Wanted to expound on Myth #2

MYTH: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process - and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don't wait to intervene until the addict has lost it all. This is a view that is espoused in some circles and is dangerous. What is accurate is that there is no formula for determining when addicts as a group should begin treatment. They can begin recovery at any stage of addiction. Because some individuals do not have insight into their disease and cannot be physically forced to enter treatment, they do need to reach rock bottom first. However, many addicts realize that they have a problem, and it is best for family and friends to intervene as early as possible and offer them an alternative to dependence on the substance - before the substance becomes increasingly more of a priority and replaces people and activities that they once valued. This whole idea of "hitting bottom" is out of date. Some people will wait years - even decades- for their friend to reach this mythical point in their alcohol and drug use. But why wait for them to"hit bottom"? Why not help them by raising their bottom? There are ways to encourage someone to reach for help much earlier and by doing so, we can avoid a lot of unnecessary pain and heartache - and maybe even save their life. For some people, hitting bottom will be six feet underground.

When I am asked "Does everyone have to hit rock bottom?" I would say no. Tough love and setting bottom lines can prevent a substance abuser from prolonging their usage. There are loving ways to refuse to rescue someone that in the long run will help him or her to choose recovery. Loving means doing the right thing to help. This can take all of our strength and energy at times. We all hate to see someone suffer - even when the suffering is a consequence of his or her bad choices. This approach, or some form of it, is something you might consider; Raise the bottom. The next time this person you care about appeals to you to get them out of a bind (loan them money, pay their electric bill, buy them gas, pay for a lawyer), think twice. You might just be prolonging their disease and robbing them of the natural consequences that they need to experience in order to seek help and begin to connect the dots.

4 myths about Drug Addiction

MYTH 1: Overcoming addiction is simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brains in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will.

MYTH 2: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process - the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don't wait to intervene until the addict has lost it all.

MYTH 3: You can't force someone into treatment; they have to want help. Treatment doesn't have to be voluntary to be successful. People who are pressured into treatment by their family, employer or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.

MYTH 4: Treatment didn't work before, so there's no point trying again; some cases are hopeless. Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn't mean that treatment has failed or that you're a lost cause. Rather, it's a signal to get back on track either by going back to treatment or adjusting the treatment approach.

The importance of interventions

Have you heard these words many times before? "Today I'll stop. I promise." "This is my last drink." "I don't have a problem." "I'm in control of it." "I know what I 'm doing." "Leave me alone I'm fine!"

Drink by drink, your loved one is slipping away...but you have the power to bring them back before it's too late! Many people suffering from alcoholism are convinced they have the power to stop...if they want to. And they persuade you to think the same. But unfortunately, not only are they harboring delusional thoughts regarding their capabilities, if they do actually attempt self-detoxification, it can have severe consequences: seizure, heart failure and death.

Professional alcohol intervention is not a luxury. You may view your loved one as a person who just can't control their drinking habit. But in reality, they are a loaded gun, ready to go off at any point in time. Alcoholics commit drunk driving and commit suicide. Alcoholics can kill people: family members, friends and themselves. Professional alcohol intervention is necessary to delicately raise awareness in the mind of the alcoholic that he or she has a problem, one that is too overwhelming for them to control, and that they need to accept medical help.

Many family members attempt to perform alcohol interventions themselves, but without the key knowledge and proper approach, they do more harm than good. These well-intentioned meetings often result in violence and irreparable damage to the chances of ever helping their loved ones to recover. A professional alcohol intervention is always implemented in a loving, caring, and non-judgmental manner, gently coaxing the alcoholic along the path towards acknowledgment of the problem and agreement to rehabilitation.

More on How Trauma Leads to Addiction

Living with the kind of unpredictable and damaging behaviors that surround addiction, often challenges our sense of a normal and predictable world. It undermines our trust and faith in relationships and their ability to nurture and sustain us. It interferes with our ability to communicate our needs and have them heard or to listen to another person communicate theirs. It is in other words, traumatizing.

Over time this "cumulative" trauma can engender trauma related symptoms such as depression, anxiety, hypervigilance, low self worth and somatic disturbances (head and body aches, chronic tension and so forth). These symptoms, if they go untreated in family members, can become full blown PTSD. They can lead to all sorts of life, learning, health, psychological and relationship complications and yes, you guessed it, a desire to self-medicate.

