Watch this video with Dr. Dawn-Elise Snipes to learn a bit more about depression and antidepressants.
Note: If you are feeling suicidal or your depression is severe, contact a health professional immediately or dial 911 to be taken to your nearest emergency room. Online videos are not a substitute for the assessment and advice of a licensed healthcare professional.
Major Depression and Antidepressants
November 7, 2011 by
AA Alternatives
July 17, 2011 by
While AA is A way to recover, it is not the ONLY way. Unfortunately, due to the fact that the 12-step community is self-governed, and has no central oversight, there are some amazing groups with amazing sponsors, and groups where people are actively using crack in the bathroom or going out for drinks after an NA meeting. Additionally, AA tends to not be totally multiculturally sensitive. The emphasis on bearing your soul, speaker meetings, and the concept of a higher power is very off putting for many people. Therefore, while AA is, and will continue to be a very viable approach to recovery, we need to open our hearts and minds to alternative solutions. Failure to do so is just perpetuating the rigid, addictive mindset—”My way or the highway.”
At Gainesville-NOVA Counseling we take a more inclusive, solution focused and action-oriented approach. Is it spiritual? Sort of. Spirituality is a set of universal principles on which the majority of religions are based. However, spirituality is NOT religion. It is a lifestyle. We encourage you to nurture relationships; however, unlike AA, we believe that healthy family members can learn to be sober social supports (instead of mandating a sponsor). Our program uses the following 8 principles to help you change your negative thoughts, set and achieve realistic goals and stop relying on alcohol, drugs, sex, food or gambling to escape from the stress, anxiety, disappointments and frustrations of life.
1. Honesty: Fairness and straightforwardness of conduct; adherence to the facts. We start by talking about head-heart-and-gut honesty. If it is logically right, doing it or believing it does not make you feel bad and it does not tie your belly up in a knot, you are probably being honest. When one of those areas does not feel right, it usually means you are trying to do something, or convince yourself of something that is just not right. In recovery you need to practice not only being honest with others, but also being honest with yourself. If you grew up in an addicted household, this can be very difficult because you were taught to not trust yourself or anyone else and not feel. Many addicts have no idea what they like, want and feel, because they have never been allowed to figure it out. The first step in recovery is just that. Get honest with yourself. Figure out what is awesome about you. Evaluate all of those negative messages you have in your head, and figure out if they are true or messages/should that you can purge. Then figure out what you want 3 months from now, 6 months and 5 years. This will give you an idea about what path to start taking. It is important to remember that change is very stressful, and many times people change not to reach something, but to run or escape from something. To that end, AAs notion that you should avoid major changes for the first year are spot on.
2. Hope: Desire accompanied by expectation of or belief in fulfillment; expectation of fulfillment or success; someone or something on which hopes are centered (including yourself and mankind). We have to have hope that if we start changing our thoughts and actions we will start to feel better and our relationships will improve. Hope is the foundation of motivation. In the first step, Honesty, you figured out where you want to go and started figuring out who you are. In order to do the hard work to stay true to yourself, you need to be motivated. Without hope there is no motivation.
3. Faith: Allegiance to duty or a person; loyalty; fidelity to one’s promises; sincerity of intentions; something that is believed especially with strong conviction. You must have faith in the process, faith in yourself that you can do it, and faith in others that they will do the best they can with the tools they have. This means you need to surround yourself with people with good tools (coping skills, social supports, resources and recovery skills). You need to see that you can have fun clean and sober. You need to have faith that if you do the work, good things will come.
4. Courage: Mental or moral strength to venture, persevere, and withstand danger, fear, or difficulty. Courage closely follows faith. Changing the way you interpret things, learning to trust people, persevering even when the immediate outcome is not positive and forgoing the short-term, immediate rewards for the greater rewards when you complete your journey. These all require great faith in yourself, faith in the process and courage.
