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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.

 

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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.

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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.

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