Addiction Recovery

“Recovery is a process of change through
which individuals work to improve their own health and well-being,
live a self-directed life, and strive to achieve their full potential.”
U.S. Substance Abuse and Mental Health Services Administration 2010 —

unite photo2Sunday October 4, 2015 thousands of Americans celebrated in the National Mall at the Unite to Face Addiction Rally.  Music by Sheryl Crow and Steven Tyler led a star studded concert.  The fundamental purpose of the event was to begin chipping away at the stigma of addiction.  So few people realize what it really is, what recovery is, that the short and irresponsible answer is to deny work which holds people back on changing their lives for the better.

Their short description, unite photo1
The time has come to UNITE To Face Addiction and stand up for recovery. On October 4, 2015 a transformative event will take place in Washington, DC that will ignite and build a movement to address one of the most pressing health issues of our time.

While addiction and recovery is kept behind the doors of judgment and invisibility , the fact is, millions of recovering people conquer their addiction, one day at a time.  Anonymously meeting in small alano clubs and church basements all over the world, addicts quietly serve one another’s mastering sobriety.  Passing on the street, barely a nod is exchanged as the rest of the world has stigmatized both the disease and the recovery.  While great galas are thrown to party about conquering other diseases, the word drunk remains a punchline or pejorative in HR’s everywhere.    The hosts of UNITE To Face Addiction hope to change that.

The Standard on Addiction Recovery

Whole Life Recovery, a name carefully, mindfully chosen, reflects the facts.  Recovery is not only stopping the use of alcohol / drugs but the adoption of an entirely new way of life; body, mind and spirit.  It radiates from the breath to the outstretched hand.  It means a clear head and a lighted spirit.  The cloudy, misshapen consciousness is surrendered in the relief of clarity.

FOUR DIMENSIONS OF RECOVERY

Health: as addicts, we must recover our health by overcoming and managing our disease, while also living in a physically and emotionally healthy way.

Home: recovery from addiction means having a stable and safe place to live.

Purpose: recovery from addiction means having meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society

Community: addiction recovery means having relationships and social networks that provide support, friendship and love.

PRINCIPLES OF AN EFFECTIVE RECOVERY

Acceptance
We start our journey into recovery on the principle of hope that there is a solution and that we can recover. Many times we find this hope in a 12 Step fellowship through witnessing others who have recovered. We come to accept our condition as a disease and are willing to take actions to recover from it. This small leap of faith — based on the experience of other addicts — gives us the courage to work the 12 Steps. We ultimately address all the areas of our lives, and in doing so reclaim the life we were originally meant to live. Acceptance and hope are the catalysts of the recovery process.

Our Responsibility
Taking charge of our lives is the principle foundation for recovery. Once we accept we are suffering from a disease and take responsibility for our recovery, we make the choice as to which path to take to achieve our goal. We feel empowered by taking an active role in choosing and working with the services and supports that assist us in our recovery. By doing so, we gain the strength and clarity to make decisions about our recovery, and regain control over our lives.

Fellowship Support
12 Step fellowships play an invaluable role in addiction recovery . Fellow addicts encourage and engage with each other, providing each other with the support needed to recover and, more importantly, to maintain recovery. Getting support from 12 Step fellowships has proven to be the most effective means for us to recover. We need the help of each other to overcome a disease that is much bigger than anyone of us alone. Studies have shown those of us who are involved with Fellowships often benefit from improved social functioning, material and family adjustments, and improved psychological adjustments. Working the 12 Steps with the support of the Fellowship enables us to develop an active spiritual life, a greater sense of self-reliance and self-confidence, and a decreased dependence on others.

Another contributing factor in our recovery process is the involvement of people who believe in our ability to recover. In addition to fellow addicts in recovery, this group includes family members, providers, faith groups, community members, and other allies that form vital support networks. Through these relationships, we discover a sense of belonging, empowerment, and autonomy.

It is a Process
Each of us has distinct needs, strengths, preferences, goals, culture, and background – which determine our process in recovery. Unlike other diseases, addiction cannot be treated by a doctor giving us a generic pill to “cure” us. The disease of addiction affects each of us differently, damaging different aspects of our lives — which need to be addressed for our recovery to be successful. For example, addiction drives some to crime and into legal problems, whereas others suffer marital or financial problems. Addressing and resolving these problems have to be part of our recovery process to ensure we don’t go back to using drugs, which has been our usual way of coping with life’s problems. Fortunately the 12 Steps not only help us overcome our disease but also provide us with the tools to deal with all of life’s problems.

Recovery from the disease of addiction is not linear, and many of us relapse during our journey into recovery. This is part of our recovery process. In fact, relapse usually teaches us things we needed to learn about our disease. It does not mean we have failed or that we cannot recover. The basis for our recovery, though, is simple: Abstinence from drugs and a fellowship of people who can support us along the way.

Holistic
An effective recovery should encompass our whole life, which means that all aspects of our well-being should be taken into account. In 12 Step programs, they say that addiction to drugs is only a symptom of our problem. What happens then is that addicts in recovery can point to improvements in all facets of their lives. We finally get to work on rebuilding all the things on which our addiction wreaked havoc. This means we work on improving – or winning back –family relations, our jobs, education, health, spirituality, creativity, social networks, recreation, and community participation – all the elements that define a healthy and human life.

Professionals
An effective recovery should address areas of our lives that may be contributing factors to causing or contributing to our primary disease of addiction. Among these factors are psychological issues like trauma and depression. The experience of trauma (such as physical or sexual abuse, domestic violence, war, and disaster) is often a precursor to, or associated with, alcohol and drug use, mental health problems, and related issues. It is important to treat each of our illnesses or conditions as separate issues and seek appropriate help for them.