5. Integrity: Firm adherence to a code of especially moral or artistic values; incorruptibility; an unimpaired condition. Once you have gotten honest with yourself and others, have identified a worthy goals (hope), realized that you can achieve those goals if you rely on yourself, the process and other people, and have committed yourself to change (courage) then it is time to talk about integrity. That is, the unwavering commitment to the aforementioned principles. Sometimes we call this grounding. We encourage people to have morning and evening reflection sessions (5 or 10 minutes) in which they assess where they are at/how they feel emotionally, mentally, physically, socially, spiritually, occupationally and environmentally. They also reaffirm their commitment to themselves to achieve their goals by asking themselves “What can I do today or what did I do today that is in line with where I want to go and the person I know I can be?” AND “What could I have done better?” Change is hard and you will not be 100% perfect —well ever. However, knowing what you did right and where you have room for growth is a huge step in maintaining that forward momentum.
6. Willingness: Inclined or favorably disposed in mind; ready; prompt to act or respond. As with all the other “steps,” willingness follows closely on integrity. Get honest about what you want. Cultivate hope that with work things will get better. Have faith that your goals can be achieved. Muster the courage to keep going even when there are easier choices. Maintain a constant focus on your goals, values and commitment to yourself (integrity), and be willing to do the hard work.
7. Humility: Sometimes the hard work required means getting over yourself. Having to admit when you are wrong. Saying I am sorry and remembering that we are all one bad choice away from devastation.
8. Brotherly Love: “Love thy neighbor as thyself.” Once we have humbled ourselves, and learned to love and accept ourselves, despite our shortcomings, we can move on to having compassion/brotherly love for others. This is one huge stumbling block for many people. The inability to forgive, accept or let go of resentments; and the tendency to get angry over even the smallest things trips up most people’s recovery. This anger festers and negatively colors everything else. Seeing the bright side. Looking for the compassionate explanation. Realizing that what most people do really does not have anything to do with you (that whole getting over yourself thing again). All of these things feel awkward at first, but eventually become second nature.
Who Said: Removing the shoulds (and the stress) from our lives.
July 14, 2011 by
So often we get stuck in the shoulda, coulda, woulda trap without even knowing why. Who said you should have been a lawyer instead of a teacher? Who said you could have been a millionaire, but instead you chose to be a cop. What makes you thing that you would have done anything differently? Shoulda, coulda, woulda, but didn’t. Through listening to our parents, teachers, friends and the media, we develop a litany of “Shoulds” in our head. Most of the time we take these things at face value without even asking ourselves if we believe it is something we should do, or if it is just something others are trying to convince us we should do. When we start to get depressed or stressed out, often it is because of all of the things we are telling ourselves we should be doing, but are not. For example, there used to be a commercial in which a very pretty woman sang about being able to bring home the bacon, fry it up in the pan and never let you forget you’re a man. In reality, how many women can work a full time job, do all of the house chores, errands and cooking and handle the bedroom as well without getting stressed out? Very few. Unfortunately, many women in the 70s and 80s grew up believing that they “should” be superwomen, able to be everything to everyone all of the time.
There are times when we are unable to do things and we wish we could have. However, many times these things we “should” have done are simply overly high standards or goals someone else has tried to convince us that we care about. If you are going to beat yourself up over something you “shouda” done, then at least make sure you are the one that believes that and why. Try filling in the following statements: “I believe I should have done this because ______. The fact that I did not do it means that I am _________.” If you can fill in that statement with something that is reasonable and true, then move to the next step. If you cannot complete the exercise with reasonable answers, then you have to ask yourself why you are beating yourself up for something that really does not make that much difference anyway.
There is a basic principle that we do the things that are most rewarding (and least painful). Sometimes there is something that you truly believe you “should” do, like going on a walk instead of eating another piece of chocolate cake. If it is something that you really want (as opposed to something someone else tells you to do), then the challenge becomes figuring out how to make the desired activity(exercise) more rewarding than what you currently are doing (eating cake).
The first step is to do what we call a decisional balance exercise. Identify the pros and cons of eating a second piece of cake and the pros and cons of exercise. It is important to make the pros of exercise and the cons of eating cake strong arguments for exercise. If you need to, add incentives. For example, under the pros of exercise, say that you will get to go buy a new outfit every time you successfully complete 20 miles of walking (over multiple days of course).
