Staying Sober Through the Holidays: 5 Tips for Keeping it Clean This Holiday Season

At times, Talk Therapy invites our friends and colleagues from the community to share their thoughts. Here is an informative post from one of our guest writer:

“Let’s face it, the holidays can be challenging when we’re trying to stick to our health goals and not get caught up in the cycle of drinking and partying to get us through the winter. Stressful family demands, long nights, and maybe some time off work can throw us off our game. If we are not prepared we might find ourselves looking for comfort in our old unhealthy habits to get us through.

With the holiday season right around the corner now is the time to start preparing so you don’t find yourself hanging out by the punch bowl at Aunt Nancy’s house on Christmas Eve. Here are five things you can start doing right now to prepare for the upcoming holiday season.

  • Plan your holiday schedule in advance – The holidays can mean spontaneous invitations and unexpected plans, which can be fun but also very stressful. Take the time now to plan out any major travel plans, parties, or family gatherings so you can start mentally preparing for any unforeseen challenges.
  • Cross off any high stress activities from your calendar – The holidays are a time of celebration, kinship, and relaxation. You don’t need to feel obligated to attend any event that does not fully support these three things. Don’t let family or friends guilt you into attending events where you feel uncomfortable, out of place, or bitterness toward others.
  • Plan plenty of “me time.” – With everything going on during the holidays it’s easy to lose touch with our own personal wellbeing and needs. In your holiday planning be sure to include breaks between social events for you to decompress and stay connected with your goals. Plan to start each day with a meditation or a walk, or go on a retreat somewhere by yourself.
  • Reach out to your health-minded friends now – Now is the time to start thinking about coordinating holiday hikes, walks, or bike rides with your friends. If you anticipate the weather keeping you inside plan a few indoor group activities that keep the blood flowing like yoga or bowling. And tell them to bring healthy snacks and juice instead of high sugar desserts.
  • Keep it positive – So many people dread the holidays and start feeling old temptations creep in just as soon as the days start getting shorter. Challenge yourself this year to keep an uplifting, positive, and healthy perspective on all aspects of your life throughout the holidays. Turn off the news and take a break from negative friends or conversations for a while. Replace the negative with positive books, movies, music and conversations.

It’s no coincidence that mental hospitals do the most business during the holidays. The “mood wards” are full of regular folks who simply let the holidays get the best of them. This year set the intention that you’ll be spending your holidays not in despair but in a state of harmony and good health. The outcome of your holiday season is entirely up to you.”

About the Author:

Joseph Cervantes is an advocate for the de-stigmatization of addiction in our culture. As a community organizer and journalist in the addiction treatment space he has had the opportunity to work with hundreds of individuals struggling with various addictions and mental health issues. He is also a vocal advocate for the development of new methods and strategies for treating addiction. Having completed several IOP and inpatient programs himself over the past 20 years, he offers a unique perspective into the rehab experience through both a patient and practitioner lens.

Why do individuals with addiction isolate?

There are numerous reasons for why individuals with addiction isolate:

1) They would like to hide their addiction from others. Friends and family do not generally respond well to someone who is engaged in addictive behaviors. Isolation keeps them from getting scolded and being pressured to change the behavior.

2) Individuals with addiction are often shunned by friends and family and tend to be lonely.

3) Low self esteem is often associated with addictions. As a result, it is easier to not put oneself out into public scrutiny where self-esteem issues may be triggered.

4) Additionally, it is not uncommon for loneliness and isolation to precede the addictive behavior and to contribute to the person adopting unhealthy coping behaviors, such as drugs or alcohol.

Humans are social creatures and we crave connection to other humans. This is even more important for someone who is struggling with addictions as they need the extra support and encouragement. Alcoholics Anonymous has become as powerful of a recovery tool as it has partly because it promotes a sense of community and connection. The isolated mind has a tendency to get stuck in patterns of thinking that are unhealthy. For example, when we talk to a friend about something that is upsetting us, it often helps because our friends validate our feelings and help us put things in perspective and move on. The isolated mind has the potential of getting stuck in a negative loop reinforcing the addictive behavior.
Author: Dr. Seda Gragossian

Clinical Director
TalkTherapyCenter.com

How to Evaluate an Intensive Outpatient Program for Treating Addiction

IOP is a mainstream treatment option and one that is frequently covered by commercial insurance. There are many facilities offering programs and there is very little regulation about what should and shouldn’t be done within the treatment setting. It is in the best interest of the patient, then, to do the necessary evaluation of programs to identify a suitable service provider.

