.

Some writers, like Craig Nakken, even talk about addiction as a pathological RELATIONSHIP with a drug or behavior as all other relationships are ignored or abused in order to get money, housing, or transportation to maintain the addict’s using behavior.

Recovery programs universally focus on rebuilding social relationships whether they are residential long term Therapeutic Communities (TC), recovery houses, residential clinical treatment facilities that include “group work”/ therapy groups, 12-Step Support Groups, Faith Based Support Groups, Rational Recovery Groups, and numerous group activities.

Activities and work projects like gardening, dining hall duties or daily chores promote a sense of social responsibility and service to others.

shadow-ornament

Developmental delays can be dealt with and overcome in safe social interactions within a structured recovery process. We grow and learn through relating to age appropriate role models and by identifying with others who are similar in some way and who can show the reality of progress and hopefulness.

Beating Isolation in Addiction Recovery

Great suggestions from Addiction Campuses Blog : http://www.addictioncampuses.com

Living life isn’t as easy as it sounds – especially when you are new to sobriety and recovery. A crucial barrier to break in addiction recovery surrounds beating isolation and loneliness. Below are a few suggestions on how to do so.

  • 1

    Allow yourself to grieve the loss – of drugs and alcohol.

    In active addiction, drugs and alcohol can seem like your best friends: The only ones who are there for you in the darkness and the loneliness. It’s understandable that the loss of that relationship may cause you pain, anger and loneliness in your early recovery. Keep in mind that your relationship with your drug of choice was a one-sided, destructive friendship.

  • 2

    Make amends. And make peace where amends aren’t possible.

    During active addiction, we cut people out – and hurt those whom we love the most. You may have disconnected from good friends, and damaged relationships with family. Hurt and confused, your loved ones may have written you off. In recovery, you have the opportunity to apologize, and take action to make amends. While some relationships may be salvageable, some will not. In the situations where relationships are damaged beyond repair – make peace with knowing you have apologized, and accept that there are some things beyond your control.

  • 3

    Disconnect from unhealthy relationships.

    While you may struggle with wanting to connect with others, some relationships and social connections are unhealthy. There will be some people who will not support your recovery – and they have no place in your life, regardless of your loneliness or desire to connect. Cut out the negative influences, and move forward.

  • 4

    Connect online.

    Graduates of Addiction Campuses’ programs have secret Facebook groups and chat forums to connect with each other. In addition to that, there are numerous support outlets that allow people in recovery to connect with one another. These forums often have daily affirmations, verses and advice – along with information about local support groups. We recommend incorporating both online networking along with face-to-face programs into your schedule.

  • 5

    Mix it up.

    I’m very guilty of getting into a comfort-zone – which usually leads to an uncomfortable zone, meaning I get into a rut. Diversify your activities and the people with whom you connect. You don’t have to go to the same meeting every week. Try a different time or place. Try a new activity – or even just a new restaurant. Getting caught the daily grind can make it impossible to climb out of isolation.

  • 6

    Build self-confidence – and boundaries.

    Connecting with others and trying new things is essential to breaking the barriers of loneliness and isolation. However, it’s important to build your own self-confidence and be comfortable in being alone, and choosing who you interact with and when. Building a support network requires building boundaries in your relationships, and being a good friend, relative, or significant other in return.

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Loneliness can be one of the Biggest Causes and Effects of Addiction – and Addiction Relapse.

Through fellowship, friendship and connections, it’s possible to break the cycle of isolation and addiction. Connecting with others in recovery through meetings, sponsors, groups, or social function means sharing a bond with others on a similar path to you. We are social creatures – and we depend on each other for survival. If you’re lonely in your addiction or in your recovery – reach out to someone who can truly listen and care. Break free of the emptiness and solitude.

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Jean Lacour: Family Recovery Programs

were developed to restore families torn apart by addiction and may be part of a residential treatment program.   Family members can find tremendous healing, insight and freedom even when the addicted family member is not participating or no longer “in the picture.”  For many people, it’s like stepping out of a horrible, sad, never-ending movie and realizing they are not to blame.

