Treatment for Drug and Alcohol Addiction - Rehabilitation or Habilitation?

Many years ago, when I was working as an Addictions Therapist in an Intensive Outpatient Program someone said something in a group setting that was quite insightful and ingenious as it related to treatment and recovery - “I have been in and out of treatment and have been in treatment in several inpatient and outpatient programs and just now seeing that I don’t know how to live and I am terrified!” This person went on to say that it often assumed that just because people are grown-ups, that they do not always have the skills to live effectively - That somehow the drugs or alcohol curtailed functioning and the goal was to restore it. But, as he said , “When I try to remember how to live, there is not anything to recall. It is not that I am ignorant, but I never learned anything about how to manage myself and my life in a way that worked for me! Addicted people are not in need of rehab but we often need habbing! In a way, addiction fills a gap and it is my way of coping in the world. Sometimes I am aware that I am digging my heels into the ground, because I don’t know how to move forward and I’m scared.”

It is often assumed that adults know how to do things and are skilled enough to be effective in life and that somehow it was lost along the way and needs to be rehabbed to get that knowledge and skills back. This is not always the case. As a Behavior Therapist and Addictions Specialist, I am aware that despite my clients success in other areas of their lives that they are are starting form scratch in some fundamental areas. knowledge and skills are being taught and learned for the first time or in such a way that they as recovering people (can be applied to recoveries from addiction, depression, chronic pain, etc.) can learn and integrate new material in order to apply it to their lives in an effective manner. This, in turn, reduces stress and confusion, while building more productive coping skills and ultimately makes way for eradicating relapse behavior. It may seem too basic, but not any less important. Sometimes the obvious is easily overlooked; we judge what we think we ought to know. However, life requires a lot of teaching and learning – since managing ourselves, relating to others, organizing, and problem-solving are not necessarily skills that are totally inborn. We learn them.

I think of the man who shared his insight about needing habilitation at times and his complete honesty and candor. He was able to get beyond the human ego and self-examine in such an open way. He also made a lasting impression on others and gave permission to be human and to accept imperfection and the need to learn. He also reminded me to be aware of the danger of assumptions and how they can negatively impact the delivery of quality treatment that is appropriately tailored to the individual.

Hence, rehabilitationis a process of rebuilding and taking a foundation and restoring it. Conversely, habilitation is development from the ground up – the putting into place for the first time. Although adults have life experience and points of strength – perhaps successful in business, popular with friends, a strong athlete – they may have significant skill gaps or other issues, medical or otherwise, which they have been subconsciously trying to compensate for or work around. This impacts the ability to manage themselves and their thoughts, emotions and behavior which negatively impact one’s ability to function and be effective in life.

Hence, although there is a strong genetic component, addictive behavior can be utilized as a coping strategy, although not a healthy one. Repeated use of substances can become habituated behavior and ultimately grow into an entrenched and highly destructive disease that when not treated gets worse and become terminal.  Comprehensive and effective treatment matters.

Next week we will talk about what makes for Successful Drug and Alcohol Treatment with focus on assessment and choice of treatment with emphasis on dual diagnosis/ co-occurring disorders.

Improving Relationships Through the Power of Validation

Human emotions are complex. They are also unique to each and every person. This means that each person experiences emotions differently.  If a group of five people who were sad were asked to describe their experience of sadness, we would more than likely get five different responses. Why?  Because emotions are private experiences.  Emotions are part of a complex tapestry including human temperament, life experiences, relationships, and perceptions. No two people are completely alike.

In my counseling and therapy practice in Chestnut Hill, Philadelphia and West Chester, Pennsylvania my clients tell me about their feelings and emotions and how they were responded to by the people in their lives. Since I work with issue involving, addiction, codependency, depression, chronic pain, etc., learning self- care and self- advocacy is of primary focus.  In order to build these important skills one needs to learn how validate themselves. This is harder than one might imagine, especially if the person has been exposed or is living in an invalidating environment.

So, what is validation?  Validation is to recognize and accept another person’s thoughts and feelings, regardless of whether or not you feel that they should be experiencing them. Validation helps us to develop a sense of self-worth. People who are validated feel reassured that they will be accepted and loved regardless of their feelings, while those who are not validated are more vulnerable to emotional and behavioral problems and relational difficulties.

