Getting to the Root of Addiction: An Integrated Approach

When I started my practice Integrated Treatment Solutions in 2009, I did so out of professional conviction. My experience working in a variety of healthcare and drug and alcohol treatment settings led me to rethink my approach as a behavioral health professional. I could no longer only treat symptoms at the expense of being complete and addressing underlying issues. I realized that I was at a critical choice point and that working within a traditional clinical framework was preventing many clients from getting help – That was not going to work for me. I wanted to collaborate with clients in the exploration of their problems and see what made sense for them in their respective recoveries.

These are some things about addiction and recovery that I have learned along the way and implement in my daily practice as an addictions specialist and behavior therapist…

Understanding addiction and moving into recovery is a process, not an event. Addiction recovery takes willingness, honesty, openness and time. Recovery is not linear. In fact, it can vary person to person.

The decision about one's relationship with substances is personal. Individuals use substances and engage in addictive behaviors for different reasons – Essentially, all behavior is purposeful. As human beings, we are always trying to accomplish something. Each person has his or her perspective and goals concerning their use, lifestyle and level of wellness desired.

As a co-occurring disorders specialist (previously referred to as dual diagnosis – addiction and mental health together) I counsel and treat clients presenting "clinical complexity." Many have been trying to gain clarity about their conditions and make progress for many years having been through many courses of treatment but continue to struggle with relapse or are "white knuckling" it through tough symptoms. Despite previous attempts at recovery and disappointments incurred along the way, they have stepped up again! I applaud their courage and determination.

I also believe that there is hope. Even after several attempts have been made.

It has become apparent to me that there are no failed clients only failed treatment. While addiction, depression, bipolar disorder, etc. tend to be fairly standard in their presentations, each person affected is different within the issue at hand. Each brings unique strengths, vulnerabilities and life experiences which need to be taken into account when planning treatment.

Treatment must be tailored to the individual – always.

People want to get well – not only sober. To feel at home in their bodies and positive about themselves, others and their relationships - To be able to trust themselves – their thinking, abilities and choices.

Many clients who approach treatment with me had been sober before – for long periods of time and yet continued to be in physical and or emotional pain. Many have made attempts at sobriety in traditional drug and alcohol rehabs and attended daily Alcohol Anonymous (AA) or Narcotics Anonymous (NA) meetings – Worked with a sponsor through the 12 Steps of AA or NA.

Symptoms from chronic pain, mood disorder, trauma, attention deficit (ADD) or chronic physical conditions/ diseases involving the autoimmune system, or unresolved post-surgical complications can surface when the person stops using substances - "breakthrough" symptoms can result in powerful triggers fueling drinking and drug use again. Inflexible personality traits or personality disorders can also serve as barriers to effective therapy and treatment. Trying to manage what is not known or understood is confusing and painful for people.

Unfortunately, situations presenting this level of complexity are not uncommon. There are often multiple problems occurring at the same time, playing off one another. The idea that addiction is a singular issue is often a false construct – An incomplete, inaccurate or an ill-founded psychological concept.

Addiction often travels with other issues – It is critical that all of the problem issues are identified, understood and addressed in order to move towards stabilization and recovery. Expecting a person to reduce their drinking or substance use or to completely abstain (depending on risk) is not realistic without a comprehensive and holistic approach offering precise diagnosis and a personalized plan.

No problem is about "one thing and one thing only."

 

Clients need and have the right to know exactly what the issues are and to be educated about them. Identification of the issues and a conversation about them needs to happen even if it means talking about conditions like borderline personality disorder (BPD), narcissistic personality disorder, Asperger's or anything that is tough to accept.

If difficult issues are NOT talked about, they will sabotage treatment and leave clients confused and defeated yet again, resulting in an increased sense of hopelessness and helplessness. When people are not informed they are deprived of the opportunity to move through their own process of "self-diagnosis", which means "Do I agree with this?" and "What does this mean to me?"

Knowledge is power.

 

Engagement and commit to change can only happen when clients are clear about what they are dealing with and have a sense of what to expect moving forward.

Effective treatment starts with a thorough bio- psychosocial assessment to obtain information about the major physical (bio), psychological, and social issues. A holistic approach posits that separate issues are often related. - No stone is left unturned in the interest of getting the "bigger picture" of what is going on.