This is how the insidious baton of addiction gets handed down through the generations. Addiction engenders trauma symptoms and trauma symptoms engender addiction. Even if family members do not become alcoholics or drug addictes themselves, they are at increased risk for other forms of self-medicating (food, sex or money, or hybrid combinations of two or three).

The connection between Trauma and Addiction

In the context of addiction, trauma is an event that affects a person in a way that can been seen to have caused a substantial, long term, psychological disturbance. The key to this way of looking at trauma is its subjective nature.

Things like emotional/physical/sexual abuse, childhood neglect, divorce, bullying, rejection or physical injury can all be considered traumatic. Anything counts as long as it leaves a painful emotional mark.

While we're all pretty adept at covering up such trauma, the emotional pain often needs to be soothed and a good way to soothe it is with drugs that make it temporarily go away. The first drink of alcohol, or hit of some other drug, will often take care of that.

Some call the experience of covering up the pain of trauma with drugs "self-medication". Emotional pain can begin a search that often leads to risky behaviors and drugs. I think that self-medication can be an important factor in drug abuse and one that cannot be ignored. As the stigma of emotional pain, or emotional responding, is reduced, people's ability to deal with such pain in a healthy way should lead to a reduction in seemingly helpful, but ultimately self-destructive behaviors.

One of the most useful roles for psychotherapy for addicts is in dealing with the trauma in a healthy, constructive manner. This way the shame, guilt and other negative emotions associated with it stop guiding the person's behavior. While this is rarely enough to stop the need for self-medication by itself, it can be a very useful part of a comprehensive treatment plan. It's important to remember that once someone has entered the realm of chronic drug use, there are brain and body changes that can often trump whatever the reason for beginning drug use was.

The ignored reality about addiction is that it often has an origin in behavior and unfortunately, trauma is often that starting point.

Family style invitational interventions

When doing an intervention I find it helpful to work with the addict as well as the family members who have had their lives destabilized and who feel they have lost their sense of control. The central philosophy of family-style intervention revolves around working not only with the addict but with the entire family to restore that feeling of control and healthy boundaries, after which, the theory goes, recovery of the chemically dependent individual can follow.

Sometimes, the intervention comes as a total surprise to the alcoholic, but new techniques have been developed in which the members of the intervention team tell the alcoholic that they are talking with a professional about his drinking/substance abuse problem several days prior to the actual intervention. With the newer invitational model, the addict realizes that the most important people in his life are meeting about his problem, and when he is finally invited to the discussion, he does not feel as "ambushed" as with the earlier intervention techniques.

Why is it necessary to conduct an intervention? Because nothing else has worked. Most people attempt to change a person or situation through reason and discussion, usually one-on-one. When this fails, frustration may lead to anger. This can go on for years. Appeals to reason and one-on-one discussions rarely produce change in someone engaged in self-destructive behaviors. On the other hand, an intervention that includes several people meaningful to the person, that is executed in a controlled and logical way, that focuses on changing everyone's behavior at least for the moment, is highly effective.

Different styles of Intervention

June 15th, 2010

A&E’s “Intervention” is a reality series that follows one individual struggling with addiction per episode. Family and friends gather with an interventionist toward the end of the episode and an intervention is planned. The addict is then given a choice between leaving immediately for rehab or risk losing contact, financial support or some other privileges from their family and friends.

All interventions are not the same

This style of intervention used in A&E’s “Intervention” is known as The Johnson Model (JM), as thought up by Dr. Vernon Johnson in the 1960s. This intervention model has, because of the show, become the most recognizable version of addiction intervention. An interventionist using this style aims to abruptly break the denial that is harbored by the chemically independent individual. By assembling loved ones and presenting an ultimatum, the addict is forced to hit “bottom”, in hopes of pushing them toward recovery and avoiding further destruction.

There are alternative intervention approaches, including Motivational Interviewing (MI), and CRAFT (Community reinforcement and family training). These relatively more recent and less confrontational approaches also employ professional counselors or interventionists who seeks to move the addict into a state in which they themselves are motivated to change their behavior (MI) or who focus on teaching behavior change skills to use at home (CRAFT).