We can validate another person by paying attention and reflecting back what we heard them share with us, asking questions, and identifying with them. This helps all of us feel “part of” and less alone. We can easily overlook the fact that ignoring others or neglecting to acknowledge them is indeed invalidation.  This is why childhood neglect is considered abuse.

Here are a few everyday ways of validating one another. These can be built into how we communicate over the course of time and help improve relationships.

• Listen with empathy and genuine concern, being careful to stay in the moment. Display interest and engagement through verbally and non-verbally: Nod and maintain eye contact, and use verbal replies such as “Yes" and "I understand."
• Be responsive by reflecting back what the other person has shared. For example, “It sounds like you were very hurt that your friend didn't call you back." Check for accuracy by asking "Is that right?"
• Observe and articulate the individual’s unspoken feelings and emotions, based on what he or she says as well as nonverbal cues. Ask if your observations are accurate. For example, “So you are frustrated when your friend does not communicate directly with you about plans - That when she doesn't call by a certain time that it means that she cannot follow through.  You cannot accept that way of interacting.  Is that correct?”
• Communicate that you are aware of the "bigger picture" of the person's feeling or emotion.  Acknowledge that his or her current emotions are understandable within the context of his or her past experiences and/or present circumstances. For example, “Considering that you grew up in an alcoholic home with little stability, it is understandable that you would feel anxiety when cancels plans with you and  things are uncertain.”

We can validate one another quite readily if we pay attention and seek out opportunities to do so. Validation strengthens relationships, communities and reduces conflict.

What is your experience with validation?

Beating Overeating

It is easy to overeat – especially when we are not paying attention. Have you ever mindlessly noshed away on potato chips or some other munchies at a party without noticing how much you have eaten? That can easily happen. Especially in a social situation when there is socializing with other people.

We live in an eating and drinking society – many social situations are centered on food and alcohol. It is very rare that there is healthy low fat food at social gatherings. As one of my healthcare colleagues says, “You can go out to a party or dinner and yet, there can be nothing to eat!” – meaning nothing healthy or  nourishing. He suggests either eating before going or bringing a healthy snack of your own.

In my counseling work with clients, in West Chester and Philadelphia, PA, I routinely hear how difficult it is to maintain healthy eating habits – Mostly due busy and rushed schedules with little time for homemade meals. This type of lifestyle can turn into a runaway train – get totally out of hand. “On the fly” food is often high in fat, salt, sugar and carbs. They create cravings.

Mark Hayman, MD, author of Ultra Wellness uses this example - if a person was presented with a bowl of chips and a bowl of broccoli, what are the chances that the broccoli will be over-consumed? Right…no chance! Natural foods just don’t ignite addictive eating.

So, what might happen if you could change your palate? To rectify your sense of taste to what you find is pleasing, satisfying and good? Do you believe that is possible? It is.

Modern day foods are often processed and genetically engineered. They can distort the sense of taste and confuse the palate. Salt, sugar, chemicals, alcohol, dairy, food additives and overly processed foods are notorious for distorting taste. We get used to intensely flavored foods which are not real, but enhanced. Then something like a fresh salad no longer tastes good enough and seems bland. We grow distant from what is natural and seek out artificially flavored and altered “food substitutes.” Our taste buds get worn down and turn bland. They take a lot to be stimulated – making way for low nutrition flavored and presentation enhanced food products.

In a way, these foods can be viewed as synthetic drugs. After all, food is a substance that can be abused, and addiction is about high stimulation and intensity.

Cutting down on these “foods” is a start, but giving your palate a breather and cleansing to re-focus on real, pure taste can be of most help. A confused palate can make it difficult for your body to recognize true hunger verses a “hankering.” True food cravings for greens, protein, water, fruits, and other foods which hold the building blocks of health can go unnoticed or misinterpreted. Junky – fatty, salty, sugary foods can creep in as replacements and fuel powerfully addictive food cravings. There is an easy way to re-center your palate and recreate how you eat – restructure your mindset.