Some of us may need professional help for detoxification or other mental or physical ailments. It is important to recognize the limitations of a12 Step program and not treat it as a medical or a psychological form of treatment. For example, if you are suffering from diabetes, working the Steps will not cure you, although its principles will help you come to terms and cope with it. We need to go to the right professional for treatment. This is all part and parcel of our recovery – which is ultimately about taking responsibility for ourselves and taking care of ourselves. There is a saying in the fellowship that poses the question: “are you willing to go to any length to get sober and stay that way.” And “any length” often means getting help from doctors or psychotherapists for our non-drug issues.

THE STAGES OF CHANGE IN RECOVERY
Precontemplation (Not Ready)
Contemplation (Getting Ready)
Preparation (Ready)
Action
Maintenance

People may differ in their time in each stage but the order of the stages is not variable.  A person must collect the benefits, accomplish the work and conquer the pitfalls of each stage before moving on to the next.  It is a building process of steady accumulation to reduce resistance, facilitate progress, and prevent relapse.  Along the way a person will most likely fall back and begin collecting again.

Precontemplation (Not Ready)
As far as I’m concerned, I don’t have any problems that need changing.   I’m not The problem one. It doesn’t make much sense for me to be here.

People in the Precontemplation stage do not intend to take action in the foreseeable future, usually measured as the next six months. Being uninformed or under informed about the consequences of one’s behavior may cause a person to be in the Precontemplation stage. Multiple unsuccessful attempts at change can lead to demoralization about the ability to change. Both the uninformed and under informed tend to avoid reading, talking, or thinking about their high-risk behaviors. They are often characterized in other theories as resistant, unmotivated, or unready for help. The fact is, traditional programs were not ready for such individuals and were not designed to meet their needs.

Contemplation (Getting Ready)
I have a problem and I really think I should work on it.  I’m hoping this place will help me to better understand myself.

Contemplation is the stage in which people intend to change in the next six months. They are more aware of the pros of changing, but are also acutely aware of the cons. This weighting between the costs and benefits of changing can produce profound ambivalence that can cause people to remain in this stage for long periods of time. This phenomenon is often characterized as chronic contemplation or behavioral procrastination. Individuals in the Contemplation stage are not ready for traditional action-oriented programs that expect participants to act immediately.

Preparation (Ready)
Preparation is the stage in which people intend to take action in the immediate future, usually measured as the next month. Typically, they have already taken some significant action in the past year. These individuals have a plan of action, such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book, or relying on a self-change approach. These are the people who should be recruited for action-oriented programs.

Action
I am doing something about the problems that had been bothering me.  Anyone can talk about changing: I’m actually doing something about it.

Action is the stage in which people have made specific overt modifications in their lifestyles within the past six months. Because action is observable, the overall process of behavior change often has been equated with action. But in the TTM, Action is only one of six stages. Typically, not all modifications of behavior count as Action in this Model. In most applications, people have to attain a criterion that scientists and professionals agree is sufficient to reduce risk of disease.

Maintenance
It worries me that I might slip back on a problem I have already changed so I am here to seek help.   I thought once 1 had resolved the problem 1 would be free of it, but sometimes I still find myself struggling with it.

Maintenance is the stage in which people have made specific overt modifications in their lifestyles and are working to prevent relapse; however, they do not apply change processes as frequently as do people in Action. While in the Maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes.

Contax Aria on Fuji Pro 400

As with anything which separates us, understanding is the only bridge.  There was a time when every dis-ease was thought to be an evil godless state of human life.  With each discovery, with comprehensive research, but mostly with an open heart, humanity leaps forward from juvenile myths and puny judgments.  Addiction is still a mystery to most, even the addict.  Recovery is coming into focus which liberates everyone, addict and non-addict, from the shackles of misunderstanding.  Everyone will benefit from their own Whole Life Recovery into the light of understanding and bridging humanity.

The Great Addiction Counselor

drug-addiction-counseling-1000When an addict/alcoholic person reaches up to begin a new phase, nothing is more important than the convergence of counsel, environment, therapeutic choices, an open custom plan, defined inspired outcomes and hope.  Whole Life Recovery knows this from the ground up; from personal history.  Stepping into view, to welcome change, to start (again), is all extraordinarily brave.  Our first response is ease and acceptance from a staff that regards service primary.  From the ride to the facilities, intake and hospitality, everyone is quietly offering their seasoned hand.

We breathe with our clients to pace self-discovery, self-care, self-de-escalation.  We practice the mindfulness we propose for our clients.  Tested and proven.  We know it works.   In fact, we have worked with great addiction counselors
ourselves and, thus, are able to hold that example to guide us.substance-abuse-counseling

Here are some selections from one of our touchstone documents on Addition Counseling by Delinda Mercer, Ph.D., of The Center for Psychotherapy Research, University of Pennsylvania.

1.OVERVIEW, DESCRIPTION, AND RATIONALE

1.1 General Description of Approach
Addiction counseling addresses the symptoms of drug addiction and related areas of impaired functioning and the content and structure of the client’s ongoing recovery program. This model of addiction counseling is a time-limited approach that focuses on behavioral change, 12-step ideology and tools for recovery, and self-help participation.

1.2 Goals and Objectives of Approach
The primary goal of addiction counseling is to help the client achieve and maintain abstinence from addictive chemicals and behaviors. The secondary goal is to help the client recover from the damage the addiction has done to the client’s life.

1.3 Theoretical Rationale/Mechanism of Action
Addiction counseling works by first helping the client recognize the existence of a problem and the associated irrational thinking. Next, the client is encouraged to achieve and maintain abstinence and then develop the necessary psychosocial skills and spiritual development to continue in recovery lifelong.

