blog written by Chelsea Kline, STL Addiction Intern

Life is full of change, good and bad, that makes you grow as a person.  However, change can also be stressful and confusing. Going through treatment and stopping an addiction is one of the most difficult changes a person can make. Before true change can happen, we must be ready for it and want it for ourselves. In the beginning of addiction treatment we think the only thing we need to change is the addiction it-self. However, for the addiction to change, we must change our lives too. We have to change the friends we are with, environments we are in, and a lot of behaviors that have become a part of our lives. This usually engages a grieving process because we are needing to let go of our life as we know it and find a new, healthier one. This can be scary, but it is necessary for sobriety to last. Looking at what motivated us to make the change in the first place is a productive way of handling the stress change causes. We discussed some of our motivators for this change in our lives during group today. The negative consequences of addiction (death, broken relationships, legal/career ramifications, etc) are good motivators because they are real consequences that we are trying to avoid, mostly out of fear. The negatives are important to remember, but it is helpful that we find positive motivators as well to help our progression. Looking at the good that comes out of being sober (more time and money to spend on other things, healthier relationships, healthier body, finding a new and fun lifestyle, etc.)  can be even better motivators because it helps you see what you are getting out of recovery instead of focusing so much on what you are giving up in recovery. Now that we are taking away a lot of aspects of our lives for change, we need to supplement them with new, positive relationships/behaviors/places. We must find new ways to self-soothe, new social networks, and new ways to have fun. Look at recovery as an opportunity to have major self-growth and challenge yourself in ways you may have never done before. Although there is some grief and sadness with change, remember your motivators and that this is  a positive change for your life and your future. 

Tonight we looked at a handout with a list of common high risk situations for recovering addicts. A few stuck out and we discussed how to counteract them in a proactive way. 

We Start Romancing the High: 
        We may start only remembering the good times we had when we used and forget about the bad and consequences that follow from our use. We start to convince ourselves that if we use again it we can relive those good times and block the negative. To counteract this we must be mindful of these thoughts and force ourselves to play the tape all the way through. In other words, don't just remember the good first few minutes of the high, mentally walk yourself through the consequences like how you feel the next day after using, the next few days, and the consequences each use has on your life (broken relationships, money loss, time loss, jail time, etc.) When you walk through not only the good, but the bad parts of using, you can change your association of drug=positive to drug=negative. 

We Awfulize Being Sober: 
      We start thinking about how hard it is to stay away from alcohol or drugs. We convince ourselves being sober is awful, unbearable, or boring. Many times we think we are funnier, smarter, or more fun when under the influence of drugs or alcohol but those attributes are already there, the substance just makes you feel more comfortable acting that way. We can find other ways to make us feel at ease or confident in social situations where these positive attributes can be shown. Once we realize we own these attributes and they aren't controlled by the substance, we can let them shine while sober.        Boredom is definitely a high risk situation that can lead to use. One of the biggest initial complaints about living sober is the boredom factor. These times are especially pronounced during times when we used to use, like once we are home from work ready to relax. It is smart to have a list already made of positive things to do, maybe things you used to like or new activities, that you can pull out in times of boredom. In the beginning of recovery it is helpful to have your days planned out with proactive activities if you find yourself suffering from boredom that is leading you to want to use. If you can't think of anything else, you can almost always go to an AA meeting to beat the boredom and cravings. We may not get instant gratification like we are used to from the high dopamine level from substances, but over time, your body and mind will think less of using and more of these alternative activities. 
        Try to think of sober life as giving you more time to do more productive and healthy activities instead of thinking of being deprived of the substance. 

We Face a Loss or Crisis: 
       The overwhelming feelings of a death, a life crisis, or even just a really bad day, can lead to substance use and relapse. Sometimes it's easy to try justify the use with the loss or crisis but use will only repress and/or prolong the feelings of sadness. It is important to feel the emotions sober and have a time of grief, but the grief shouldn't last more than a few weeks or months depending on the situation. Using in these situations may alleviate the feelings for a short time, but they will come back and using will only make the situation worse. We need to find a new way to self-soothe that is healthy, like talking to a loved one or counselor, working out, being in nature, or having some sort of spirituality or faith that can give you comfort that there is a bigger plan. 

Think about your own high risk situations and decide how you are going to counteract them and stay sober. We don't want to be in high risk situations, especially in new recovery, but they eventually happen and it is best to have a plan on how you will cope with and handle life events in a healthy way. 

**High-Risk Situation List adopted from Relapse Prevention Counseling Workbook by Terence T. Gorski (2000) and blog by Chelsea Kline. 



       

Today in group we discussed climbing the mountain of recovery and the slips/relapses most people face along the way. There are two ways to reach the successful recovery/fully sober stage. One way to get there is by becoming sober and staying completely sober with no slips at all. This is the fastest and most ideal way to recovery; however, it is the least common and very rare. The most common way to get to that stage is through a path where slips are made initially, but progress continues. 

