substance abuse counseling

Make a Habit, Break a Habit: Here's How:

Make a habit, break a habit. Are addictions treatable habits? Yes, but it's just a little more complicated than that. If you're wondering if you have a drinking problem, do you remember when you first started drinking, what it was you were really going for? Some of my clients report everyone else was doing it - these are usually teens.  For many the drinking provides temporary relief from stress or anxiety, a way to shed the days worries. Or, just to relax and have fun socially. Over time, a habit forms and gets bigger because it creates a craving which can become an obsession.  The habit of self-treating anxiety or stress with a few glasses of wine or a 6 pack of beer. That's when people start to feel really out of control of the addictive habit.

Is it possible to shift drinking behaviors and other addictive habits by developing new routines which become new habits?  Of course. AA members know the truth of this. Sceptical new members attend meetings where they see that seasoned members are staying sober because they've developed the "habit" of attending meetings rather than drinking.  Group support becomes part of the new habit.

What's the process to change a habit?  Let's say you have a slight drinking issue you'd like to adjust. You come home and drink a glass of wine each night with a meal and you're not happy about the weight gain. How do you begin? First of all identify the "cue" or what's driving the craving. For this wine drinking woman, the cue is stress relief. She comes home stressed, tired and a glass of wine relaxes her. The "routine" is getting the bottle out and pouring a glass of wine. The reward is the "relief" as the stress and anxiety melts away as she drinks her wine with her meal.

To change this habit she needs to look at other more positive ways to relieve stress and anxiety. New behaviors which turn into routines could be stopping at the gym and working out for an hour between work and home. Here the cue is the still the stress, but the routine is different and leads to the reward of relaxation AND weight loss. Practicing this change over 90 days will cement in the new habit. The reward of stress reduction with exercise and weight loss helps to keep the new habit in place.  (For more:  read The Power of Habit by Charles Duhigg)

 

We Must Do Better with Alcoholism Treatment - Remember Smoking?

We must and can do better to prevent and treat alcohoism and addiction. We have had success with another addiction - smoking. The U.S. reduced smoking rates from nearly 60% in the 1950s to about 20% today. We did it with a collective will to stop that killer and with a focus on prevention and treatment through Public Service Announcements, early education in the school system, and government supported smoking cessation programs.

Alcoholism is the 3rd leading cause of death in the United States and it's an expensive illness both emotionally to those struggling with it and their families. Financially, alcoholism is incredibly costly. "Each year medical problems caused by addiction, along with lost earnings, accidents and crime, cost Americans more than $500 billion."* 

Very troubling to me as an addiction counselor is that the failure rate for long term sobriety is a grim 70%. This is a shocking statistic because treatment success rates have remained virtually unchanged for the 30 years I've been in the counseling profession. The majority of addiction professionals and the medical community treat the problem primarily with behavorial and psychosocial approaches meaning group therapy, 12 Step meetings and education. This is important, but the newly sober brain often can't process or remember well until the brain has had time to heal - 4-12 months for most.

Part of what gets in the way of better treatment is that society still views addiction as a moral rather than a medical issue. But there's plenty of scientific evidence that concludes "...addiction is a chronic, progressive disease of the brain with many simiarities to other chronic diseases such as diabetes, hypertension and asthma..."*

Cutting edge treatment for alcoholism includes medications such as Vivitrol and Campral. Vivitrol is a once a month, extended-release injected medication (naltrexone), approved by the FDA in 2006. Vivitrol reduces the high that someone gets from drinking, and it decreases cravings. Because it's prescribed once a month, it eliminates the daily decision making that goes with Antabuse.  

Another effective medication is Campral approved by FDA in 2004. Campral also reduces cravings and "...restores the balance in certain neurotransmitter pathways altered by chronic use." Campral can accelerate brain healing which normally takes 4-12 months after someone stops drinking. Vivitrol and Campral can be prescribed together to enhance the effects according to Dr. Urschel* and he recommends usage for 18 months on average. 

Society needs to get over judging alcoholics and drug addicts as moral failures, treat addiction as the medical problem it is and spend the right kind of money on prevention, early education and treatment. We can change the course of this disease as we've done with smoking.  


 

*Healing the Addicted Brain by Harold C Urschel, III, MD, MMA, Advances in Addiction and Recovery Magazine Spring 2013

The Blessing of Addiction Relapse?

The Blessing of Relapse? Really. Yes, really. Let's say Joe has been using alcohol and pot since he was 13. At 29 he's tired of being exhausted, broke, fighting with his girlfriend, having his parents upset with him. He's done. Joe starts attending AA/NA 12 step meetings. But, he doesn't do the 90 meetings in 90 days as suggested. He doesn't get a sponsor. H's doing ok. Four long sober months go by and the stresses of every day life are getting to him. He may be romancing the feeling that a beer or a toke will give him. His cravings come up especially when he's struggling to pay the bills or his girlfriend is on his case about there not being enough money. Joe's thinking about using to solve his problems becomes a daily thing. He's still going to meetings, but he's not talking about what he's thinking or feeling. You know what happens.... Joe stops by his friend Don's on the way home from work - like hs used to. He gets high. He's off and running for the weekend. He's relapsed.

What are the steps that brought Joe to relapse? According to Terence Gorski and Merlene Miller, Relapse Specialists,  there are warning signs that show up before the first drink or use.  