So, to sum it all up. Identify what is important in your mind to do and why. Those are the goals you focus on. The rest of it can be delegated, ignored or compromised.
Responding to the Needs of Returning Veterans
July 6, 2011 by
Appropriate responses to the needs of returning veterans will include:
• A strength- and recovery-based focus
• An empowering, skill-training approach
• Careful, individualized, respectful, veteran-specific assessment and treatment planning
• A primary emphasis on stabilization and development of internal and external resources
• Education for veterans and families on the physical, cognitive and emotional aspects of trauma and substance use disorders
• Assertive linkage to ongoing support within the community—and in the larger military and veteran community nationwide
Effective responses to the needs of veterans with post-employment stress effects include a consistent approach that integrates trauma-informed addictions and mental health care, but what does that mean? It means that when treating a veteran for mental and/or substance use issues the clinician must realize that the traumas experienced have changed how the person feels, reacts and perceives the world. These changes are normal reactions to abnormal events. Unfortunately, they often persist even when the danger is past. This is the mind’s way of making sure the body survives. In order to help consumers to regain a sense of balance, we must create an environment of safety, trustworthiness, choice, collaboration and empowerment.
Safety means ensuring physical and emotional safety not only in the treatment session, but also in veterans’ daily lives. Even Abraham Maslow believed that safety helped form the foundation of mental health and wellness. When people do not feel safe, they are on guard, and they cannot rest well which negatively impacts their health, mood and relationships which could be supportive. So the next question I am often asked, is “What do they need protection from?” They need places where they are not subject to judgement or evaluation, and are not concerned they will have to defend their actions or the actions of the military in general. If they have been deployed for a while, they need a community that can help them feel less like a stranger in a strange world. They need places where people understand what they are going through, who have survived the nightmares, the insomnia and the feeling of utter isolation, not knowing who they can trust. They need to learn the skills to deal with the flashbacks and the nightmares, and to relaxs at the end of the day.
Trustworthiness is developed in the process of creating safety by maintaining clear, appropriate, consistent boundaries and objectives. Many people—veterans included—will not tell you everything until they believe you are trustworthy. Those things that haunt them at 2am are not things they are going to tell just anybody. Throughout the process that led to the PTSD–whether it be one single incident or years of traumas—the person regularly was stripped of their control, second guessed for every move and, often questioned on their decisions. Trauma informed treatment not only relies on consumers learning to trust their therapists, but also on them learning to trust themselves. Failure to keep promises reinforces the notion that the world is an unpredictable, terrifying place. Failure to help consumers see the logic in what they did, or are doing, reinforces the notion that their behavior is unpredictable and they are out of control. Remember to ask yourself what the benefit is to any behavor. Our brains are programmed to survive. How is the behavior helping the person survive. Substance abuse numbs pain and helps people survive until they develop alternate skills. Fear reactions/fleeing protect the person from imminent danger. Explosive anger can neutralize a perceived threat.
Choice means allowing consumers to prioritize what issues will be dealt with, when and to what extent. The caveat to this merges with collaboration. While it is certainly advised to maximize consumer input and control, there are some things which may need to be negotiated. When consumers are putting themselves at risk, even before treatment starts, the chances of them engaging in highly dangerous behaviors when they are in the midst of a crisis is much greater. For example, if Johnny is drinking a fifth of whisky each night and chasing it with hydrocodone, I would certainly not recommend delving into deep, emotionally charged issues in a traditional outpatient environment. It is likely when the pain increases, so will the desperation to stop the pain. Johnny first needs to get safe—mixing hydrocodone with whisky is just a slow way of committing suicide. If he can create a support plan that includes a drastic reduction in drinking (preferably 100%) and at least 3 people who will be there to support him, then I might consider working with him on the trauma issues in outpatient. My preference is for people with dual disorders (i.e. PTSD and substance abuse) who live alone or do not have a strong support system to enter into either intensive outpatient or a 3-5 day retreat in which they can have 24-hour access to a therapist and have their medication and substance intake monitored.
