“I can’t have fun unless I’m drinking.”

“I can handle it; it’s not a big problem.”

During the early part of the recovery process, conniving, deluding self- talk is always present. Before you know it, this deceptive self- talk can become a deafening self-shout, and the danger of relapse increases. That’s the power of automatic thoughts and how they shape our feelings and actions and behaviors.

But it is possible to get hold of this self-defeating, one-way conversation with yourself. Change your self-talk, and you change yourself.

Often, people use substances to help avoid painful emotions. Even though one has begun abstinence, it doesn’t mean that the painful emotions go away. To the voices in a person’s head, it’s all about short-term relief, which some have called self-medication. The voices in a person’s head are the automatic thoughts-often maladaptive thoughts-that provide the cues for the deluding self-talk.

Lynne Namka, author of Avoiding Relapse: Catching Your Inner Con, refers to the automatic self talk as the “Inner Con.” This is the grand seducer who tempts one to return to their addiction with inner thought processes that are fabrications, distortions, tricks and rationalizations that ignore the severe emotional, interpersonal and physical consequences of continued substance use.

Ms. Namke writes, “Your Inner Con is absorbed in totally protecting and preserving itself.” She also states, “it feeds a person’s fixation and agonizes them about not being a complete person without using substances.” The Inner Con seduces, swindles and victimizes an individual to go against themselves and their better nature. The maladaptive self-talk creates mistrust in self. Self-talk is often described as being like having an angel on one shoulder and the devil on the other. The Inner Con’s purpose is to keep hounding you until you weaken and give in. It will say anything to get you to return to substance use.

This Inner Con is a fear-based part of each individual. It fears change. It fears facing the painful emotions that the use of substances has allowed one to numb or evade. The Inner Con is the active voice of your addiction. It is not who you are, it is just an automatic thought process that can be changed with work. Doing some or all of the following actions will help counter the negative, seductive self-talk:

1. Get Support – Work with a counselor or sober accountability partner.
2. Journal – Use a Thought Feeling Journal to document your inner dialogues. Share these with your support person(s).
3. Schedule Quiet Time – This helps with journaling, meditating, prayer, reading or study.

Always remember, in early recovery, the goal is to replace the negative self-talk with supportive beliefs and new affirmations for success and continuing abstinence.

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These new understandings that addiction may be a potential brain chemistry disorder are providing valuable insights that we use to inform patients about our methods of care, improves clinical outcomes and provides evidence based approaches to treating addiction.

At Awakening, we have five major areas of treatment focus:

Individual Therapy – Motivational Interviewing and Enhancement – This style of therapy allows us to encourage treatment engagement, meet people where they are in the process of beginning abstinence, roll with their resistance and utilize cognitive behavioral therapy (CBT) to assist client movement through the Stages of Change. Most people are very ambivalent when beginning treatment because they are fearful of losing something that is remembered as something that creates (produces) pleasure. Moving a person from a state of ambivalence to a place of actively being involved in changing an old destructive lifestyle requires motivational interviewing and enhancement. We use CBT techniques to reframe thinking via journaling and homework to help a person consistently explore the pros and cons of lifestyle change. As described in Addiction and Change by Dr. Carlo DiClemente, the use of targeted change processes that focus on self-re-evaluation, developing new social skills and environmental re-evaluation is critical in facilitating movement from the Contemplation to the Action Stage of Change and to obtain early recovery.

Cognitive Therapy – Cognitive therapy is considered evidence based by SAMSA (Clinical Issues in IOP, TIP 47). Assisting changes in thinking has proven to be very effective for lapse prevention. We use CBT to teach clients to identify, evaluate and change distorted thinking patterns associated with their using so that therapeutic changes in mood and behaviors can be effected. Three levels of thought are addressed in our therapy: automatic distorted thoughts, underlying assumptions and beliefs that guide addictive expectations and behaviors and schemas as they influence thought processes. Changing thinking is critical for long-term lapse prevention.