Assumptions are dangerous.  Illnesses presented as being "treated" such as autoimmune disease, diabetes, depression or conditions that tend to be minimized like, Lyme disease, premenstrual dysphoric disorder (PMDD), or sleep problems can fuel addiction and its ‘problem behavior. Medical treatments often need to be reevaluated to determine if they continue to be effective.

People are not always consistent with or misuse medications. Many do not have a trusted primary care physician. There are oversights and misunderstandings that can happen which have the impact on any health problem.

So, the solution to the problem is only as good as it's' conceptualization. To be inaccurate or incomplete is time, energy and resource draining.

An integrative approach to addictions treatment and its' co-occurring disorders is collaborative, thorough, health and well- being oriented – Not just about "one thing" or symptom oriented.

Strategies to Increase Energy and Stabilize Mood

Keeping a pulse on our stress level is always a wise idea. Many of us don’t really know our baseline stress level; therefore we don’t really know where we are and what is manageable for us so we keep doing more. For example, all of a sudden we can find ourselves triggered into anger by an erratic driver on the road and wonder how we went flew off the handle. This is what often happens when stress piles up. We become reactive and, at times, out of control. We can decline quickly.

Many stresses cannot be avoided altogether, but we can support our bodies in being more resilient, as well as reorganize some of our routines to minimize mood and energy problems. To help our bodies, it is important to:

-          Get adequate sleep each night. During seasonal change, more sleep is often needed to sustain the shift. Adding an extra half an hour can be of benefit to you.

-          Decrease sugar and carbohydrate intake. When mood declines you may notice increased food cravings, especially for sweets and carbs as the body is looking for that spike in energy. Focus on eating a balanced diet, including fruits and vegetables.

-          Move your body. Make sure that you are getting some physical exercise daily; a walk, time at the gym, working outside.

-          Take your supplements, including probiotic, Vitamins B, C, D, and fish oil.

-          Attend meditation, yoga, or tai chi classes – especially if you are anxiety-prone or get overwhelmed easily.

 

Creative thinking is important in learning to help you and may lead to stress-reducing methods, such as delegating work or deleting less important items from your to-do lists. Then you can look for ways to improve your coping ability, such as learning a new, useful skill or spending more time unwinding each day.

Cognitive therapy or skills-based counseling can be helpful in learning how to control the mind and work through thoughts that fuel depression and drain energy. But, working with the mind and body together is necessary in improving or resolving mood issues. After all, the mind and body dwell in the same organism.

To maintain a healthy mind and body, it’s important to engage in the effort to review and assess yourself – and, if need be, consult a professional to help.

Quote:

The higher your energy level, the more efficient your body. The more efficient your body, the better you feel and the more you will use your talent to produce outstanding results.

~ Tony Robbins

Depression During Life Transitions: Is it Normal?

Life is all about cycles - Seasons change, weather moves in patterns, the economy fluctuates, trends ... change...transition...all of which are happening constantly.

Recently, I was talking with a woman who had moved into a lovely home.  It was the home of her dreams.  She had been very excited about the move and creating this wonderful space. However, about a month or so after the move she found herself feeling depressed and lethargic.  She was very concerned and considered anti-depressant medication.

Change brings forth many emotions, sensations and shifts - ups and downs. Generally we don't associate depression with "good things" but in truth each one of us responds to change in our own unique way.

Plants were my first teachers about change. Have you ever moved a plant from one spot to another? What happens? They tend to wilt and look like they might die. Just when you think it is a lost cause the plant perks up! Go figure...

We do a little of this too. Our moods and energy are always in flux and subject to change. This can make most people nervous - Who really feels comfortable when feeling, a bit depressed or down?
However, is what is being felt a symptom of depression or a human experience?

There is a difference between a clinical condition and a response to a life event. We tend to label unwanted feelings and experiences as being related to sickness, but just like the plant or the woman who moved, that might not be the case. It just might be because change takes energy and lots of it - more than we might think.  Also, anytime something is gained something is lost. Loss is part of every change - Even the changes that we want or goals we have worked towards. Grieving is a natural response to loss. Depression is part of grieving.

Preparation for change is key in setting ourselves up for success.  Being able to move through change and transition safely and successfully without putting ourselves at risk or sabotaging our success. Each one of us may be sensitive to specific triggers/ stressors, events or circumstances - The conditions that may challenge our sense of mental, emotional and physical balance.

Mood and energy cycles often parallel with the environmental conditions occurring within and around us. If you are a person who is sensitive to change and or has mood, addiction or chronic health problems it is important to pay extra attention to change, especially when it involves your personal space, work or people in your life. Self knowledge is key.