1.4 Agent of Change
Within this addiction counseling model, the agent of change is the client. The client must take responsibility for working a program of recovery. However, although recovery is ultimately the client’s task, he or she is encouraged to get a great deal of support from others such as the client’s counselors, treatment staff, sponsor, drug-free or recovering peers, and family members.

1.5 Conception of Drug Abuse/Addiction, Causative Factors
Drug abuse is thought to be a multidetermined, maladaptive way of coping with life problems that often becomes habitual and leads to a progressive deterioration in life circumstance. Habituation of drug abuse is addiction, seen as a disease in its own right, which damages the addict physically, mentally, and spiritually. Causation is not a prominent focus of treatment.

2. CONTRAST TO OTHER COUNSELING APPROACHES

2.1 Most Similar Counseling Approaches
Because this model of addiction counseling is time limited and focuses on behavioral change and 12-step ideology and participation, the most similar approaches would be short-term cognitive behavioral therapy to treat addiction or short-term counseling based on the 12-step approach to recovery.

2.2 Most Dissimilar Counseling Approaches
The most dissimilar approaches are the traditional approach as provided in a therapeutic community, not because of the content that might be similar but because of the format that would probably be more punitive and confrontational and less respectful of the client, and the open-ended, nondirective psychotherapy approach.

3. FORMAT

3.1 Modalities of Treatment
This counseling model has been developed for use in individual and group contexts.

3.2 Ideal Treatment Setting
This model was developed for use as part of an outpatient addiction treatment program. It could, however, be adapted readily for use in an inpatient program with the following modification: It is planned to span 6 months, and usually inpatient treatment is 4 to 10 days for detoxification and up to 28 days for rehabilitation. The model could be altered to offer sessions more frequently over a shorter period of time.

3.3 Duration of Treatment
This model is progressive and time limited; the active treatment phase runs 6 months, and there are follow up sessions of up to 1 year. For individual treatment, there are two sessions a week for 3 months followed by one session a week for 3 months. The follow up phase involves one session every other week for 3 months followed by one session a month for 3 months.

The group component of treatment is twice a week for 2 months and then once a week for 4 months. An advanced recovery group for post-6-month clients would undoubtedly be helpful but was not developed as part of these treatment manuals.  Individual sessions should run from 45 to 50 minutes; groups run 1-1/2 hours, including about 15 minutes for collection of urine and breathalyzer data.

3.4 Compatibility With Other Treatments
These manuals for addiction counseling, as developed for individual and group counseling, were designed to be components in a more comprehensive treatment program. Combined with detoxification, initial medical and psychosocial assessments, and ongoing participation in a self-help program, individual and group addiction counseling can make a complete treatment package. However, these treatments may also be used in conjunction with pharmacotherapy, other medical therapies (e.g., acupuncture), family or couples therapy, or professional psychotherapy.

3.5 Role of Self-Help Programs
Participation in a self-help program is considered an extremely valuable aid to recovery. It helps recovering individuals develop a social support network outside of their treatment program, teaches the skills needed to recover, and helps clients take responsibility for their own recovery.

In addition to encouraging clients to attend self-help groups at least three times a week and to locate a sponsor, the addiction counseling program educates clients about the 12-step program and incorporates many of its concepts into the content of the counseling. Breaking through denial; staying away from negative people, places, and things; taking a personal inventory; working on character defects; and spirituality in recovery are among the concepts addressed within the content of the counseling sessions.

As to 12-step versus other programs, participation in any legitimate self-help program the client gravitates toward, such as Rational Recovery and Women for Sobriety, is supported. However, because the 12-step approach to recovery is well known, more widely available, and has been an integral part of many addicts’ recovery programs, it is this approach in addiction counseling that is drawn on.

4. COUNSELOR CHARACTERISTICS AND TRAINING

4.1 Educational Requirements
For purposes of the research protocol for which this treatment was designed, the educational requirement for group or individual addiction counselor was no higher than a master’s degree. The range of education is associate’s to master’s degree in a human services field.

4.2 Training, Credentials, and Experience Required
Counselors must have a minimum of 3 years’ experience in addiction counseling and must be knowledgeable of and use the 12-step model. Group counselors must also have experience in leading groups. The professional credentials for addiction counselors (in Pennsylvania, associate addiction counselor [A.A.C.] and certified addiction counselor [C.A.C.]) are encouraged but not required. Counselors often become credentialed after having worked with institutions for a period of time.

4.3 Counselor’s Recovery Status
Many counselors in this field are either in recovery themselves or have had a family member who was addicted. An indepth knowledge of addiction and the tools for recovery and ability to empathize with the client are essential for an addiction counselor. One way to develop this knowledge and ability is for the counselor to be in recovery. It is important that the counselor be relatively healthy and able to demonstrate a minimum of 5 years in recovery. The best situation is a mixture of recovering and non-addicted counselors, because this fosters maximum learning from one another.

4.4 Ideal Personal Characteristics of Counselor
Addiction counselors should exhibit good professional judgment, be able to establish rapport with most clients, be good listeners, be accepting of the client for who he or she is (and not have a negative attitude toward working with addicts), and use confrontation in a helpful versus an inappropriate or overly punitive manner. A good addiction counselor must also be personally organized so as to be prompt for all sessions and able to maintain adequate documentation.

4.5 Counselor’s Behaviors Prescribed
The counselor will perform the following behavioral tasks:

  • Help the client admit that he or she suffers from the disease of addiction.
  • Teach the client about addiction and about the tools of recovery.
  • Encourage and motivate the client.
  • Monitor abstinence by doing frequent urine drug screens and breathalyzers and by encouraging self-report of any relapse.
  • Analyze any relapse and strongly discourage further use.
  • Introduce or review the 12-step philosophy and encourage regular attendance in a self-help program.
  • Provide support and encourage development of a support network.