Finally, empowerment means providing consumers with the tools to help them create safety, trusting them to do the next right thing and encouraging them to make educated choices regarding their recovery and their life. Empowerment means helping them find positive ways to use the energy they are currently using to try and contain their anger and devastation. In PTSD, people often have a lot of “I should haves.” They cannot change the past, but with the knowledge of what they believe they should have done, what can they do now? That is to say, they cannot change the past, but what can they do to prevent it from happening in the future and/or make ammends if they believe they have done something wrong.
Trauma informed care identifies the trauma, and all of the associated mental, emotional, physical and social changes as the primary cause of people’s mental health and substance abuse issues. Likely things will never be like they were before the trauma, but they can get better. The terapists job is to help people define what “better” looks like, provide needed skills to help the person achieve their goals and empower them to start doing the hard work necessary to recover.
Online Counseling for Anxiety, Depression and PTSD: Does it Work?
June 13, 2011 by
Over the past several years, online counseling has become more accepted in the mainstream counseling community. Nevertheless, accepted does not necessarily translate to effectively used. Let’s face it, some people just need to have the personal contact of being in a face-2-face session. However, the vast majority of people are quite comfortable with video, phone or text chat.
Some of the benefits of online counseling for anxiety, depression, PTSD and addictions include:
- Being able to connect with experts anywhere in the world
- Access to services at the most convenient time for you (8pm on the East coast is 3 pm–still during normal business hours– on the West)
- Reduced costs in terms of travel time, child care and waiting. Instead of sitting in an uncomfortable waiting room, you can be watching ESPN in your living room. This is especially important in areas like Atlanta, Arlington, Alexandria and Washington DC
- Greater anonymity. Some people do not want others to see them going in to see a counselor–for any reason. Online counseling allows people to seek services for things like depression, anxiety and addictions in the privacy of their own home.
- People with PTSD need to have a place they feel safe. Practicing some of the exposure therapy techniques with an online counselor in the comfort of their own homes can help reduce their level of hypervigilence.
- Does Fido make you feel more at ease? Well, online counseling also enables you to have him in your lap.
What are some of the considerations for online counseling for people with depression, anxiety, addictions or PTSD?
- Unless your issues are mild or moderate, many therapists will want to be able to chat with you via video such as Skype. This allows us to better assess your mental status and level of danger to yourself or others. In the case of addictions, video chat also allows the therapist to assess whether you are clean and sober.
- For online video counseling you will need to have at least DSL internet.
- If you select online counseling via text chat, it is important that you are able to type
What to expect at Gainesville-NOVA Counseling
- Your first visit will consist of an intake assessment. Your therapist will ask you a variety of questions to learn about who you are and what you hope to get out of counseling. She will probably give you three assignments.
- Your first task will be to write an autobiography. This will assist your counselor in understanding how you grew into the person you are today, when the problem started and what things make the problem worse and what things make it better. You will use a secure email account provided to you to email this to your counselor.
- Your second task will be to keep a log of the problem (i.e. how many anger outbursts, how often you have flashbacks, on a scale from 1-5 what your average daily anxiety or depression rating was.
- Pick on area of health to start working on: Getting sufficient, quality sleep; exercising, eating better or drinking more water.
- During your second online counseling session, you and the counselor will review your autobiography, your problem log and the progress you have made in improving your health. Together you will develop a service plan to guide the online counseling process. This plan will use the knowledge-skills and abilities format. Using cognitive behavioral therapy (CBT) you will be guided to learn more about the problem in general and specifically what triggers or improves your problem. Then you will identify skills that you already have which can help you deal with the problem, and enhance those. Finally, your counselor will suggest some new skills to help you cope with or alleviate the problem.
- Subsequent online counseling sessions will help you systematically go through the service plan, and make adjustments to it as necessary.
- Our goal is to help you learn how to identify the root issues of your problems, increase your motivation to deal with them and use your current strengths and skills to achieve your highest quality of life.