Group Therapy – Mindfulness therapy research shows that humans are wired to connect in meaningful ways with other people. Awakening group therapy is designed to help patients learn from each other how their old entrenched thought processes create potential lapse or relapse situations. Group therapy is primarily focused on relapse prevention. Using bio-psychosocial education, CBT, and DBT empowerment based group processes, group members are encouraged to share their collective struggles and triumphs with getting and remaining abstinent. Meaningful connection can inspire and motivate; it gives one a sense of purpose and belonging; and has been shown to be one of the best activities for brain healing via improving prefrontal cortex functioning (C.C. Nuckols, PhD).

Amino Acid Therapy – Our program believes in and has collected data for the past year that supports published scientific research by Dr. Charles Gant in End Your Addiction Now. His book provides data on how substance abuse-created neurotransmitter dysfunction can be repaired during early recovery via the use of targeted amino acid supplementation. The clinically researched nutritional supplementation protocol we recommend is designed to target and assist in the restoration of key neurotransmitters that can bring brain chemistry into normal balance, reduce cravings, and reduce post-abstinence anxiety/depression.

Support Systems – Awakening believes in creating an optimal peer supportive environment as an integral part of the change process. In other words, everyone needs safety, connection with others, privacy, predictability and order. Hence, we ask our clients to pay close attention to their social and peer environment. We request that they embrace social sober support systems such as AA, NA, Celebrate Recovery and Smart Recovery as well as explore traditional and holistic modalities that promote exercise, nutrition, mindfulness, mediation, and imagery as interventions to help clients engage in healthy lifestyles.

At Awakening, the overarching goal of translating research into clinical practice is to assist clients to gain Awareness, develop Acceptance and put those skills into Action. We have adopted the term “Discovery.” We believe that Discovery means learning to live a life not lived before. Discovery comes from raising one’s awareness to the possibilities that lie within us and are waiting to be revealed.

The post Translating Addiction Research into Practice appeared first on Awakening Recovery Center.

Below are the top 10 reasons to consider IOP as a primary treatment option or as a follow-up to classic inpatient treatment:

10. Awakening treats clients in a “real world” setting in that they are able to learn practical tools to manage environmental stressors that often enable and sustain drug-seeking behavior.

9. All options are designed to meet the individual treatment needs of each client, while at the same time, accommodating his, or her, busy schedule.

8. We provide options that will allow each client the opportunity to continue working and living at home with their family or significant other while receiving the highest quality of care

7. Awakening understands that addiction can be managed when cravings are reduced, motivation for change is enhanced, techniques to manage cravings and urges are developed, and a healthy lifestyle is maintained through exercise and proper nutrition.

6. Awakening provides a treatment program to reduce alcohol, opiate, and other drug cravings through cognitive- based therapies, and when medically indicated, utilize craving reduction medications to reduce or eliminate cravings during those critical first 30-45 days of early recovery.

5. Awakening embraces social sober support systems as well as embrace traditional and holistic modalities that promote exercise, nutrition, mindfulness, mediation, and imagery as interventions to help clients engage in healthy lifestyles.

4. Awakening uses cognitive behavior therapy to teach clients to identify, evaluate and change distorted thinking patterns so that therapeutic changes in mood and behaviors can be effected. Relapse prevention requires changes in thinking if the change is to be long lasting.

3. Group therapy is focused on relapse prevention. Using bio psychosocial education, CBT, and empowerment based group processes – group members are encouraged to share their collective struggles and triumphs with getting and remaining sober.

2. Clinically researched nutritional supplementation protocol is suggested to target and assist in the restoration of key neurotransmitters.

1. At Awakening, the overarching goal of translating research into clinical practice is to assist clients gain Awareness, Acceptance and put those skills into Action.

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The Inner Critic’s voice may be loud or hushed, shrill or whiny. Its primary characteristic, however, is the negative quality of its messages. You’re not good enough! Who do you think you are? You can’t do that. And the name-calling: you’re stupid, you’re lazy, you”re dumb-and on and on, in a litany of criticism and judgments that can cause shame, anxiety, depression and even exhaustion. If we heard someone else talking to another person the way our Inner Critic talks to us, we might be tempted to intervene. Self- talk can be exhausting. Chemically dependent people are often persons who attempt to quiet the self -talk through the use of mood altering chemicals.

The Inner Critic never lets a mistake go by and like the celebrated elephant, it never forgets. With never ending commentary, the Critic has an opinion about everything we do, think, feel and say.

