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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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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.

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Easing the Back-to-School Transition for Northern Virginia Students

June 15, 2011 by

August is Back to School which means back into a routine, back to struggles with homework and back to being sick every month.  Make no mistake, August and September are very challenging months for many families, but there are some ways to make the transition go a bit more smoothly.  Remember last month we talked about the basic needs: Food/Sleep/Shelter/Medicine, followed by safety and relationships.  The same principles apply here.

First let’s talk about the basics—primarily sleep.  Over the summer kids often get out of the school routine, stay up later and play more computer games.  When they go back to school not only are they in X-Box withdrawal, but they are also tired.  Not convinced?  Think about how just the one hour time change affects most people.  Couple all of that with the stresses inherent in being a pre-teen or teenager, and it is totally overwhelming. People’s natural response to being overwhelmed is to either get control of it or escape it. Children often try to get control by rebelling.  I remember, as a child, thinking that school wouldn’t come as quickly if I just stayed awake.  When I slept, time seemed to fly by, so I would do whatever I could to stay up later.  On the other hand, some children have just gotten used to a later schedule, so it is hard for them to get to sleep at 8:30 or 9.  Believe it or not, our bodies get into a rhythm, and certain environmental cues can help us get sleepy.  Think about how we help  toddlers develop good sleeping habits.  There is a routine—Eat dinner.  Take a bath.  Read a story.  Go to sleep.  Once  they begin the sequence, the brain  says “Oh, I know what comes next.”  Some children are more sensitive to changes in routine in others, however, if you start implementing the back to school routine at the end of July, August will go much more smoothly.

Then come the homework struggles.   Homework can be very difficult for kids after a long, tiring, stressful day at school.  For many children, it takes all they’ve got to behave all day, and they need a little while to wind down, decompress, or just be loud and get out energy.  Trying to get them to come home, eat a snack and do their homework is usually a losing battle.  Make sure they have a time limit though.  For example, they can have free time until 4pm, but from 4 until dinner they must sit at the desk and do their homework.   Some children also find it difficult to get back into the routine of being independent, and will lapse into “but it’s too hard,” or “I have too much homework. I’ll never get it done.”  This is when we, as parents, have to be coaches.  It is far easier just to give them the answer, or do it for them, and, after a long day at work ourselves, that is very tempting.  However, when that behavior is rewarded, it is very difficult to stop it. Create the safety for them.  Encourage them to try to learn the material.  Help them see that they are not stupid, and it is not hopeless.

Third, the sicknesses from the mutant bugga-buggas that all the other kids were exposed to over the summer/break/holiday.   Your kids are going to go to school, hug their friends, play on the playground and share not only their memories, but also their germs.  Our bodies are pretty adept at dealing with the stuff we encounter on a daily basis, but have you ever noticed how kids always seem to get sick right after a break.  And by sick, I mean really ill not just fake throwing up.  Well, there are a few things we can do to improve our odds.  First, wash your hands often.  Secondly, make sure everyone is getting plenty of rest, drinking plenty of water and eating plenty of fruits and vegetables.  Vitamins A, C and E can help people boost their immune system.  Third, and the one that people forget about is have fun.  When we are stressed our bodies release all sorts of chemicals to prepare us to fight or flee.  Why should we care about that?  Look at the presidents before they take office and after they have served 2 terms.  Most look as if they have aged 20 years, not eight.  Stress takes a huge toll on the body.  If you are having fun, you will be less stressed.

That leads me to my final point, all work and no play. . .  If families go from all play during the summer to all work during the school year, it is not surprising that children resist going back to school.  Set up one day a month that you can do something fun as a family.  Movie night with the grandparents?  Bowling?  Camping?  Cook out?  Whatever works for your family.  Try having each person write down what they like to do on a piece of paper and put it in a jar.  Then, before family night, draw from the jar to see what you will do.   Finally,  find one night per month that you can do something just with your partner.   Too often couples start having problems because they are too caught up in the day-to-day stresses of the family, housework and the like.  Have at least one night a month that you can go out and actually talk in complete sentences without interruption.

This is not an exhaustive list of things to do, but it gets you started and might spark some of your own ideas.  I would love to hear any suggestions you might have that makes back-to-school  not-so-cruel.