In short, does online counseling for anxiety, addictions, depression or PTSD work? It works if you work it. If you just show up and expect the therapist to fix it for you, then I would not expect to see significant improvement. If you treat counseling as a learning experience, to learn more about yourself and how people in general “tick,” then, yes, online counseling will probably work quite well.
What Goes on Behind Closed Doors
June 12, 2011 by
Counseling can be very intimidating for people, so in the next few paragraphs we will take a look at what happens in the therapy room.
Okay, so first, there may be a couch, but that is usually to provide seating for multiple people (i.e. your spouse or family) if they come for a group session. Most therapists these days do not expect you to lie down, nor talk about your mother. Counseling in the 21st century usually involves one of two broad approaches. The Rogerian approach is what most people think of when they envision counseling. The thought is that if people are provided with a safe, nonjudgmental environment in which to explore their feelings, they will be able to identify and resolve their own issues. This process takes more or less time depending on how long it takes to create that safety and how directive your therapist is.
The second approach is cognitive behavioral or CBT. CBT is focused on 1) What is going well and not so well in the present, 2) What does the resolution to the problem look like, and 3) What steps need to be taken to get there. While people’s past is important, because it has shaped who they are and how they view the world, the focus is on identifying (and maybe changing) how the past is impacting the person in the present. CBT deals in facts, evidence and rational thought. Many of the things we tell ourselves we must, should or can never do are good life lessons that have morphed into something irrational. To top it off, most people are depleting the energy needed for dealing with stress by not sleeping well, eating poorly and not exercising. In most cases, the first steps are the most basic. People need to start taking care of themselves and making one or two small changes in their attitude.
For example, Tom comes to counseling because he is totally stressed out and feels like he cannot do anything right. Tom’s therapist might ask him what it is he hopes would be different if he were doing *everything* right. She might point out that he seems to be holding himself to an unreasonably high standard, and would he hold his son to that same standard? What would happen if his son failed to meet that standard? Would it impact their relationship? She might also ask him to identify one or two things that he feels he must be good at, and focus on doing those things right. (Once that happens he loses the argument that he cannot do *anything* right). She will probably also ask him to start trying to get at least 7 hours of sleep each night and walking his dog for 20 minutes each night after dinner.
Okay, so you get the idea, Rogerian tends to be more conversational and free flowing, CBT is much more directive, active and problem focused. So why use one over the other? Different people process things in different ways. I am a therapist’s worst nightmare, because I need both. When I am struggling with something, I want my feelings acknowledged, then I can go about the business of problem solving. My husband, on the other hand, just wants to get down to business. He figures the sooner the problem is solved, the sooner he will feel better. Meanwhile, my best friend is one of those people who needs to talk about her feelings and use a therapist (or me) as a sounding board.
But is that all there is? No, after all the talking comes the case notes. You know, the secret stuff doctors write in people’s medical record that they do not think they are supposed to see. Let me be the first to tell you that you have every right to see those. I usually spend the last 10 minutes of the session writing them together with my patient. Why? Because it serves as a good summation of what we talked about, and then there is no mystery. My job is to help people learn why they may be feeling or reacting in a certain way, provide them the tools to better understand themselves and help them fix negative reactions/behaviors. It is not magic. Just like a mechanic can hear an engine hum and tell you volumes, so can a therapist hear what you are saying. I could learn to be a mechanic, but I don’t really want to. You could learn to be a therapist, but let’s start with listening to yourself first.
Common Sense Wellness: Steps to Health and Happieness
June 8, 2011 by
Do you want to be happier, have more energy and less stress? Awesome! Each month, this column will present common sense information about how to get (and stay) happy and healthy. I do not believe that any one piece of information or intervention will work for every single person. We are all different. What I do believe is that any positive change you make in any area of your life will create positive changes in other areas of your life.