4.6 Counselor’s Behaviors Proscribed
The counselor should not be harshly judgmental of the client’s addictive behaviors. If the client did not suffer from addiction he or she would not need drug counseling, so it is useless to blame the client for exhibiting these symptoms. Also, because clients often feel a great deal of shame and guilt associated with their addictive behaviors, to help resolve those feelings it is important that they be encouraged to speak honestly about drug use and other addictive behaviors and to be accepting of each client’s story.

It is also important that the counselor be respectful of clients. The counselor should not be late for appointments and should never treat or talk to clients in a disrespectful manner.

The counselor should avoid too much self-disclosure. While occasional appropriate self-disclosure can help the client to open up or motivate the client by providing a role model, too much self-disclosure removes the focus from the client’s recovery. A good rule regarding self-disclosure, if the counselor is so inclined, is that the counselor first have a clear purpose or goal for the intervention and then think about why he or she is choosing self-disclosure at this time.

Finally, the counselor should be aware of when his or her own issues are stimulated by a client’s problems and therefore refrain from responding to the client out of his or her own dynamics. For example, if a counselor in recovery feels it extremely important to break ties with addicted peers, but a particular client with an addicted spouse or partner cannot break free of the relationship, it is imperative that the counselor respond flexibly and creatively to the client’s perception of the situation and not rigidly adhere to the notion that breaking ties with all addicts is the only way to recovery.

4.7 Recommended Supervision
Ongoing supervision is a necessary part of counselor training and support. Lack of adequate supervision can contribute to counselor stress and burnout, both of which are seen frequently.

The ultimate goal of supervision is to enhance the quality of client care. Focus to achieve this goal is twofold. First, it is centrally important that the supervisor provide support and encouragement to the counselor along with the opportunity to expand his or her skills. Second, it is important that the supervisor have the opportunity to review the clinical status of clients and offer suggestions or corrections.

The format of supervision is for each individual to have a supervisor and meet with that supervisor for 1 hour once a week to review counseling sessions. Individual counseling sessions are audio-taped, and the supervisor is responsible for listening to a percentage and rating them for adherence to the counseling manual. This feedback is then given to the counselor.

5. CLIENT-COUNSELOR RELATIONSHIP

 

5.1 What Is the Counselor’s Role?
The role of the counselor is to provide support and education and to hold the client accountable through nonjudgmental confrontation. Ideally, the recovering person sees the counselor as an ally in the struggle to achieve sobriety.

5.2 Who Talks More?
The client should talk more than the counselor. The counselor should structure the session and provide information and direction, but also do a lot of listening.

5.3 How Directive Is the Counselor?
The counselor must find a balance between being directive and allowing the client to be self-directed. The counselor must be directive in many ways. The counselor imposes a session structure that includes giving feedback on the most recent urine drug screens and the client’s progress in recovery as well as processing any episodes of use or near use. The counselor identifies the relevant topic for discussion, based on what the client seems to need, and introduces that topic.

Also, the counselor may directly pressure the client to change certain behaviors, for example, to start attending three meetings a week. However, the client is also encouraged to be self-directed in this counseling approach. For example, within the framework of a particular topic, such as coping with social pressure to use, the client will ventilate or explore the direction he or she needs to take, and the counselor will respond to the client’s direction. Also, when the client is unable to change an addictive behavior, such as being in a dangerous situation, the appropriate counselor response is to accept where the client is and assist in exploring what the client can do to handle the situation differently the next time.

Ultimately, recovery is seen as the client’s responsibility, and the counselor wants to encourage self-directed movements toward the recovery. However, the counselor will discourage movements toward addiction in a number of ways, many of which are directive.

5.4 Therapeutic Alliance
It is important for the counselor to give the client a sense of collaboration and partnership in the counseling relationship. This is accomplished in three ways. First, the counselor should possess a thorough knowledge of addiction and the lifestyles of addicts. Second, no matter how expert the counselor is in the field, he or she must acknowledge that it is the client who is the expert in discussing his or her own life. The counselor must listen well, empathize, and avoid passing judgment. Third, the counselor should convey to the client that he or she has an ally in the struggle to break the cycle of addiction. Their relationship is a collaborative one.

Generally, the interventions that are most helpful in fostering a strong therapeutic alliance (TA) are those that involve the counselor’s active listening and that emphasize collaboration. For example, after the client reports a relapse, the counselor might say empathically, “Let’s examine what happened and develop a plan together to help you avoid using the next time.” Language like this highlights the joint effort in the relationship.

If the TA initially seems weak, the counselor might find it helpful just to ask the client what is not working in the relationship. Often the client knows what might improve the therapeutic relationship but does not feel comfortable enough to mention it unless the counselor does so. It is important that the counselor be willing to accept feedback from the client and make changes if necessary. In responding to a request to change, the counselor should not feel pressured to change or compromise his or her philosophy of addiction but only the manner of relating to the client.

6. TARGET POPULATIONS

6.1 Clients Best Suited for This Counseling Approach
This treatment has been developed for adult male and female ambulatory cocaine addicts. It has also been used with individuals addicted to alcohol and with those addicted to cocaine and other drugs, including alcohol, marijuana, and opiates, who have found it to be appropriate.

6.2 Clients Poorly Suited for This Counseling Approach
Dual diagnosed individuals with significant psychopathology probably require more attention to the psychopathology than this approach provides. Previous research has shown that addicts with more psychopathology derive greater benefit from psychotherapy combined with addiction counseling than from addiction counseling alone.