The ability to understand our own cycles is needed in order to help ourselves in the best ways possible.

In order to feel well and to be effective, we need to adapt to changing conditions. This means that we need to identify, understand and prepare for them according to our individual needs.

 

This is why it is critical that we create the conditions we need to be well and successful. We can control that part.

 

This helps us in becoming skilled in managing change.  Being adaptive and able to work with change is needed to be able to grow, increase our skills and capacities and to reach our personal and professional goals.  As we move through life and experience its' joys, our victories, defeats and losses we will have many intensive and personal feelings many of which are part of the process of becoming a whole person. Growth can be stressful and uncomfortable, but necessary if we are to become more skilled in living life.

Approaching ourselves with kindness, inquiry and flexibility allows us to create the conditions we need to move forward through the changes in our lives. This means not judging every uncomfortable feeling and or event that does not go as planned as something wrong or a sign of failure. Instead setting things up so that we have what we need - support, healthy lifestyle habits and a mindset of willingness and openness.

Through this process we become more resilient- meaning stress hardy. Then we truly become more healthy, adaptive and bounce back from set backs and stressors even using them as leverage to move forward.  We are then truly able to move forward with confidence and in a manner by which we can be our best selves.

What is Problematic about Mood Problems? Dysthymia, Bipolar Disorder, and Major Depression

When we think of mood problems, we often think of low energy, negative thinking, sadness, and tendency to isolate. However, mood problems are not just “mental” or “emotional.” According to a September 2013 report from the World Health Organization the amount of damage untreated mood disorders causes takes a greater toll on health than chronic angina, arthritis, asthma, or diabetes. A growing body of research also indicates that mood disorders trigger certain diseases: chronic pain, acid reflux, heart disease, diabetes, cancer, osteoporosis, and other problems. Mood disorders wreak havoc on the entire body by throwing the stress response out of whack. Mood issues are not just about being “down” or feeling unmotivated; they can, indeed, be very physical and need to be taken seriously.

People who are seeking counseling are often looking for relief from mood problems. They are trying to regain or boost their mental, emotional, and physical energy. For the person suffering the energy loss, it can feel that the mood shifted all of a sudden or gradually became worse until they could take no more and sought help. However, it generally becomes more clear that there had been stress building over the course of time, whether that be from physical illness, major change, loss, or unresolved difficulties from the past. We can often identify that the mood issue had been operating in cycles; however, they easily go unnoticed. For instance, a person may experience depression after getting a new job or home. Even though it may be needed or wanted change, it is still change and change takes energy to accommodate, hence the dip in mood.

Over the next month or so, as we start to move from summer into autumn we may be more aware of fatigue as sunlight decreases and we prepare for the solitude of winter. Our bodies are rallying to accommodate this major change. We are part of nature - we go through our own cycles in response to nature.

The changes in our lives are felt deep within the organism (body) in which we live. It is important to pay extra attention when preparing for and or moving towards change. This is something that I notice as a  behavior therapist working with clients with mood problems is that preparation for change is often lacking -- The fallout of lack of preparation can make for unanticipated immense suffering. The overwhelm and dysregulation of emotions can result in regression back into self defeating and self harmful behaviors making for negative impact to self esteem.

Structure and self care are necessary staples.  Eating healthily, getting a good nights sleep, movement, fresh air, recreation.  Moving forward one breathe at a time of course is most important! Creating the conditions to be safe, healthy and stable is key in living and even thriving with a mood disorder.

Optimism: Maximizing Strengths – Protecting Health

Well, thoughts make for well behaviors. It is hard to be sick or to feel "unwell"  in mind that is balanced and positive. Optimism is well thinking and increases positive mood, moral, persistence while increasing creativity and the ability to solve-problems. It is very needed, especially in our complex world.

Optimism can get a bad rap. Perhaps, some of us have known people who possessed blind optimism – looking at the bright side of things at any cost – All the while discounting another’s personal pain. This can feel immensely invalidating. This type of blind optimism is often another person’s defense against what they deem negative and unacceptable – What they cannot tolerate. It can be wounding to another, however. I hear this often in my counseling practice in West Chester and Chestnut Hill, Philadelphia, PA. I work with people who suffer mood problems, anxiety, or have challenging personality traits and  teach them skills to become more flexible and resourceful. However, it can be hard for some people to accept being more optimistic and open because others have made light of their pain and tried to reframe issues and problems in an unhelpful way. Taking an optimistic view can feel like giving in or making the other people “right.” This can become quite a dilemma – a real set up.