So what are these areas? Well, I wish I could take credit for it, but, many years ago, a psychologist named Abraham Maslow said that humans have a hierarchy of needs. At the foundation is our biological needs. This makes sense right? If you are exhausted, sick, hungry and homeless, you probably do not care very much about getting in shape or improving your self esteem. Ironically, many of the people with whom I have worked over the past 15 years can trace many of the “roots” of their problems back to this first area. Think about when you have the flu and an earache. What happens to your patience? Concentration? Overall mood? Impatient, indecisive and irritable right? Let’s be honest, most people do not want to be around you when you are like that. When you are sick, they can justify and overlook your disposition; however, if you are like this most of the time then it probably is starting to impact your relationships. One of the first things I suggest people take a look at, is their overall health. How well are they sleeping ? Are they eating a relatively nutritious diet? How much exercise they are getting, and are they in pain a lot. When they make even small changes in one or more of these areas, many people start having more energy, improving their concentration and generally being more pleasant to be around.
The second level of the hierarchy is safety. When people think of safety, they often think of making sure they do not get robbed, but there is much more to it than that. We need to not only have a sense of physical safety, but also psychological safety. That is, we need to live in a world in which most people (including ourselves) abide by the principle, “If you don’t have something nice to say, don’t say anything at all.” In many cases, we are our own worst critics. People bombard themselves with negative self talk and, essentially, make themselves feel stupid, inadequate or less-than. This often results in feelings of depression, anxiety and desperately seeking others (friends, relatives etc) to tell them they are okay. It is easy to make your external environment a safe place to be. It is much harder to make it safe inside your own head, but until you do, those negative messages are going to hold you back from feeling truly happy and achieving your goals.
So what can people do? Most people’s negative thoughts are so automatic, they do not even realize they had them. I encourage people to focus less on trying to figure out what they thought, and more on trying to see the positive in every situation. What did you learn? What could have been worse? What positive could come out of this? It is also helpful to start the day with a journal, meditation or list that provides an outline for all of the positive things they are going to accomplish. Get pumped! At the end of the day repeat the process and identify one or two things from the day that they are grateful for. Example:
(Morning) Today I am going to go to work, finish the monthly reports and then go workout with Tom.
(Evening) Work was okay. I am grateful to just have a job. I was kind of tired during my workout, but it was a great stress reliever and it was good to see Tom. (Isn’t that better than: “I hate doing monthly reports, my job sucks and all that stress made me have a terrible workout.”)
Once you are eating well, sleeping well and not so negative, irritable and distracted, then you can start addressing the next tier in the hierarchy: Relationships. Believe it or not, these don’t happen over night or run on auto-pilot. People have to work to keep a relationship going. People need to know what makes their spouse/children/friends tick. What are they interested in? What is rewarding to them. Too often people choose gifts and rewards that they would like themselves. For example, my husband is a reserved guy. For his birthday, he is happy going out to dinner and spending time with the family. I am a bit more outgoing. I like big gatherings with lots of my friends. What do you think I did for his birthday the first year we were together? Yup! I threw him a huge party—and a surprise one at that. Not one of my better choices. People should keep a running list on their iphone of what their friends like, so when it is holiday or birthday time, they will have something to reference.
But rewards are not the only part of a relationship. Sorry! The other big one is communication. Tired, sick, depressed people are typically awful listeners. They want their basic needs to be met, and conversation is simply extra noise. Once people are out of the sleep-deprived, sluggish, stress-induced fog, they have more energy to do things like listening and saying what they need. Unless I missed it in an RSS feed somewhere, humans still cannot read minds. Figure out what your needs are, so your friends do not compare the relationship to herding cats. Then—hold on to your hats—you must tell other people what your needs are. Be clear, concise and specific. Telling my 11 year old to clean his room is probably not going to get the job done. Put everything back where it belongs on your shelves and make your bed. Now that gets results. When people are vague in their requests, then misunderstandings occur leading to tension in the relationship and a whole host of other stuff that we’ll discuss in future articles.
For now, eat, sleep, exercise, be nice, look at the bright side and say what you mean. You might be surprised at how things so simple can make such a huge difference.
Dr. Dawn-Elise Snipes PhD, LPC, CRC, NCC is a psychotherapist and a nationally renowned speaker and counselor educator. She recently moved to Northern Virginia with her 2 children, husband, 3 dogs, 3 cats, and 2 birds. She uses a cognitive behavioral, reality-based approach to helping people find the happiness in their lives.