Family members or adults who grew up in alcoholic or dysfunctional home have found liberating health by learning about Family Issues in Recovery through a counselor, a professional recovery coach, or in a group program.  The rules and roles and boundaries related to Co-dependency can be the first step to life long health.

The program of Alanon for family and friends of an addicted person is a mutual aid support group; it’s role is not to teach or give advice. A phrase that can be heard in Alanon meetings that brings great relief about the burden of a loved one’s addiction is this: “I didn’t cause it, I can’t cure it and I can’t control it.”   For many family members this is nothing short of permission granted to personally heal and “get on with living well.”

Spiritual:

Recovery = Restoration

Rediscovery or Development of:

  • An authentic Self
  • A reconnection or Reformulation of Family
  • A new social contract with Community and Culture.
  • Recovery Historian William White
    Recovery Historian William White

    Recovery as Transformational Change

    Transformational change (TC) is an alteration in personal identity, personal values and interpersonal relationships through an experience of change that is unplanned, profound, positive and permanent (Miller and C’de Baca, 2001).

Alcoholics Anonymous:

For over eighty years, Alcoholics Anonymous (AA) and related 12-Step Programs have addressed the shame, guilt, fear, denial, hopelessness, grief and powerlessness that are at the center of addictive behaviors. AA offers a spiritual program that gets to the heart of these issues. A Higher Power will help me if I surrender my struggle and my will.

William L. (Bill) White wrote an article called Spirituality and Addiction Recovery: An Interview with Ernie Kurtz, PhD., author of The Spirituality of Imperfection, based on years of researching Alcoholics Anonymous.

Bill White: What are the major themes about Spirituality that you identified through the stories of A. A.? +

Ernie Kurtz:  I believe that all spirituality begins with the acceptance of finitude, of limitation, and the recognition “I am not God.”   For the alcoholic, it is the admission, “I am an alcoholic—I cannot safely do something that my culture regards as normal and that most other people can happily and safely do, drink alcohol.”

There follows on that the realization that some other kind of spirits/spirituality is essential to recovery, and that that spirituality is different from what most think—that it involves not magic but miracle, and that it is both open-ended and pervasive of one’s being.

He noted his unfolding discovery that Spirituality is lived in six experiences:

  • The sense of being freed/released, a real gratitude, a genuine humility that opens to a generous tolerance, a pervasive forgiveness, and a deep discovery/ sense of “being-at-home,” of having found a communion that is more than mere community.
Bill White: How did You discover these? +

Ernie Kurtz: Very simply: by listening very carefully to all the A.A. stories I could manage to hear. And let me emphasize that at least for me, it had to “hear” rather than “read.” Hearing live, in person, rather than on any kind of recording—was and remains absolutely essential. And I mean hearing at meetings.

All stories require a context, and for the kind of stories told in A.A.—spiritual stories, however weird that claim may sound to some—there is something about an A.A. story that makes sense, that can be truly heard, only within a community of listeners, of fellow hearers who are making an effort to identify with the story-teller, to absorb her or his story into their own.

Faith-Based Recovery

Celebrate Recovery is one of the seven largest addiction recovery support group programs. Promotional materials assert that over 3.5 million people have participated in a Celebrate Recovery step study in over 30,000 churches. Approximately two-thirds of these participants are in recovery for something other than drugs or alcohol.

Leaders seek to normalize substance abuse as similar to other personal problems common to all people including high anxiety; co-dependency; compulsive behaviors; sex addiction; financial dysfunction; drug and alcohol addictions; and eating disorders.

Celebrate Recovery uses both the 12 steps developed by Alcoholics Anonymous and a very similar set of eight sequential principles that are understood as a lesson of Jesus' Beatitudes. In addition to issue non-specific large group gatherings and individual mentoring, Celebrate Recovery encourages participants to form a small group of "Accountability Partners" who all have the same problem and support one another closely.

Celebrate Recovery groups are held under the management of local church organizations. A study of Celebrate Recovery participants found that levels of spirituality were associated with greater confidence to resist substance use. Celebrate Recovery is a recovery program aimed at all "hurts, habits, and hang-ups” and began in the late 1990’s at Saddleback Church in Rancho Capistrano, California.

The 12 Steps and the 8 Principles work seamlessly together, tying historical recovery to timeless Biblical teaching.