The Fear of Disappointment
Each one of us has unique talents and strengths. However, we often focus on our less developed parts of ourselves rather than maximizing our strengths. Perhaps this comes from fear of lack in that if we have all the bases covered we can be prevent anything “bad” from happening. Of course, this is a form of self-protection often manifesting as perfectionism. Much like a performance review whereby accomplishments are acknowledged, but, then there is that one “opportunity for growth” which stands of like a demerit igniting alarm bells. What happens to the accomplishments? Yes, they get lost and the perceived negative gains complete focus.

What gets in the way of being more optimistic? Perhaps, it is not fear of trying or failing, as much as it is a disappointment. Disappointment can feel heavy and be a letdown. In fact, perhaps it is not as much the fear of things not turning out as planned as it is the difficulty accepting the feeling of disappointment. Time after time disappointment can erode at mood and outlook. It can weave into the fabric of a person’s personality. This is what makes change so hard – Although not impossible! Just to be optimistic of course. It takes time a dedication to increasing optimism. Pessimistic thoughts need to be identified and replaced by more optimistic ones, based in reality. This means that optimistic thoughts must have depth, purpose and value – Not be repetitive “fake it til you make it” talk.

Just like we talked about in last week’s blog on pessimism – We develop a lens based on our world view. Through that lens, we filter information in support of that view.

Choosing a Lens: Positive or Negative
Here’s a snapshot of the difference between optimism and pessimism –
Suppose you are scheduled to meet a colleague for lunch to talk about an important piece of business. You are waiting, and she is late and not answering her cell phone. By the time, 20 minutes pass you notice some pessimistic thoughts:

- “She is not interested and blew me off.”
- “I was duped.”
- “This was not a priority and she forgot.”

There is a choice here, on how to think about this situation. You may tell yourself instead:

- “Something must have come up or is in the way of her getting here and in the car and can’t answer the phone.”
- “I am sure there is a good reason for her not being here or being here yet. I am sure she will be apologetic.”
- “She is human and maybe she genuinely forgot.”

The optimistic thoughts leave more room for moving forward with the relationship. They are less personal and upsetting. They are more kind to both parties, while preserving self-esteem and possibilities. They keep people’s character and integrity intact. Optimistic thoughts also put less pressure on our bodies and less strain on our central nervous system.

Not to mention many times it is more important to be kind rather than right – Open rather than “decided” and forgiving rather than just. It gives us all more room to “be.”

Summertime Blues?

For anyone who was around last weekend over July 4th you may have noticed that there wasn’t a soul on the roads – no one around. It was immensely quiet. Perhaps many folks ventured to the shore points or to visit family. Regardless, it was desolate in the Philadelphia area. There was a palpable “hush” that was much like the stillness that settles in later in the night on Christmas Eve.

A friend of mine who is also a healthcare professional routinely comments about how we are communal beings and tend to share a common biorhythm – That we are “plugged into each other."

We were talking about how eerily quiet it was on the holiday weekend - That people did not seem to migrate to the fireworks until the last minute and that even the local ice cream stand was vacant of patrons until late into the evening.

Why would this be the case? Well, we as living beings are very much affected by our environment. Over the course of the last year, we have endured constant pressure from extreme weather. The winter was relentless with one-snow storm after another with intense cold and ice. The rain storms have been no better. When we anticipate storms, we have come to expect to be left without power for days and or to anticipate damages. This is hard to endure as a steady diet. Perhaps, there is a collective feeling of “burnout” in the atmosphere. Maybe we haven't recuperated.

We had been desperate for warm weather and the ease of summer, but perhaps the heat and humidity of late has introduced yet another extreme to rally against and accommodate. Extremes zap us of our energy. The intensity of extreme conditions can create distress in our bodies and minds – more than what we would imagine. For instance, over the winter you may have noticed yourself getting more tired, cranky, low energy and impatient as the snow storms continued - Due to being tapped of energy and resilience being worn down. Heat and humidity can be equally as damaging to energy and vitality.

For those who suffer mood problems and chronic illness, such as depression, pain syndromes, ADD, etc., you may find yourself more irritable and cycling or dipping mood-wise unexpectedly despite the sunshine and longer days. Heat can also fuel aggression. Be on the lookout for subtle and not so subtle changes in your thinking, emotions and behavior.