The key idea here is not to focus on perfection, but to focus on progress. It is completely normal for people to have slips and relapses, especially in the beginning of their journey. Every slip can be dangerous and can potentially be life ending, but they do happen and the best way to handle it is to keep moving forward. Although each slip will make recovery harder, being overly hard on yourself about it will also make recovery more difficult. 

When slips happen just remember to be compassionate toward yourself. Instead of saying, "I drank last night. I am a failure and will never be able to stay sober" you can say, "last night was a mistake, but it is in the past. All I can do now is learn from it and move on with my recovery and progression." Having compassion for yourself is not the same as minimizing or justifying your actions (saying, "it was no big deal," "I didn't hurt anyone by doing it," "I deserved that drink."). You don't want to justify the slip, but you don't want to beat yourself up about it either. When you are harder on or mean to yourself, it can also make you want to use even more. 

Focusing on being compassionate towards others and yourself will only help your recovery process. If you are having trouble with this, try being more mindful of what you say to yourself when you mess up. Try saying/doing things like:

• "If I loved myself, what would I say to myself right now?"
• "If a friend had the same problem, what would I say to him/her?"
• "If I were really listening to my deepest needs, what would I say to myself?"
• Use kinder language, like a mother to a frightened child. 
• Put it to practice!

Remember, no one is perfect! The goal of recovery is to progress, not to be perfect. When the slips happen, take them seriously, but don't forget to be compassionate to yourself and the situation you are in. The slips are all a part of the journey and will continue to teach you lessons. Just be mindful of them and beware of them. The goal is for the slips to continually get further and further apart until they don't happen anymore. 

Chelsea Kline
STL Addiction Intern

Yesterday in group we discussed how we can substitute substance use with a positive activity during free time in our lives. When you get rid of one activity (substance use) you need to replace it with something else. 

It's helpful to think of positive activities that you used to like to do and maybe haven't done since you started filling more of your time with drugs/alcohol. You might remember how much you loved painting when you were younger or that you like to play basketball with friends. Your new positive activities can be any kind of hobby (sewing, reading, playing an instrument, etc.), exercise (walking, yoga, rowing), or reconnecting with old or new safe friends. You may reconnect with an old activity/friend, or you may take this opportunity to reinvent yourself during your new, sober life and try some new activities or join a new group. 

Instead of being sad or angry about being deprived of your old behavior (substance use), rejoice in the fact that you now have more free time to do activities that will give you a more positive and healthy lifestyle. If you continue the positive behavior, your thoughts and feelings will follow in that positive way and you will feel more content about your new activities and lifestyle. 

Today in group we reviewed some successes and struggles from the past week dealing with recovery. Many of the struggles come from hours and hours of negative repeating thoughts, usually about something we have little or no control over. When you become mindful of your thoughts and notice the negative or self-blaming start to arise, repeatedly looking at or saying a list of affirmations or a list of your legitimate rights can help you reframe the situation and see it in a more rational way and allows you to stop beating yourself up about a situation that is out of your control. 

During group tonight one part of the discussion really stood out to me. We got to talking about the anger that is felt by the depressing thought that addicts/alcoholics, no matter how many days, months, or years sober, will never really be "cured." In other words, an addict will always be in remission or recovery. 

Addiction is a disease and an addict has different brain and chemical reactions when thinking of or seeing the substance, making it harder for the addict to stay away from it than someone who is not addicted. Once in treatment, it is a never ending journey to deal with one's recovery. Many times this brings up feelings of unfairness that other people don't have to manage recovery or deal with high risk situations when it comes to the substance(s). The daunting and overwhelming thought that recovery is unending can be scary for some people or cause feelings of anger. This righteous anger is a normal and understandable feeling, but staying angry won't help one's recovery progress. 

Francine then drew her graph, which I tried to (poorly) imitate above, and discussed the flow of a successful recovery and how it becomes a positive part of one's life rather than a burden he/she has to think about 24/7. In the beginning of recovery from an addiction, the individual needs frequent and intense treatment. Recovery becomes priority and the individual is not very engaged in "normal" life. There needs to be a constant mindfulness of what one is thinking, feeling, and doing, especially in high risk situations when it comes to the addiction. 

However, Francine points out that in successful recovery, after a period of time the individual needs less and less treatment. This is because after so much intense and frequent treatment, the person should be able to remember and use the tools given to them in counseling and be able to more easily incorporate these recovery activities such as meditation or self-soothing behaviors into their normal lives and hopefully make habits of them. As the recovery activities are used and thought processes have changed for the better, the individual has to receive less treatment and normal life becomes more prevalent and fulfilling. 

Francine reminded us that although recovery/treatment is a part of an addict's life forever and never completely goes away (new things will always pop up in life and challenge sobriety so it is best to maintain some sort of treatment, even if it is only a few times a year), the longer one can stay on track, the less prevalent and burdening recovery is. 

