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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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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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