 

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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.

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PTSD What is it Really?

June 2, 2011 by

PTSD impacts the lives of people directly and indirectly on a daily basis.  It causes great physical, emotional and mental distress in the person who has it, and it also takes its toll on the people around them.  I want to start by emphasizing that PTSD is a normal reaction to an abnormal situation.  Let’s take a look at what PTSD really is and what you can do to deal with it.  In the simplest sense, PTSD or Post Traumatic Stress Disorder can result when a person experiences or witnesses a horrific event over which they have little or no control .  While it is important to remember that not everyone who experiences such an event develops PTSD, some people will.  Further, if the event is repetitive such as may occur in war, child abuse or law enforcement, then the chances for PTSD to develop increase dramatically.  People are just not meant to experience that level of horror on a regular basis.

But what IS PTSD?  It is a cluster of symptoms which is thought to result from changes in the traumatized brain.  Why is this important?  Because it is vital for those with PTSD and their loved ones to realize it is not just something they can “snap” out of.  It is not “just” a nightmare, and they are not “crazy.”   It is somewhat interesting though to consider the symptoms of PTSD and assess how they represent the mind’s best attempt at coping and protecting the body and itself.

  • Re-Experiencing the traumatic event, intrusive memories, flashbacks, night terrors
    • Okay, this part really sucks, but why does it happen?  It is possible that the brain is trying to assimilate something that it does not know how to deal with.  It is also possible that these memories are coming back as the mind’s way of saying “Okay, that was awful.  Make sure we don’t do that again.”  When faced with a traumatic event, our natural response is to fight or flee.  When you can do nothing, your mind cannot figure out what to do with that…which brings us to…
  • Avoidance of Reminders of the Trauma
    • Like reminders of pleasant things bring back pleasant memories, reminders of the trauma bring back memories of the horror and helplessness. So, yeah, it is natural to avoid reminders of the trauma.  Unfortunately, reminders come in sights, smells, places, people, dates, noises etc.  Eventually avoiding these things can lead the person to avoid leaving the house or sobering up.
  • Subjective Numbing.
    • The trauma and its effects have overwhelmed your coping skills and permeate most areas of your life.  Even if you had enough energy to be happy, it just hurts too much to feel anymore.  Some people just turn it all off and simply exist.  Others use substances or other activities to forget or numb the pain.  This numbing prevents husbands from “connecting” with their wives, parents from being emotionally available to their children and often is one of the biggest culprits for relationship problems.    “He’s just going through the motions.”  “He does not seem to care about anything anymore.”
  • Hypervigilance, feeling jumpy and easily startled
    • Many of us know people who seem to be like robots with extra sensitive sensors.  They do not seem to feel anything, but they always seem to be aware of everything that is going on.   For people with PTSD, they cannot relax.  They are always on guard—even when they are sleeping.  If you have ever taken care of a group of toddlers, you might begin to grasp how exhausting it can be to always have to be “on.”  This exhaustion can negatively impact relationships that can be supportive, can increase the flashbacks and can lead to a greater sense of helplessness and irritability.  In extreme cases, people can become paranoid, reclusive and overprotective.  I see this a lot in law enforcement officers.  One deputy once told me, “After a while,  I just assumed the worst out of every black male between the ages of 18 and 25.  I could be out with my family and see someone matching that description and suddenly be in cop mode.  Heck, I cannot go to Home Depot without bringing my gun. ”
  • Increased anxiety and emotional arousal, difficulty sleeping, concentrating, irritability and anger outbursts
    • Think back to the last time you were sick or exhausted—maybe right after you brought junior home from the hospital?  Were you more emotional?  Did seemingly silly things stress you out? Did you get Mommy-Brain—The inability to remember more than 1 thing at a time for more than 5 minutes?  All of these things can happen when you are tired.  The mind itself is mounting a fight or flee campaign.  It is trying to force you to get some rest.  It is telling you it cannot handle one more thing (hence the Mommy-brain).  When we feel this way and try to fight it, we get irritable.  We  often feel like we “should” be doing _____.  However, we just cannot seem to get it together enough to do so.  We get frustrated with ourselves and often lash out at others. (We also might be inadvertently pushing people away to stop them from putting any demands on us).