Substance Abuse and Addictions Outpatient and Intensive Outpatient
May 30, 2011 by
For the past 15 years I have been working with persons with co-occurring mental health and substance abuse issues. One of the things that strikes me is that, even in this day of information overload, there are still several common misconceptions about substance abuse, addictions and recovery. Over the next few minutes, we will discuss each of these.
Misconception #1 Drug addiction, alcoholism, eating disorders, sex addiction, exercise addiction and being an adrenaline junkie are all separate and distinct issues.
Reality: They all can be addictions. Addictions are behaviors that people continue to engage in, despite negative consequences as a means of escaping from physical or emotional distress. This distress can be anything from utter boredom to major depression or chronic, unrelenting pain, and everything in between. To meet the criteria for an addiction, the behaviors have to have all three characteristics. It is also important to remember that people do the best they can with the tools they have at any given time. It is when their anxiety, depression, boredom gets to be so overwhelming that they turn to something outside of themselves for relief.
Misconception #2 People with addictions are “sick” or “lazy.”
Reality: The majority of people have occasions in which they use a substance or activity to escape from negative feelings. The difference is that they either stop before it starts to cause problems, or as soon as they realize it is causing problems. People with addictions “cannot” deal with life on life’s terms without the buffer of the substance. All of their coping and survival skills have, for some reason, been overwhelmed. They are not lazy or gluttonous, they are desperate and hurting. Secondly, many people who start using do not have a mental health issue when they start using. Drugs like alcohol, cocaine, opiates and amphetamines mess with the chemicals in the brain, often leading people to become depressed and/or anxious. Once they have some clean time under their belt, their brain chemicals return to normal and they start to feel better. Think about how you crash after eating a bunch of sugar, then you want either more sugar or a good strong latte to pick you back up again. So goes the cycle of drug use.
Misconception #3 The only treatment for addiction is attending and working a 12-step program.
Reality: The most effective treatment will help people identify what thoughts, situations or issues are are causing them distress, and develop alternate ways of coping with those things. Often this involves identifying what strengths and skills the person already has, and building on those. 12-step programs provide an excellent framework for doing this, but they do not appeal to everyone. Rational recovery and cognitive behavioral therapy provide alternatives to 12-step programs, however, many in the recovery community have failed to embrace the alternatives. In this day of individualized treatment and cultural sensitivity, I believe it is imperative to provide people choices in recovery. Cognitive Behavioral Therapy (CBT) helps people objectively examine the thoughts and behaviors that may be contributing to their distress, and develop alternatives. It does not have to be about bearing your soul to a bunch of people you don’t know that well, or lying on a couch and talking about your mother. To the contrary, CBT looks at how the past may be impacting you now and changing your behaviors in the present. It is solution focused and generally provides rapid relief from symptoms. Like the 12-steps, or any behavior change such as good nutrition or getting in shape, it must be a life long commitment. Once you have the tools, you cannot let them collect dust in the shed. You have to use them every day, continuing to reflect on your thoughts and actions, identifying and accepting the things you cannot change and changing the things you can.
In my practice I encourage people to identify what is going to work best for them. The 12-steps encourage people to live a life full of honesty with themselves and others, hope, faith, courage, discipline, integrity, discipline and brotherly love. These principles are relatively universal regardless of whether you are an Agnostic or a Zionist. The difference is how you embrace them. Whereas everyone needs a sober social support, what, in 12-step programs, is called a sponsor does not work for everyone. Some people prefer to have their spouse, best friend or therapist be their sober support. I find that, during their first year of sobriety, while they are developing their sober coping skills and supports, many people who reject a traditional sponsor, are more successful maintaining their gains if they see their therapist at least once per week. For people with extremely high stress situations or who have been using heavily, it is also helpful for them to be able to contact their support at least once per day for 15-20 minutes to get focused. Regardless of the method you choose, it is imperative to remember that addictions can be treated, and many people who are in recovery go on to maintain very successful career and family lives.