Other research has indicated that most antisocial individuals do not fare particularly well with any type of psycho-social treatment.

7. ASSESSMENT

The only assessment procedures that are necessarily a part of the addiction counseling treatment are the frequent, regular urinalysis and breathalyzer tests and self-reports of any drug use. The other assessment instrument routinely used in association with treatment is the Addiction Severity Index (ASI), an interview schedule that measures seven addiction-related domains: drug use, alcohol use, medical problems, psychiatric problems, legal problems, family/social problems, and employment/support problems. Because this interview examines problems and drug use over the previous month, it should be given at baseline, when the client enters treatment, and then either monthly or after 3 or 6 months to measure change. It requires approximately 45 minutes for the initial administration and about 30 minutes for a followup administration.

8. SESSION FORMAT AND CONTENT

8.1 Format for a Typical Session
In each individual session the counselor should:

  • Find out how the client has been since the last session and ask specifically if the client has used any drugs. If the client has used drugs, analyze the relapse and develop strategies to prevent future relapses.
  • Ask if there are any urgent problems and, if there are, deal with them.
  • Provide feedback as to whether recent urine tests have detected drug use.
  • Discuss the recovery topic most relevant to the client’s stage of recovery and current treatment needs.
  • Group sessions have the following format:
  • Members submit a urine sample and take a breathalyzer test.
  • Members introduce themselves, admit to their addiction, and state their date of last use of any type of drug or alcohol.
  • Members are encouraged to talk briefly about how they are doing and about any cravings or temptations experienced since the previous group meeting.
  • If any members have used since the last session, the group will help them process the event and develop a plan to prevent further relapse.
  • If there is a topic, the group leader will introduce it and encourage members to discuss how it relates to their recovery. (In the more advanced problem solving group, members are encouraged to describe a current problem or concern and get feedback from one another.)
  • In the final 10 minutes, members are asked to state their plans for the next few days in an effort to help them structure their time. Members are also encouraged to mention the self-help meetings that they are attending and perhaps invite others to attend with them.
  • Members then join hands and recite the Serenity Prayer aloud.

8.2 Several Typical Session Topics or Themes
Treatment is conceptualized as occurring in stages. The first stage includes denial and motivation.

The next stage, early abstinence, includes issues of:

  • Addiction and associated symptoms.
  • People, places, and things.
  • Structure of personal time.
  • High-risk situations.
  • Social pressures to use.
  • Compulsive sexual behavior.
  • Postacute withdrawal symptoms.
  • Use of other drugs (other than the primary addiction).
  • Self-help participation.

 

The next stage, maintaining abstinence, includes:

  • The relapse process and tools for preventing it.
  • Relationships in recovery.
  • Development of a drug-free lifestyle.
  • Shame and guilt.
  • Personal inventory.
  • Character defects.
  • Identification and fulfillment of needs.
  • Anger management.
  • Relaxation and leisure time.
  • Employment and finances.
  • Transference of addictive behaviors.

 

8.3 Session Structure
Both group and individual sessions have a clear structure. However, within the framework of that structure, the content of the discussion is largely up to the client. An effort is made to address effectively the client’s individual needs at any point in treatment while also recognizing the commonality of many issues in addiction and recovery.

8.4 Strategies for Dealing With Common Clinical Problems
Clients are repeatedly urged to arrive for all sessions promptly, to call if they are going to be late, and to call at least 24 hours in advance if they must cancel a session. If they fail to fulfill these obligations, the counselor will confront them about it in the session.

If a client arrives late for a session, the consequence is a shorter session because the counselor will end the session on time. Repeated missed sessions without appropriate cancellations and rescheduling will eventually result in dismissal from the program, but because this occurs only after 2 months, clients are given many chances before termination from treatment for nonattendance.

Clients are requested to arrive clean for all visits. If a client arrives obviously intoxicated, the counselor will remind the individual of the responsibility to come clean and will reschedule the session. If a client arrives for a group or individual session mildly under the influence but not intoxicated (e.g., blows a low positive on a breathalyzer test), it is at the counselor’s discretion whether to continue with or reschedule the session.

8.5 Strategies for Dealing With Denial, Resistance, or Poor Motivation
Denial and motivation are central themes in the beginning of addiction treatment. For this reason, they are addressed in the first several sessions of counseling and then repeatedly addressed, as needed, throughout the course of treatment. The major strategy is to chip away at the client’s denial by pointing out the addictive behaviors and consequences of addiction and gently confronting the client about the denial.

Resistance is a concept that is not directly addressed in this addiction counseling model. Much resistance falls within the concept of denial and is addressed in that way. Also the 12-step suggestion of turning one’s will over to a higher power is a way of dealing with resistance that would be used in this model of counseling.

Regarding motivation, clients often express ambivalence at some point in treatment, and several strategies are used to address this directly. Clients may be encouraged to review the pros and cons of getting sober, or they may be pressed to explore fully the consequences of their addiction. Clients may also be asked to identify specifically the benefits of sobriety in their life. Basically, these issues are reviewed continuously throughout the early period in treatment.

8.6 Strategies for Dealing With Crises
If the client presents with an urgent, addiction-related problem such as marital dissolution or financial problems as a result of the addiction, the counselor should try to address these problems, with emphasis on how they are related to the addictive behavior. The counselor should then help the client develop strategies for dealing with the problems in a manner consistent with recovery, including identifying how to obtain appropriate assistance from social services.

If the client presents with a true crisis (spending all of his or her money on a cocaine binge and becoming suicidal), the counselor should organize a team effort among the appropriate treatment staff to provide any medical or psychiatric services that the client requires in order to remain safe.