Okay, so we can see how these symptoms may be the mind’s way of protecting us, but how do we fix it.  People with PTSD cannot live in a state of exhaustion and hyperarousal forever.  The first step for many people is finding a way to reduce their anxiety and hypervigilance enough that they can get some sleep.  Although I have known some people to push through the early stages of recovery without medications, a short course of something like Zoloft and/or BuSpar may be in order.  I try to encourage people to stay away from super intense benzodiazepines like Valium or Xanax because they are highly addictive, and people with PTSD are at high risk for developing substance use issues.  Other things that help are limiting caffeine or alcoholic beverages after 2pm, drinking plenty of water, exercising and setting a routine so your body knows when it is time to sleep and when it is time to be awake.

The second thing we work on is developing a strategy for handling reminders of events and flashbacks. I encourage people to know what situations are likely to trigger flashbacks and prepare before the storm.  For example, one person I worked with was a trooper who watched a trucker burn alive, trapped in the cab of his truck.  We talked about how hearing the tones for a priority call, driving on the interstate, smelling gasoline fumes and seeing semis could all trigger flashbacks for him.  Likewise we practiced something called systematic desensitization in the office, so encountering these things would not be so overwhelming.

Systematic desensitization involves gradual exposure to a stimulus until the point people are feeling anxious or agitated.  Then they are coached through a calming sequence.  For many the calming sequence is a phrase or set of phrases to help them get control back.   Over time, the stimulus arouses much less of a reaction.   Think about the first time you asked someone out on a date.  It was terrifying, but you told yourself that you could do it.  Each time after that it got a little easier.  Or, remember the first time you hear the tones for a hot call when you were a rookie—tunnel vision right?  But after your 5th year on the force, tones aroused no more of a reaction than your morning alarm clock.   Same principle here.  Once people have practiced talking themselves down a few times, then when it happens in real life, they can more easily identify what is triggering them and talk themselves down.

Now this is not the end of treatment by any means.  It is only the beginning.  The above suggestions are simply those steps that can be taken to help you get on level ground so you can start dealing with the trauma.  Oh, and for any counselor types reading this…some people prefer the word “reaction” to “feelings.”  If you find that your patient is not responding well when you ask about how he felt in a situation, ask what his reaction was.

Good  luck and stay tuned for more mental health tips.

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Substance Abuse and the Veteran

May 31, 2011 by

We don’t know how many veterans will seek substance abuse treatment.  We do know that significant numbers of veterans may be avoiding treatment for fear of the stigma associated with postdeployment stress effects (Tanielian and Jaycox, 2008).  For many veterans who seek services, fear of having “mental health problems” or “substance abuse” attached to their service records may contribute to their decision to stay outside of all structures even remotely connected with the military. Experts at all levels agree that shame, stigma, and fear of military repercussions are significant blocks to help-seeking and recovery (Tanielian and Jaycox, 2008).

So let’s stop mincing words…are these soldiers weak or crazy?  No.  Absolutely not!  The connection between post-trauma effects and substance use disorders is well known. For example:

  • Between one third and one half of people seeking treatment for SUDs may also have posttraumatic stress disorder
  •  Having untreated PTSD has been associated with a more severe course and worse outcomes for substance use recovery.
    Drug dependence is frequent in war veterans with posttraumatic stress disorder (Alcoholism: Clinical & Experimental Research, 2008)
  • One preliminary study shows that “this generation of veterans has been much closer to trauma, has completed or may complete multiple tours of duty, and experience a greater prevalence of mental health issues (40%) and of those upwards of 60% also have a SUD” (Danforth, 2007, p. 11).

