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.

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.”