8.7 Counselor’s Response to Slips and Relapses
If a relapse occurs, the counselor and client should use the session immediately following the relapse to identify and process the events, thoughts, and feelings that precipitated the relapse.

Relapse to drug use is a common occurrence that can be devastating to the client. The counselor must communicate to the client that relapse to drug use does not mean that the entire treatment program has been a failure. The counselor should educate the client about relapse and about how important it is to take corrective action rather than be overcome by feelings of depression or failure. Most episodes of drug use can be managed without seriously interrupting the treatment program and can be used in a positive and educative way to strengthen the recovery process. In dealing with a relapse, the counselor should use the general principle that relapse is caused by failure to follow one’s recovery program. Thus, the counselor should identify where the client deviated from his or her recovery plan and help the individual do all that is reasonable to prevent such a deviation from recurring.

Relapse can be viewed as having differing levels of severity that determine the appropriate therapeutic response. The counselor must understand the appropriate interventions to be used in each case.

The least severe type of relapse is a slip. A slip is a common occurrence involving a very brief episode of drug use that is associated with no signs or symptoms of the addiction syndrome, as defined in DSM-III-R criteria. Such an episode can serve to strengthen the client’s recovery if it is used to identify areas of weakness and point out solutions and alternative behaviors that can help prevent future drug use from occurring.

The next most severe type of relapse is when the client resumes drug use for several days, and the use is associated with some of the signs and symptoms of addiction. In such a case, the counselor might want to intensify treatment temporarily. This intensified contact will usually reinstitute abstinence. The client should be encouraged to think about what was done and learn from the experience how to avoid relapse in the future. The client should also be encouraged to recommit to his or her recovery program.

The most serious form of relapse is a sustained period of drug use during which the client fully relapses to addiction. Often a client who relapses to this extent will also drop out of treatment, at least temporarily. In this case, if the client returns to treatment, he or she should most likely be detoxified again, either in an inpatient or outpatient setting. The decision to detoxify a client as an inpatient or an outpatient should be made conjointly by the treatment staff involved. The decision should be based on the severity of the relapse, availability of social support, and presence of unstable medical or psychiatric conditions.

  1. ROLE OF SIGNIFICANT OTHERS IN TREATMENT

This model of addiction counseling does not focus much attention on the role of family members in treatment, not because it is not important in treatment but because this model is not intended to provide all-inclusive treatment. This model offers the individual and the group the addiction counseling components of a treatment program that can include numerous other components.

In general, the inclusion of partners, family members, and even close friends in addiction treatment by holding family sessions can facilitate recovery. Encouraging family involvement can help the addict create a better, more knowledgeable support network; it may decrease the family’s enabling or codependent behaviors that tend to impede the addict’s recovery; and it will allow the counselor to intervene in any upsetting family situations that might otherwise potentiate a relapse.

The National Institute on Drug Abuse
Approaches to Drug Abuse Counseling
Delinda Mercer Ph.D.
Center for Psychotherapy Research
University of Pennsylvania

Floatation Tank Therapy

 All of humanity’s problems stem from man’s inability
to sit quietly in a room alone.
                                                                                                                            Blaise Pascal

The addict or anyone in a cycle of obsession and craving who is seeking relief may be ready to try anything, everything.  From aversion medication to a spiritual awakening, the goal is the same, to end the spiral of addiction.  The conditions must change to continue to live but the question resounds, how?  How can I do this?  Can I do this?  Can it be done at all?  How fast can this cycle be broken?

Community and service are the pillar of the Twelve Step program.  The fact is that inside this way of life there is a call for selfless service.  When fully engaged in thinking about the other, the inner voice is quieted.  It is the center of meditation, the calming of brain waves, the escape from a mind run amuck.  Fortunately, today we have the added ability to assess that mind, to document actual relief which means we can test what is happening and what truly works.  It is not a science but a beneficiary of science.  Speed, accuracy, individualized treatments are all measurable.

While addiction is generally treated medically, many alternative therapies are gaining popularity.  Some alternative therapies offer relief of symptoms that are mental and often spiritual.  Many prefer alternative therapies in addiction treatment because they do not want to become dependent on another substance during withdrawal. Common alternative therapies include meditation, creative visualization, breathing exercises, brain mapping with neurofeedback and yoga. Floatation is another alternative therapy that can assist in treating opiate addiction.

One of theFloatation Pod treatments for addiction that is being used the Floatation Sensory Deprivation Tank.  Invented by John Lilly in the1950’s,
“The idea is to separate yourself from society through solitude and confinement of a scientifically-controlled tank. There should only be 10 inches (25cm) of water, heated to 93F (33.8C) – just right for maintaining the proper brain temperature, with enough Epsom salts so your hands, feet and head all float.”

Carol Stuart, owner of Bondi Junction Massage & Floatation Centre, one of the first floatation clinics in Sydney, says it has to do with the solution in which you’re floating; water with huge amounts of Epsom salt which relaxes the muscles, relieves stress and improves circulation.
“They discovered that this solution, with its high volume of magnesium, could make you float effortlessly. You’re not fighting gravity when you’re in there so you can just let go. After a while of floating, a chemical effect happens in your body because you’re not using any muscles; all the physical processes slow down, and you start to release endorphins to balance everything out. It affects your neurotransmitters so you stop being anxious and fearful.”

REST
The measurable result of this of this therapy is known as REST, Restricted Environmental Stimulation Therapy.  There are two basic methods of experiencing sensory deprivation: REST chambers and the sensory deprivation floatation tank.

In the REST chamber, people lie on a bed in a dark, sound-proof room.  They are instructed to be still but they are not restrained.  They have a bathroom, food and water in the room which is not restricted.  They may stay in the room for up to twenty-four hours, but are able to leave at any time.