Here are 5:

1) You aren't attending meetings or meeting with your sponsor as much as you were before - you're slacking off.

2) Stress level is building: This could be from a major change - job, family financial or the daily build up of problems, mood swings or bigger emotional ups and downs.

3) Denial:  You might start thinking "I didn't have that big of a problem." "It wasn't so bad." 

4) Behavior Change:  Your healthy, sober daily routine slips back to old behavior - not getting up on time, not staying honest with yourself, overworking again or not thinking things through.

5) Social:  You make excuses not to socialize, stop hanging around sober friends or withdraw from family.

Following these 5 steps you have set up the perfect scenarios for drinking or using again.

I love this quote by Terence Gorski: "Abstinence from alcohol and other drugs is only the beginning of sobriety. It's the ticket to get into the theatre, not the movie we are going to see."   

Relapse Prevention Recipe: (Gorski)

1) Write up list of personal warning signs. For example Joe's could include: Less attendance at meetings,  stress building up or conflict with girlfriend.

2) Warning sign management - what to do with stress:  Write, journal, talk to sponsor or other 12 step friends, exercise, get enough sleep.

3) Stay away from risky enviroments - bars, old using friends. Don't let others pressure you to drink/use. Hang out with new sober friends.

4) Pay attention to how you feel - angry, sad, afraid, guilty - write or acknowledge and breathe. Talk about at meetings.

5) Work to change negative thinking - catch the negative thoughts early - Use image of a BIG RED STOP SIGN or Cancel Cancel words and replace with opposite or more positive words.

The blessing of relapse is when the experience and process leads back to more stable recovery. Recovery as every one says is a process. What's one change you'll make today to prevent relapse?

The Pain and Shame of Addiction: How to Move Through Loss

As I talk to people in the business community, at my networking groups and certainly among my clients about my sister Lane's passing I hear story after story of loss: "My brother died at 41 from heroin, my sister at 38, my daughter at 30 from an overdose." The truth is addiction kills the body and the soul of those struggling with it. One woman said to me she doesn't talk about her sister's death because everyone judges addiction so much.

It's true families often feel embarassed, ashamed and want to hide the fact their loved one is ill. Out of a lack of education or ignorance we family members often blame the addict and and let me be clear, I'm not saying addicts are not responsible for their actions - they are. This is where a good Alanon program or philosophy can help a family separate the blame/shame they feel from the love while detaching from the problem - the addiction.

I don't feel ashamed of my sister's illness - not that I liked the way she behaved at times. I feel ashamed of the medical and therapeutic community because the collective WE have not done a better job of treating this illness. The recovery and relapse rates for addiction are abysmal - I'll follow up with stats - but let's just say the recovery rates are in the very low percentages.  

Here's what I've seen in my own family:  my mother recovered from alcoholism and was sober the last 15 years of her life - yeah mom - but she died from cancer caused by smoking.  My aunt has been sober 30 years and quit smoking and is thriving at 79.  My son has been sober for 20+ years, my cousin has relapsed and is using Oxycontin (very very bad drug) that is overprescribed for pain relief, my daughter is just coming out of treatment and if she does what she needs to she'll be fine - and now Lane, my sweet sis has died from alcoholism.  

Moving Through Loss:  Breathe, journal, stay present to your feelings - it's ok - you'll get through this - talk to friends who will listen, not judge, check out Alanon, Co-DA groups, ACA groups or AA. Blocking feelings leads to stress and more anxiety. If necessary get professional help from a substance abuse or addiction counselor in your community. 

Stay tuned:  Next blog about medications that support sobriety, calm cravings, and can actually help repair the brain.  

 

Addiction and The Fear of Change

I remember when I quit smoking. I was 30. I’d been “trying” to quit for 2 years. Trying is like deciding, but not taking action. Actual change requires action.

We humans like to be comfortable. We like the familiar. Change represents the unknown. Who will I be as a non-smoker, non-drinker, recovering drug user, or conscious eater?  I don’t know. Scary. But, also exciting.

When a new client comes for counseling and wants to quit the behavior that’s causing problems I ask sometime during that session how motivated they are. “On a scale of 0-10 (10 most motivated you can be) how motivated are you to make a change?”  If someone doesn’t answer 8, 9 or 10 then our work is about helping them understand why the number is where it’s at and how to increase their motivation, even by half a number. Often change is less scary and more achievable when it’s baby steps rather than big leaps.

Another helpful way to know where you’re at with change is the “Transtheoretical Model of Change”.  Briefly the stages of change are:  1) Precontemplation: You don’t know the problem exists  2) Contemplation: You’re thinking about the pros and cons of change 3) Preparation: You’re nearly ready and talking about it 4) Action: You’ve made the change  5) Maintenance: New behavior practiced for 6 months. Slips still a risk. (From Dr. Oz’s “Goal Power” article in Time Mag 9-17-12)

If you have an addictive behavior assess where you’re at using the motivation question and the change model above.  No judgment. Just notice. Then ask: What would I need to think and do differently to increase my motivation?  Change may be scary, but so are the same old problems day after day. By the way, I’ve been a non-smoker now for 30 years. 

Feel free to drop me an email and let me know your situation and how it’s going.  lynntelfordsahl@gmail.com