Evaluating IOP offerings should comprise the following considerations:

  • Therapist experience and specialty. Look for programs that are facilitated by qualified individuals with past experience in the particular area of treatment. Additionally, the IOP program, as a whole, should be supervised by a certified psychologist with PhD or PsyD credentials.
  • Testimonials from past clients. It is important to see client feedback, even if published anonymously.
  • Group meeting attendance levels. While there is no such thing as a perfect attendance number, it is best to find programs that have no more than ten participants in attendance. If the attendance is higher, there is not enough personalized attention and air time for each participant.
  • Availability of free consultation and initial group meeting participation. While most programs will do an initial consultation, some programs may even offer a participant the ability to attend a live group meeting prior to making a long-term commitment.
  • Program tenure per client. Patients get the most out of a program when they participate for the entire prescribed duration. While most programs will not publish drop-out rates, it is perfectly acceptable to ask other participants directly about how long they have been with the program.
  • Client selection. It is a good sign when a center asks pointed questions to assess client fit. This shows that the program administrators care about the impact that a new patient will have on their existing patient base.
  • Focus on treatment. Since there is no standard around what should be covered during IOP sessions, some programs choose to focus on one-directional rhetoric. Other programs take up group time by showing lengthy videos on a regular basis. A well-rounded program will create a collaborative problem solving environment and will incorporate a variety of services and activities.
  • Availability of therapists outside sessions. Some situations call for quick access to a therapist to discuss an urgent matter. It is advisable to look for programs that offer access to after-hours consultation on an as-needed basis.
  • Treatment planning rigor. Program administrators should take the time to create personalized treatment plans for all their participants.
  • Cost considerations. IOP programs are not inexpensive, given the intensity and long-term commitment of the approach. IOP programs will cost less than residential programs, and should be more aligned with corresponding hourly rates offered in individual therapy.
  • Availability of a pre-screened network of external resources. IOP administrators should offer external references to support services and other providers to maximize a patient’s chance of recovery in the long term.
  • Track record of clients showing improvement. Client records are confidential and it is hard to publish information relative to outcomes. However, the direction of the entire health care profession is moving towards outcomes-based care. In the coming years, this is going to become a reality and IOP programs will need to do their part in demonstrative efficacy of care.

Author: Seda Gragossian, PhD
Clinical Director
Talk Therapy Psychology Center
(858) 205-2490
TalkTherapyCenter.com

 

Self-Medicating and Addiction

At times, Talk Therapy invites our friends and colleagues from the community to share their thoughts. Here is an informative personal story from one of our guest writer:

“At one point in the height of my addiction to drugs and alcohol, a good friend of mine offered a simple insight that would forever change my perspective about my struggle. “I think you are self-medicating,” she said, in a concerned, non-judgmental tone. These words instantly melted away years of guilt and shame. I had never looked past all of the negativity associated with my addiction for long enough to see it this way.

Did this more compassionate perspective instantly make my addiction go away? No. But it did shed light into why I constantly felt the need to be inebriated. By using drugs and alcohol I was not looking to “party,” “get high,” or “get trashed.” I was simply looking for relief. Relief from the constant depression. Relief from the crippling anxiety that seemed to dominate every single day. Relief from the nagging physical aches and pains I felt constantly throughout my body.

Now in my mid-30’s I was armed with a brand new perspective on the addiction that had plagued me since my teens. I no longer viewed myself as simply someone who was hellbent on self-destructing and disrespecting all regard for healthy consumption and society’s rules. I no longer viewed myself as the “black sheep” troublemaker who ruined his life with addiction. I now viewed myself as someone who had enough self-compassion for himself to want to find relief from the very real pains of life. I was simply being my own caregiver.