The second method of REST is floatation. In this method, participants enter a tank or pool, which has been filled with water and Epsom salts and is at body temperature. The concentration of the salt in the water allows participants to float on their backs easily and even fall asleep, as it requires considerable effort to actually turn over.  Float sessions typically last an hour but some choose to stay up to four hours.

Floatation REST has become very popular.  It is used in Spas, resorts, athletic clubs, therapy and is available in a home version.  It has proven to be effective in eliminating pain and stress.  The Epsom salts is used for muscle relaxation as well. Weightlessness, while not experienced in chamber REST, is experienced in floatation REST, adding greatly to the sensory deprivation.

THERAPUTIC USES
Floatation tanks are gaining popularity in therapy and treatment. They are a natural and holistic alternative to medications.  Users of the tanks state that the sessions inside of the tanks induce a sense of complete calmness, improved sleep, peace and relaxing.  Research states that this sensory deprivation addiction treatment stimulates right/left brain patterns by lowering brain wave frequency from beta to alpha. This can give a person an increase in mental clarity, problem solving, objectivity, alertness, heighten awareness and accelerate learning.  Sensory deprivation tank addiction treatment has shown to lower depression, bring up motivation, lower fear or anxiety about problems, phobias and addictions.

There is a science to the reasoning behind the effects of floatation tank addiction treatment. Due to the setup of the tank, it is designed to deprive users in the tank of all their senses creating a very reflexive experience. The water, at human body temperature, with the salt, keeps you afloat.  Half the body above and below, sound, touch and sight are all released.

One client,
When people suffer from Depression, Anxiety, PTSD or emotional pain your thoughts create a physical ailment called cortisol, which is released due to stress from your thoughts which induces all of your symptoms. Inside the Float Room your cortisol levels are reduced significantly due to the natural release of dopamine (feel good hormone) which is release involuntarily. You can think about all those horrible things that cause you stress and you are able to deal with them logically as you won’t be feeling the fight or flight response due to the release of dopamine. After leaving the Float Room and thinking about those stressors, you are able to deal with them and understand them in a lighter way.

THE SCIENCE of Floatation and Addiction
The reason that floatation helps with withdrawal symptoms is because it helps the body maintain internal homeostasis. This produces endorphins in your body to reduce pain.  In a sense, floatation partially treats addiction because it produces natural opiates in your body, relieving symptoms of withdrawal.  Floatation helps your body to relax and produce natural chemicals because it takes pressure off of your joints and muscles. This provides you with a natural relief that improves your physical and mental state without leading to further addictions.  Floatation also helps you to positively motivate yourself toward specific goals. Floatation deprives you of external stimuli, which helps you become more focused and deeply relaxed. In turn, this will motivate you toward recovery. Floatation helps to heal your body both mentally and physically from addiction.

PERSONAL TESTIMONY
              by M M Owen, PhD candidate, University of British Columbia in Vancouver 
It is June 2015 when I arrive for my 16th float. I am used to the process: check in with the cheery staff, quick trip to the toilet, then head for my float room. Select a lighting color and lock the door. Strip down. The tank dominates the space, a huge white oblong resembling the pods sci-fi characters enter before being cryogenically frozen. Prop the door open. Shower with the unscented body wash provided. Cleaned and dry, bury silicone plugs in my ears. Perhaps some light stretching, a final glance in the mirror. And then in I go, feet first into the gloom, as with the waterslides of my pre-adolescence.

Man in TankI lie back, the door directly above my face. Pull it shut. Utter darkness, a night sky stripped of stars. The water is a welcoming temperature – 34 degrees Celsius (93 degrees Fahrenheit), to match the skin – and so saturated with Epsom salts (850lbs!) that it feels like liquid silk. Sixty years’ refinement of Lilly’s earliest experiments have produced a near-perfect setting. I bob, like flotsam and jetsam (what is the difference between them, I wonder, my mind already alighting desperately on things with which to occupy itself). The silence is deafening; usually I break it with a few grand exhales. And so begins the next 90 minutes.

If you try to describe floating to people, many look bemused. And with good reason: floating is strange. Virtually everywhere else in modern life, opportunities to expend one’s leisure time are based on the explicit promise of sensory stimulation. The majority of people’s spare time and money goes towards experiencing the precise opposite of nothing: tastes, sounds, smells, sights. My float center, for example, sits next to an ice-cream parlor. More than once, alone in the blackness, I have thought of their salted caramel offering.

The freedom afforded by capitalism is nothing if not the freedom to excite our senses when and how we please. Such freedom is what many see as the pinnacle of our day and age; hence we deny it to those we imprison. We want bigger, louder, more vivid things. IMAX cinemas, clubs with four floors, 10-bird roast dinners – sheer sensual load, a ‘hedonic treadmill’ that correlates directly with value. We crave it with our evolved biology, the same way we crave sugar even as it makes us obese. The hollow utopia of Aldous Huxley’s Brave New World is one in which this tendency is taken to its logical conclusion; in which a citizenry has willingly sacrificed all worldly freedom in return for the ‘imbecile happiness’ of unceasing sensory indulgence.

‘The truth,’ wrote Samuel Johnson in his apologue Rasselas (1759), ‘is that no mind is much employed upon the present: recollection and anticipation fill up almost all our moments.’ The first thing you learn during a float is the same thing you learn when you meditate: Johnson was right – conscious, inward-directed thought is a stormy business.  During the first phase of every float, a sort of frantic summary of the immediate conditions of my life intermingles with random, angst ruminations. The personal blends with the general, the trivial with the profound.