Make it a point to get more connected to your food. Next time you eat fruit, such as an apple, first look at it. Notice the color and variation of its skin. Smell it. Then bite into it noticing the juiciness, and the depth of the flavor – sweet and tart. Eat slowly – take in the detail. Feel the consistency on your tongue.

This is more mindful eating – getting back in touch with our senses and coming back to the moment experiencing what is, pure and simple – And, of course, learning to love it.

This is the way we reclaim what is natural and healthy.

Understanding Obesity & Food Addiction

Something that I have learned over the years in my work as a Behavior Therapist and Addictions Specialist is that issues with food and eating are often lurking in the shadows of other problems, including alcohol dependence, drug abuse, problems with anger and impulse control, and difficulties with overwhelming emotions.

When I assess a new client in my Philadelphia or Chester County based office, I find it immensely important to understand their daily habits of living as they generally complete the picture in understanding the presenting issue and what is keeping it going. Lack of proper sleep, exercise and nutrition exacerbate mental and physical health concerns making them worse.  Energy drinks, take-out food, protein bars, pizza and coffee are not staples of a healthy diet. They do create poor eating and food habits and distance from what is normal and healthy via reinforcing impulsive and “on the fly” eating.

Most people want to be healthy, but struggle with making the changes needed to establish balance in their relationship with food and eating.  First, a person must understand their own tendencies with food along with how they deal with stress, emotions and people, as well as making sure there are no medical concerns (endocrine, etc.) which may be negatively impacting ones’ behavior with food.
I have found that obesity and food addiction are related much of the time.  I also find it curious, however, that issues with weight – obesity are not challenged and inquired about as much as one would think, despite the increase in health risks- That many people silently suffer food addiction.

Obesity
Obesity is at the forefront of today’s health concerns and warrants focus, because it is linked to many health problems. Did you know that that approximately 65% of adult Americans are overweight and 30% are obese? It is also estimated that roughly 80% of obese adults have at least one of more conditions such as: cardiovascular disease, diabetes, hypertension, sleep apnea, arthritis, and cancer. There is then another tier of problems which includes depression, substance abuse, and chronic pain that can develop as a result of those issues. Studies show that 25-50% of obese individuals binge eat and that there is a 75-95% recidivism rate to obesity among formerly obese individuals who have undergone treatment. Obviously, this points to a significant epidemic. It also raises a question, “What happened to our relationship with food?” “What went wrong?”

Food Addiction?
The medical community, insurance and food industries all encourage consumers to exercise “personal responsibility" when it comes to preventing obesity, addiction, and chronic health problems. Self-control, better choices, avoidance of over-indulging/over-eating, and staying away from packaged, high fat, carbohydrate, sugary foods is emphasized and encouraged. Seems simple, right? Being informed and then choosing? No!

Food, like alcohol and drugs, is biologically addictive. Food is a substance.

There are specific biological mechanisms that drive addictive behavior. Addictive behaviors are fueled via primitive neurochemical reward centers in the brain that override one’s ability to exert reason, self-control, manage cravings, stop eating and to recognize biological signals of true hunger, appetite, and satiation.

Liking vs. Wanting.  Research shows that obese individuals are similar to non-obese individual in their “liking” of foods, but that they have a stronger “wanting” / desire/ drive for the foods they want. They are also willing to go to great lengths to obtain and consume them. It is noted that this may be due, in part, to neurological changes that cause a blunted psychological reward response to food – Much like how a drug addicted person might crave their drug or “want” it very strongly, long after they stopped enjoying or “liking” it.


Craving vs. Addiction. We all crave certain foods from time to time. Women are notorious for craving chocolate.  Some other common cravings include fat, sugar, or carbs. Food cravings are important because they play a role in over or compulsive eating – as they serve as “trigger foods.” It is said that our industrialized society ripens the opportunity for obesity, due to the availability and exposure to addictive food substances: sugar, fat, sweeteners, refined carbohydrates, salt and caffeine -- eroding at self-control and ability to regulate consumption of these foods.  “Loss of control” is both a term and behavior associated with addiction.