Unfortunately, my medications of choice were not good for my body, my mental state, or my life in general, even though they momentarily took away the pain. But they were convenient and accessible, and in my case, relatively affordable. Over the next several years, I learned all I could about natural medicines, neuropsychology and neurobiology, nutrition, exercise, and anything else that might provide a healthier pain-relieving alternative to the damaging drugs and alcohol.

Although this insight was immediate, real change took time and I had to do a lot of inner work to keep my “self medication” perspective fresh in my mind. Most importantly, it was critical for me to chip away at the guilt and shame I was holding onto that was directly related to years of self-destruction. Guilt and shame are often so interlocked with our addiction that it can take years of inner work to break free from their chains. Guilt and shame can keep us imprisoned by our old, pain relieving ways.

When we do “the work” we begin to peel back the layers of guilt and shame and learn how to be compassionate toward ourselves. Humans respond best to positive reinforcement and encouragement. Self-abasement, negative reinforcement and coercion are not effective strategies for permanently changing our behavior. Self-compassion and non-judgment toward ourselves is critical if we want lasting change.

Are you self-medicating? Are you drinking or using to mask a particular emotional or physical pain in your life? What specific pain are you escaping from? Identify this pain in one word or sentence (I was escaping from my depression and anxiety). Once you identify what specific pain you are escaping from, ask yourself, is it normal for a human being to want relief from pain? Of course it is! The multi-billion dollar pharmaceutical industry is proof that humans have an insatiable desire for relief from pain.

This does not make us bad people. This does not make us flawed or sick. We no longer need to feel guilty or ashamed of desiring to be free of our pain. We are merely humans seeking relief from our very real pain. We may not be the best choice of primary care providers for ourselves at the moment. But by doing the inner work, this too can change.”

About the Author:

Joseph Cervantes is an advocate for the de-stigmatization of addiction in our culture. As a community organizer and journalist in the addiction treatment space he has had the opportunity to work with hundreds of individuals struggling with various addictions and mental health issues. He is also a vocal advocate for the development of new methods and strategies for treating addiction. Having completed several IOP and inpatient programs himself over the past 20 years, he offers a unique perspective into the rehab experience through both a patient and practitioner lens.

Are Intensive Outpatient Programs (IOP) Effective for Treating Addiction?

Over the last 40 years, there have been several studies on the use of IOP in treating addiction. Some of these research studies are referenced at the end of this document. What is apparent is that IOP have consistently shown positive outcomes in treating substance use disorders successfully. Several studies (Guydish et al, Schneider et al.) have, in fact, suggested that IOP have no significant differences in effectiveness to residential programs. While some other studies (Finney et al.) indicate that there is only a small difference in effectiveness favoring residential treatment options. The consensus, however, across most recorded studies, is that clients benefit from both levels of care. In fact, comparing effectiveness between inpatient and outpatient is not necessarily productive as the two approaches tend to have different applications and can be undertaken in parallel or sequentially with good results.

In one of the earliest research studies carried out on outpatient program effectiveness, the American Journal of Psychiatry published strong results based on data from 564 patients. The majority of program participants successfully completed outpatient detoxification and half continued engaging in related rehabilitation programs. Furthermore, only 19% of participants required inpatient care, and there were no fatalities across the patient population. This study, published in 1975, led the way for acceptance of outpatient programs as effective treatment programs for substance use disorders. Up to that point, outpatient programs were largely untested. Up to that point in time, it was also commonly believed that only clients who were high functioning, employed and free from significant co-occurring psychiatric disorders could benefit from IOP. Through clinical and research findings, this belief has been dispelled and it is now widely accepted that IOP is an effective treatment approach for patients with substance use disorders who may also suffer from a range of co-occurring disorders. In particular, patients benefit from the IOP’s intensive approach and emphasis on rigorous case management, support services, and psychiatric counseling services.