Do make sure to keep hydrated, drinking plenty of water. Eat healthily and veer away from quick unhealthy meals because you may not feel like cooking. Maintain exercise – perhaps swim or take a late night walk after the sun goes down. Overall, maintain structure and routine.

Moreover, of course, remember that this too shall pass. Most importantly, bear in mind that the conditions around us are impacting us on a deeper level.

Recovery - Healing: Forbearance and Resulting Gifts - Part #4

Recovery & Healing: Turning “Crisis into Opportunity"

Part #4: Forbearance and Resulting Gifts

Our world has become fast, furious and bottom line oriented. Technology tools like texting, emailing, Face-Time, SKYPE, on-line shopping and others set an expectation that we are all accessible 24/7 with no "wait time." Our expectations for quick response can be almost addictive and our dependency on these technologies an addiction. Regardless, we have become "trained" to expect immediate response - It is easy to lose sight of process and that all things take their own time.

Healing is a process not an event. Recovery and healing from addiction, depression, chronic pain, distress/ burnout and other medical issues take time. These issues tend to take longer in the making and therefor are not quick to resolve -- Paying attention to the nuances of these conditions and healing is important to be able to recognize progress and sustain motivation. This is where forbearance comes into play.

Forbearance is a form of patience - tolerance or self-control, especially in not responding to provocation. Forbearance requires refraining from action: the fact of deliberately not doing or saying something when you could do or say it. This is not the same as shutting down or repressing one self, but consciously choosing to suppress action in favor of the overall good of the situation. Forbearance is necessary in life and a quality that comes with maturity and wisdom. As we get older we often come to see that we have little control over many things that happen, and that we need to find other ways to cope which go beyond "grinning and baring" or resisting and pushing through circumstances. Through forbearance we often learn more about ourselves and the process of life.

Forbearance is another learning that sounds simple but is not easy! But it is worth developing as we learn to understand ourselves, our behavior patterns, assumptions, and motivations. We also learn about others, and the overarching process of how things work in the world and how the pieces come together in their own timing. This helps with learning to be more relaxed and present in the moment and not be over-focused on the future at the expense of living more fully right now. We also learn to be more patient and accepting of ourselves and others, and be the kind of people with whom others feel safe and enjoy spending time. And, of course, our efforts and goals have more opportunity to be completed.

In order to get and to stay well staying centered, in the moment, organized and balanced is required. This may sound immensely simple but again, not easy! In behavior therapy we learn how to develop skills to focus and be more mindful (less reactive), process difficult emotions, tolerate and cope with distress and to advocate for ourselves in a graceful and effective manner. By increasing our life skills in these areas we decrease the stress and pressure on our bodies, freeing up energy for improved functioning and well-being. We establish the roots of health and wellbeing - http://myintegratedtx.com/our-philosophy/ .  

Recovery and Healing: Crisis Meets Opportunity - Part #2

Crisis Meets Opportunity

What can be more traumatic than addiction? To become aware of being out of behavioral control and attached to a substance and or process to the point of sheer destruction of one's life? Sounds pretty scary - Not to mention the "ripple effect" of such a crisis, on others connected to the individual, family, workplace, etc. This can make for a highly complex issue leaving people feeling confused, overwhelmed and powerless. However, whether one is dealing with addiction, depression, pain issues or the like, deep within the situation there is a way through it - solutions, and a gem of opportunity waiting to be discovered.

The Chinese have been aware of this phenomenon for thousands of years. In Chinese the word for crisis consists of two characters: one meaning danger, and one meaning opportunity. Why? Because crisis always feels dangerous and can indeed be dangerous. However, it is often our response to sudden or unwanted events which impact outcomes and the future; but that can be tough to see in the moment when paralyzed by fear. Our fear of danger may be necessary for self-protection in some cases, but can distract us and impair our ability to see through presenting situations and identify important information and solutions. We often miss themes and patterns that are embedded in such circumstances which are clamoring for our attention and trying to provide guidance for us to find our way. Hence, the interpretation of the Chinese proverb also says that it is the rare person who can see the opportunity within a crisis.

In talking health and wellness, we need to recognize that our symptoms are messages communicating our needs, fears and wants. As a trusted mentor once said, "It is easy for human beings to mislabel experiences as symptoms." It is natural to not want to be uncomfortable and when we do feel uncomfortable we may be apt to view our unwanted experiences as symptoms to be cured. But, when this type of thinking occurs, we miss the learning and information we need to create more productive conditions to move forward, to learn about ourselves and our needs.