Do You?...
* Eat when you're not really hungry or eat as a result of emotional triggers
* Feel guilt or shame after eating
* Eat alone, in secret or hiding the amount of food your eat from others
* Feel out of control and/or can't stop eating
* Crave certain foods only as part of binge eating
* Get a feeling of relief from emotions when eating certain foods

Evidence in Support of Food Addiction
According to a report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University, up to one half of individuals with eating disorders (including bingeing) abuse alcohol or illicit drugs, compared to 9% of the general population. Conversely, up to 35% of alcohol and illicit drug abusers have eating disorders, compared to 3% of the general population.
A direct correlation has also been established between the dramatic increase of obesity and overweight population and the aggressive marketing, increased availability, and consumption of foods over the same period (similar to tobacco).

• People who are addicted to food tend to exhibit many of the same characteristics as those addicted to alcohol and drugs:Exhibit behavior in times of transition or stress
• Common family history
• Common brain chemistry (decreased sensitivity of dopamine-reward system)
• Low self-esteem, depression, anxiety, impulsivity
• History of sexual, physical, or emotional abuse
• Obsessive preoccupation, cravings, and secretive rituals
• Experience mood altering effects from use of substance

- National Center on Addiction and Substance Abuse (CASA) at Columbia University
There is help available – One does not need to suffer.  Counseling for eating disorders coupled with professional nutritional guidance and self- help programs such as Overeaters Anonymous and Eating Disorders Anonymous are the basis of a well-structured plan.  If you are concerned about your relationship with food and eating but not sure if you are addicted and or not quite sure if you are ready to make any big changes, help is still available. Effective counseling allows room to sort through issues and make new choices.

Getting Well - Staying Well: Healing vs. Cure - Part #3

Recovery and Healing: Turning “Crisis into Opportunity"

Getting Well - Staying Well: Healing vs. Cure - Part #3

As a Philadelphia and Chester County - based therapist, certified addictions counselor and co occurring disorders/ dual diagnosis specialist, I see clients in my practice who have been trying to work through tough health, mental health and addictions challenges for a long time.

"When am I going to feel better?" "When are things going to change?" These are questions that my clients in my practice in Chestnut Hill and West Chester, PA ask when feeling uncomfortable or when life presents an illness, disability, or loss - some sort of crisis that was not asked for but happened.

There are times in life when we want change and often need change to happen in order to establish or restore well-being. However, as adults who have been around a while, perhaps we know that change is a process not an event. That there is no real "cure" to our problems or conditions - But, our desire for things to be fixed can keep us searching for immediate solutions and attached to false expectations, reinforcing and prolonging our discomfort.

I listen closely to people's life experiences. I hear about the adversity and struggle that people have endured and survived.  Although such wear withal is a sign of strength, such rallying can certainly take a toll over the long term. When help is long overdue is only natural to want to be done and better. So, it is important to be aware of expectations and to have a sense of the difference between curing and healing.

"Cure" is intermingled in the definition of healing, healing means something very different than merely "curing" or eradicating illness or disease, but restoring to balance, repairing, and returning to soundness. Healing often has more to do with emotions and a sense of safety; fostered by self- respect and control, and having positive people and conditions in one's life. Healing requires the deeper work of change involving reflection, self-examination and acceptance of what was and is. This type of settlement prepares the foreground for health and life-long well-being, the type of inner comfort and satisfaction that most of us long for and see in others who we deem "enlightened," but often do not know how to attain for ourselves. Healing is necessary for any lasting change to take place.

Starting with "what is" and accepting "what is" is the starting point - developing a willingness and capacity for being and staying in the moment and noticing what is real as compared to the mental fiction of our minds is necessary if we wish to develop inner resilience and strength.  Being able to follow and notice the moment to moment changes within ourselves, including our thoughts and emotions and how we respond to other people and our environment is part of regaining control of ourselves, behavior and improving our lives.

One of my favorite as well as being a client favorite books for teaching mindfulness and how it is linked to our health and well-being is The Power of Now, by Eckhart Tolle. His teaching on the "Pain Body" is helpful in understanding the mind-body connection.

https://www.youtube.com/watch?v=gcgSYC3h1ew

Join us next week to read about: Recovery - Healing: Forbearance and Resulting Gifts