In a study by McLellan and his colleagues, it was stated that patients who had access to case management, coordinated medical, housing, parenting, and employment services, had less substance use, fewer mental health problems, and better social function after 6 months of IOP care.

Another study performed by Gottheil, Weinstein, Sterling, Lundy, and Serota, it was found that “patients who completed the intensive program showed significant improvement from intake to end-of-treatment scores on the Addiction Severity Index, the Beck Depression Inventory, and the Symptom Checklist. At nine-month follow-up, patients who had remained in treatment longer had fewer drug problems, a smaller proportion of positive urine drug screening tests, a better employment status, and fewer psychological problems compared with patients who left treatment earlier. Patients who remained in treatment were also more likely to be attending self-help meetings, continuing in outpatient treatment, or attending school.”

Similarly, Cournos performed a study where he found very significant improvements on “seven of nine symptom scales, including depression and anxiety.” Additionally, significant effects were shown on all four of the measures of global distress and symptom severity”, and upon discharge from the IOP program, the average patient had returned to his or her premorbid level of functioning on the Global Assessment of Functioning (GAF) inventory. Cournos also showed that IOP patients gave very high marks on perceived satisfaction with their treatment.

Author: Seda Gragossian, PhD
Clinical Director
Talk Therapy Psychology Center
(858) 205-2490
TalkTherapyCenter.com

The role of willpower in addiction recovery – Part 1

What is willpower?

Willpower is the mind’s ability to say ‘Yes’ or ‘No’ when faced with a decision. We are all familiar with the experience of making a decision to make a small or large change in our lives, such as deciding to start exercising regularly, start eating healthy, start arriving to appointments on time, or giving up a destructive habit. Often, we fall short of achieving our goal. What happens?

You tell yourself, “I am so tired of arriving late to appointments and feeling guilty, ashamed, and anxious. I am motivated to change but I just don’t seem to be able to make the change.” Or, “I am so tired of getting drunk and giving in to alcohol and feeling guilty, ashamed, and just awful. I am motivated to change, but I just don’t seem to be able to make the change.” Why is that? When the decision point is out into the future, it appears easy for us to make a choice. However, when the moment arrives, there are multiple variables at play. Let’s look at them:

Delaying Gratification

You have to give up something in the moment, such as an immediate pleasure, for some potential point in the future. If I skip drinking every day, I stand to make my health better, mend my relationships, and even save a bit of money in the long-run.

Ego Depletion

You wake up in the morning and you have all the intention of not giving in to a destructive behavior, such as over-eating. You have your balanced breakfast. You pack your healthy lunch and snacks for the day. You stick to your routine all day. You watch your co-workers devour tasty but fattening foods. You are so proud of yourself for sticking to your diet and saying no as they ask you to go out for lunch or offer you a cookie or some other junk food. According to the theory of Ego Depletion, every time that your mind makes a decision, your willpower gets a little more taxed. You get home after a whole day of eating healthy and abstaining from junk food and you lose it and go for that big fatty chocolate bar. According to the Ego Depletion theory, your willpower runs out of juice. You wake up the next morning and you don’t understand what happened. You had been so in-control all day. You decide today is going to be different. You pack your healthy foods and off you go.

Shifting Priorities

Our decisions are driven by the motivation to reduce discomfort. You wake up in the morning and you feel awful for getting drunk the night before or using drugs “one last time.” Your loved ones are angry with you; you can’t perform at your job because you are hung over and you have a short fuse. This is too painful and you tell yourself, “I am done.” You are motivated and you get back on track. A few days go by and the pain you felt a few days ago is no longer as severe. A new discomfort has settled in: your friends have been going to the bar for happy hour everyday and you have been left out since you have chosen not to drink. To eliminate this discomfort, you cave in and go with your friends and you end up getting drunk again.

The above three variable are in constant interplay when dealing with an addiction. In the near future, I will talk about how to work with these variable, how to expect them, and how to properly manage them.

Author: Seda Gragossian, PhD
Clinical Director
Talk Therapy Psychology Center
(858) 205-2490
TalkTherapyCenter.com

 

Copyright. 2016. Talk Therapy Psychology Center, Corp.