So why do veterans develop substance abuse issues?  Here are a few reasons…

  • When people respond to intense or unrelenting stress or threat, it often creates chemical imbalances that people instinctively try to deal with.  When “normal” coping skills fail to bring relief, people may seek sex, drugs, alcohol, food or gambling to numb or escape the pain.  Eventually the brain gets used to these substances and start to need more of them to get the same feeling of relaxation.  To compound this, the drugs or alcohol cause changes in the brain which may also lead to feelings of depression and/or anxiety.  Did you know that initially alcohol is a system depressant, but as it wears off, it causes symptoms of anxiety (fast heart rate, shortness of breath, dizziness, irritability)?
  • Many of the other aftereffects of war—from the neurological effects of trauma to the psychological and spiritual effects of exposure to death and destruction—can be very destructive.  Scientists are now doing imaging studies to show that people with traumatic brain injury often have similar brain changes as those who have been exposed to extreme trauma.  
  • It is important to remember a couple of things about trauma.  First, not everyone responds the same way to the same situations.  When we triage people after a crisis to identify who is more likely to develop PTSD, we look at if they have a history of mental health problems, how many stressors they have experienced in the last 6 months, how similar the person is to the victim, how close the event was, or how much of a threat the event posed to the safety of the person’s home, and how much positive social support they received immediately after the trauma. Secondly, when the alcohol and drugs that have “medicated” or numbed the memories leave the system, those stored memories and other symptoms of trauma can emerge at higher levels of intensity.
  • Injured veterans with pain-management needs are often prescribed opioid pain relievers (Vicodin, Lortab, Hydrocodone etc). Even in the absence of combat stress effects or prior histories of substance use problems, their injuries can leave them more vulnerable to dependence on those medicines.
  • Young male veterans with traumatic injuries may be more vulnerable to a number of risk-taking behaviors, including the misuse of alcohol, and less likely to seek or accept help for trauma and mental health issues (Good et al., 2008).  Part of this may be due to the mistaken notion that seeking help means they are weak, or believing counseling involves talking for hours on end about that “F” word…you got it….Feelings.

Substance abuse treatment providers have begun to focus on individualized treatment and recovery-based systems of care. It is imperative for these providers to receive specialized training in the specific needs and issues veterans face both in the field and at home.  Additionally, clinicians should use a comprehensive approach to helping the veteran in the areas of sleep hygiene, relationship issues, garnering social support, dealing with traumas and sheer exhaustion from being overstressed for an extended period and addressing problematic substance use behaviors.  Remember that the veteran may or may not be willing to address issues which he or she feels could come back to destroy their military career.  Provided the patient does not exhibit suicidal or homicidal ideation, the therapist may choose to present holistic interventions such as exercise, nutrition, time management, scheduling and sleep as adjuncts to assisting the person deal with “exhaustion” or “stress.”  For sustained recovery, people need to feel like they are not “the only one.”  They need to feel a connection with people who can relate to them (notice I did not say understand).  they need to have a safe zone where they can physically, mentally and emotionally relax.  And, they need to feel like what they do or have done has a worth and a purpose.

At Gainesville-NOVA Counseling, we provide a variety of services ranging from anonymous individual sessions to confidential group treatment.  While group therapy is excellent for treating substance abuse, some people do not want to be “exposed.”  What is most harmful not only to veterans, but also to their military and biological family is failing to have the courage to seek help.  While many vets come back in body, many leave their heart, soul and spirit on the battlefield.

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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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Gainesville Counselors

December 6, 2010 by

Gainesville is one of those unique locations that houses a major university churning out counselors at the speed of light. Many (myself included) end us staying here for one reason or another. Why do you care? Simple. It means that there are more counselors than you can shake a stick at, and they all have slightly different styles. It also means that, in many cases, if you are willing to go “out of network” you can get an appointment rather quickly. (Most insurance provider panels have been closed in Alachua County for years.) Most counselors in Gainesville have sliding scale fees, or simply accept 50% of their customary fee if you are paying out of pocket. Why? Well, I can tell you that after many years of wrangling with insurance companies, I can easily spend a full hour trying to get preauthorizations and conform to each unique rule of each insurance company. I did not get into this business to get rich. I want to help people.

A couple counselors in Gainesville, such as myself and Meridian Behavioral Healthcare, also offer group counseling. This is a much more cost-effective way to get many of the same services. Groups usually cost about half of what individual services cost. Just like for individual counseling, you need to ask how the groups are run. For example, my groups are more “psychoeducational.” I open group by hearing how everyone is doing, any particular successes and struggles over the past week, and then move on to teaching a skill or technique that can help group participants better achieve their goals and deal with their stresses. The last half of group in spent applying this technique to each person’s unique situation. This is a very productive, cognitive-behavioral, nonthreatening approach to counseling.

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