Deprive the senses, and you have nothing to pay attention to but yourself. In the naked blackness of the tank, beautiful memories and the faces of loved ones bubble up – but so do neuroses, worries, and guilt. With nothing to distract you, you become the distraction, and often an unpalatable one. ‘The most terrifying thing’, said the Swiss psychotherapist Carl Jung, ‘is to accept oneself completely.’ But the tank demands this acceptance. No escape. Your heartbeat your only companion. One must bear witness. Avec moi, le déluge.

Floaters were not the first to suspect that the ever-preoccupied, sensually-obsessed mind might be distracting us from something better. In the Judaeo-Christian conception of life, the senses continually distance us from God. ‘The mind governed by the flesh is death,’ implores St Paul, in Romans 8:6. During the 10th book of his Confessions, St Augustine rails against ‘concupiscence in eating and drinking’, ‘the allurements of smells’, and, of course, sexual lust. Among many Native American tribes, the vision quest – in which a person spends an extended amount of time alone in a natural setting, often forgoing sleep and sustenance – was long regarded as a vital rite of passage into adulthood.

In Buddhist philosophy, number one of the Five Hindrances to enlightenment is kāmacchanda, sensual craving. Today, the Buddhist concept of sati has been secularized as the practice of mindfulness – the therapeutic and sometimes transformative practice defined by the Buddhist scholar B Alan Wallace as ‘the moment-to-moment, non-judgmental awareness of whatever arises in the present moment’. Though the goals of mindfulness are less transcendent than those of the ancient mystics, there is a common thread: we must resist the temptation to flood our consciousness via our senses. Opt for the relative boredom of a meditation cushion, and the reward is psychic control.

I’m better at being in the tank than I was. Having a (inconsistent) meditation practice helps. Amid the din of helpless thinking, I do my best to simply observe, to not chase any thought too far down a mental rabbit hole. It’s difficult: my mind is like a fireworks display in a hall of mirrors. Breathe, observe, and breathe. Those who sniff at self-help talk of being in the moment should try it first. It isn’t easy. Our minds would rather be anywhere else.

And then, after an amount of time that is impossible to calculate, my body begins to relax. This too is more complex than it sounds. Unconsciously, we knot our shoulders, stiffen our toes, and furrow our brows. I spent the first 20 minutes of my debut float beset by a mysterious creaking sound. After a while, I realized it was my jaw, struggling to go from imperceptibly tense to fully slack. My yoga teacher says we worry too much about developing strong muscles, and not enough about learning how to let them soften. I hadn’t the faintest idea what she meant until I floated.

Alongside this physical relaxation, something happens inside the skull. In tandem with the fibers of the flesh, consciousness softens. Without my noticing, a quiet has crept in. The thoughts are less like hailstones, more like gentle rain. I am really in the blackness now. Something of me has evaporated, something else remains. Eventually – sometimes only in patches – the body submits to weightlessness. All gone, bar the breath. This is the heart of the float now, if it’s a good one. Hard to believe there is a whole world out there, a human race.

It is in the depths of a good float that you brush up against whatever humans down the ages have believed can be found beyond the senses. The silky void is a deeply personal portal. Float centers might stress the objective benefits which attend floating – but the comments books occupying pride of place in their lounges are replete poetic, mystical flights of language. Turn to any random page, and what you will find is that in attempting to explain the experience of floating, no one is mentioning dopamine, or stress hormones. They are talking about the self, the cosmos, the void, even God.

Homer SimpsonOne of the most tangible effects of regular floating I have discovered is described in an episode of The Simpsons where Lisa and her father Homer try it. Before getting in the tank, Lisa is irritated at Homer’s boorishness, his lack of cultural refinement. In the tank, she occupies his consciousness, and witnesses via his senses and thoughts how he really does do his best, suffering ballet purely because he loves her. Post-float, Lisa muses: ‘Gee, I should cut Dad some slack.’ I have experienced similar leaps of viewpoint in the tank, commandeered other pairs of eyes and felt deeply that I should judge a little less harshly. Scientists would probably call this ‘increased empathy’, but it’s deeper than that – it’s the chance to jump, albeit briefly, across the thin membranes between minds.

“When you come back from a deep tank session,” wrote Lilly, “there’s always this extraterrestrial feeling. You have to read the directions in the glove compartment so you can run the human vehicle once more.”

I know what he means. After a good float, I feel genuinely overhauled, reborn. The moments immediately after a deep session can be almost unbearably vivid. At the end of my first one, I recall gingerly opening the door and leaning my torso out. My vision found the beads of tank water falling from the tips of my hair to the purple-lit tiles of the floor below. For a while I hung there, utterly captivated by the gravity of each droplet’s descent, the way the water spread out in a little soundless explosion, refracting petals of light.

THE GOOD NEWS, THE BEST NEWS
Somewhere between the stress, the mayhem, the alcohol, the drugs, the chaos and even the joys of life, there is the infinite driver.  It is the one that knows the long game, the light down the road, the one who gets all the jokes and shoots you to the top of the pool before you run out of breath.  It is the infinite you, the Witness.  It is the director of your life who is neither an addict/alcoholic or worrier.  It is the Observer, who seems to be wearing your clothes, and is stone sober, patiently waiting for the inner chatter to vanish.

In the tank, controlling brain waves, sitting in meditation, you look within and see as never before.  Across the river of life, the chaos of it all, is someone waving and smiling at you.  It is the pure Mind.  It is the one that the mindfulness movement keeps pointing to, inventing newer ways to guarantee an appointment.  That who enables self-intervention, self-de-escalation, self-care for the recovering addict/alcoholic.  Always there, will never abandon you, loves you more that science can ever measure.   It is YOU.