By using common psychological techniques such as mirroring and reflecting, MI practitioners gradually make the client face the consequences of their action, taking the burden of motivation away from loved ones. CRAFT practitioners, on the other hand, use a manual-drive method to improve the addict’s awareness of negative consequences, reinforce non-drinking behavior, and improve communication skills and participation in competing activities. Both methods also prepare family members (or friends) to initiate treatment, if necessary, when the patient was ready. Though far less dramatic and “TV worthy,” MI has been shown in research to be very effective at increasing clients’ motivation to change in many different setting including addiction. It’s also my favorite technique because it allows for amazing, non-confrontational, change.

Some of the reasons to question the confrontational Johnson Model used in A&E’s “Intervention” have to do with the fact that although they’ve been shown to increase treatment entry rates once a successful intervention has been performed, they haven’t been shown to do much for treatment completion rates. Even more important is the fact that multiple studies have found that a small percentage of those who seek consultation in this method actually go through with the family confrontation portion. Instead, the more collaborative and supportive MI and CRAFT methods have greater participation and have been shown to provide even better treatment entry as well as improvement in communication and overall relationship satisfaction between the families and the addicts (which JM interventions provide as well). Additionally, a significant portion of individuals who enter treatment after a JM intervention end up leaving treatment early or relapsing quickly since they themselves have not yet internalized the motivation to quit.

Pressure and shame can backfire

This phenomenon can be seen in Corinne’s episode of A&E’s Intervention. Addicted to heroin and crystal meth, Corinne had lost control of her life and her family was desperate to save her. Corinne is a diabetic and had not been taking her insulin for years, using her needles to shoot-up instead. When Corinne overdosed nine months prior to taping, Corinne’s family knew they needed to intervene. During taping, an interventionist was brought in to meet with the family. She helped them to plan out how they will address Corinne. She started by emphasizing how desperate the situation has become and encouraged them to be forceful with Corinne. She explained that this is a life or death situation and that if Corinne refuses treatment, they might consider turning her in to be arrested. As Corinne arrives, she reacts harshly and explains that she is not “ready” for treatment. She flees the room for a short time only to return and agree to go into rehabilitation as they had requested.

As is too often the case, Corinne struggles at the first treatment center and is quickly transferred. Eventually after getting clean, her family is overjoyed. Unfortunately this is short lived when three weeks after taping, she relapses several times. As usual, I think it’s important to know every tool available when considering how to help an addict – that’s why I believe that knowing about MI and CRAFT (as well as other intervention methods) in case the more popular Johnson Model Intervention doesn’t work is crucial. It’s a matter of life and death.

Citation:

Miller, W.R., Meyers, R.J., and Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: Comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688-697.

Rollnick, S., Allison, J. (2003) Motivational Interviewing, in The Essential Handbook Of Treatment and Prevention of Alcohol Problems (2003)

Children's Mental Health Awareness Day

I regret to have been neglecting my blog, however I am have been busy in the world of neurotransmitters, trauma informed care and the war on drugs. I have been spending a lot of time learning about how one develops a propensity for addiction and how we can better intervene early in those at risk's lives to prevent the heartbreak and devastation of addiction.

Awareness of the brain workings as babies grow up into children and teenagers can help us better understand and work with our children. Not sure if you have heard of the phrase "trauma informed care". It is a fascinating new approach to working with children and adults who grew up with trauma. And it is no secret that a large percentage of addicts and alcoholics suffered harm in their formative years. Research is now supporting that during these years of brain development, trauma affects the brain more than we ever believed before.

I have decided to learn more about this so that I can implement better care to the families dealing with current and past trauma in my practice. So this summer I will start the process of becoming a certified trauma counselor. I am thankful that I have a love of learning. For me the brain is absolutely fascinating.

Have a great one!

One Day at a Time

How powerful these words can be. As I go about launching this business I have to remind myself one day at a time. There are things I need to do every day, but I am no good to anyone if I overwhelm myself and try to do it all today. Furthermore, when it seems like such a daunting task, I need to tell myself one day at a time, and do what I can each day. That may sound like a contradiction but it makes sense to me. How is that for a first blog post.

I intend for this blog to be a place to share information that may be of interest to families in crisis, families in recovery and any one who is effected by a loved one's addiction. I look forward to candid conversation and welcome all comments.

Welcome.