Accepting the fact that recovery will always be a part of your life's journey can be scary, especially for someone who is newly sober, but if you look at it from a different perspective, you can see the positive life changes that can be made through recovery. Someone in successful recovery can proudly say that they now have remission for the rest of their life's journey instead of an addiction for the rest of their life, or worse, no longer having life because of an addiction. If you can change your attitude about a never ending recovery, you can start to see the positives that come out of it and the new, healthier, and fulfilling lifestyle you have achieved because of it. 

Written by: Chelsea Kline

Many times we find our thoughts dictating our feelings and behaviors. When these thoughts are negative it can lead to more negative feelings and behaviors and continue in a cycle. 

Many people will hear the word boundaries and immediately think that it only applies to someone who works in or understands the world of therapy or counseling. In fact healthy boundaries are something that hopefully will be developed in most families with kids, and are essential for any children or growing adolescents to have in order to feel an inner sense of security that allows them to grow.

Read more at:
http://www.sobernation.com/what-are-boundaries/

By Rick Nauert PhDSenior News Editor
Reviewed by John M. Grohol, Psy.D. on September 18, 2012

Commissioned by Congress, a new report from the Institute of Medicine, the health division of the National Academy of Sciences, finds significant problems in how substance abuse care is managed in the military.

Researchers found that outdated approaches to prevention and treatment of substance abuse disorders, including barriers to care, compromise the U.S. Defense Department’s ability to control substance use disorders among military service members and their families.

Service members’ rising rate of prescription drug addiction and their difficulty in accessing adequate treatment for alcohol and drug-related disorders were among the concerns that prompted members of Congress to request this review.

“We commend the steps that the Department of Defense and individual service branches have recently taken to improve prevention and care for substance use disorders, but the armed forces face many ongoing challenges,” said Charles P. O’Brien, chair of the committee that wrote the report.

“Better care for service members and their families is hampered by inadequate prevention strategies, staffing shortages, lack of coverage for services that are proved to work, and stigma associated with these disorders. This report recommends solutions to address each of these concerns.”

Researchers found that about 20 percent of active duty personnel reported having engaged in heavy drinking in 2008, the latest year for which data are available. Binge drinking was also problematic as the behavior increased from 35 percent in 1998 to 47 percent in 2008.

Although investigators found low rates of illicit and prescription drug abuse, the rate of medication misuse is rising as a 9 percent increase was noted between 2002 and 2008.

The armed forces’ programs and policies have not evolved to effectively address medication misuse and abuse, the committee noted.

To tackle these disorders better, DOD needs to lead from the top to ensure that all service branches take excess drinking and other substance use as seriously as they should, and that they consistently adhere to evidence-based strategies for prevention, screening, and treatment, the report says.

The committee also discovered that inconsistent use of evidence-based diagnostic and treatment strategies has contributed to a lower quality care.

In fact, investigators discovered that even the departments own Clinical Practice Guideline for Management of Substance Use Disorders is not being consistently followed.

Surprisingly, TRICARE, which provides health insurance to service members and their dependents, does not cover several evidence-based therapies that are now standard practice, the committee found.

It also does not permit long-term use of certain medications for the treatment of addiction and covers treatment delivered only in specialized rehabilitation facilities.

The committee strongly believes that TRICARE’s benefits should be revised to cover maintenance medications and treatment in office-based outpatient settings delivered by a range of providers, which would enable ongoing care for patients struggling to avoid relapses.

Another issue pertains to alcohol abuse. Alcohol has long been part of military culture, and attitudes toward drinking vary across the service branches.

The committee believes that the armed forces should enforce regulations on underage drinking, reduce the number of outlets that sell alcohol on bases, and limit their hours of operation.

In addition, the service branches should conduct routine screening for excessive alcohol consumption in primary care settings and provide brief counseling when screening points to risky behavior.

Committee members believe primary care professionals should perform more screening and intervention services. This inclusion of substance abuse delivery as a part of part of primary care would reduce the stigma associated with seeking substance abuse treatment and increase the number of places where service members and families can get basic care for these disorders.

Furthermore, health care providers should not have to include service members’ commanding officers when developing care plans for those who do not meet diagnostic criteria for alcohol use disorders and need only brief counseling.

Each branch also should provide options for confidential treatment; the Army’s Confidential Alcohol Treatment and Education Pilot offers a promising example.

Military health care professionals at all levels need training in recognizing patterns of substance abuse and misuse and clear guidelines for referring patients to specialists such as pain management experts and mental health providers.

Team care by a range of providers not only is a more effective approach but also would help alleviate the provider shortage created by the military’s sole reliance on specialty substance abuse clinics to provide care, the committee concluded.

Easier access to providers and better management of substance use disorders could improve detection and care for related conditions, such as post-traumatic stress disorder, depression, and suicidal thoughts, the committee noted.

Substance misuse and abuse frequently occur along with these conditions. Rising suicide rates among both active duty personnel and veterans have alarmed the public and government officials.

Source: National Academy of Sciences