While part of what we say to ourselves could be considered an echo of what we heard while growing up, more often than not, the Inner Critic’s voice began as our own early attempts to help us avoid rejection and shame by criticizing and correcting behavior before others could reject or criticize us. By adult hood, self- talk has become like background noise that’s present, but we aren’t consciously of where of what we hearing. It’s almost like blah, blah.

Hal and Sidra Stone, co-authors of Embracing Your Inner Critic, compare the constant voice in one’s head to an internal radio station that broadcasts a running monologue of self-critical statements.

The Inner Critic is the self- talk that can cause a person to constantly believe they are being judged and drives one to achieve perfection. It is the compulsive comparer that constantly judges and measures us against our friends and coworkers, images in magazines, on television and in movies, and even ancillary workers in our building. The Inner Critic also is the collector of negative comments about us by others. the Inner Critic is not only repeatedly thinking about events from our past, it also becomes preoccupied with something which cause one to ruminate about the message. The Inner Critic is a flawless editor-marking out any complements and holding onto only the criticisms which it reiterates in a “see, I told you so,” voice.

The voice of the Inner Critic didn’t spring up overnight. Like weeds in a garden, it’s been growing in the subconscious for a long period of time and its roots go deep. While there is no quick fix for silencing this voice, it is possible to retrain it to serve us in healthy ways. That is the purpose of CBT and DBT we use at Awakening.

The following section contains cognitive suggestions for taming the Inner Critic and retrofitting it to become an ally:

How to Quiet the Inner Critic and make More User Friendly

We may never eliminate the Inner Critic, but we can learn how to minimize the negativity and make our self- talk our ally, even our protector.

Here are some strategies:

Become aware of the voice of the Inner Critic. Often negative self- talk has become so much a part of the ongoing noises in our mind, we don’t even hear it. Learn to pay attention to the things you say to yourself and put these messages in your journal.

Identify the voice of the Inner Critic. Who does it sound most like? Your parent, grandparent, or an early teacher? A little bit of all of them? Tracing back some of the messages and self -talk the Inner Critic utilizes and magnifies will allow one to depersonalize the voice and help you understand that the self- talk in your head may not be truly you.

Notice when your Critic attacks come. Is the voice stronger at night or in the day? When you perform a certain task or engage in a particular activity? Do you hear more criticisms and comparisons when you with certain people? When you identify these Critical times, you’ll be able to journal and manage your Critic more effectively.

Examine the evidence. When the Inner Critic says, “you never do anything right,” challenge it by making a list of things you do right. Be specific. Don’t be modest. Let your list be as long as it wants.

List your assets. Make a list of you good traits. Put down everything you like about yourself that is good. The entries don’t have to be exaggerated; list simple things: “I care for my family; I’m loving and giving.” Your friends may have suggestions.

Change negative messages to affirming messages. In your journal, write the messages you have been hearing from your Inner Critic. Turn them around. If your Critic says “you’ll never amount to anything,” write “I am successful on a daily basis.” Make a list of these negative to positive messages in your journal. Affirmations work!

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The nervous system is the body’s primary communication system. This system is comprised of a network of nerve cells called neurons. The neuronal system carries neural impulses in the form of electro- chemical currents. Electrochemical stimulation naturally occurs via transmitting chemicals called neurotransmitters. The neuronal system involves a highly regulated electrochemical chain of events in which NT molecules move through a synapse between nerve cells to communicate. In this manner, the electrochemical information is transmitted, neuron to neuron, from one area of the brain or body to another region. When the neurochemical “firing” across synapses finally makes its ultimate destination, the message is translated into an emotion, thought, or action.

Neurotransmitters play central roles in our mood states and our overall health. NT’s are also believed to have a role in cognitive functions such as working memory, learning, and executive functioning in the prefrontal and dorsal prefrontal cortical regions of the brain. Author Dr. Charles Gant in his book “End Your Addiction Now” reports that disruptions in the levels and balance among the many NTs may contribute to cognitive impairment, depression, anxiety, ADHD, and even mood and addictive disorders.

Inadequate NT production or availability can cause dramatic changes in mood and the way we behave. Scientists at the National Institute on Drug Abuse (NIDA) agree that several key NTs act as agents in changing cell function in the brain and subsequent behavior. The amount and availability of these natural neurotransmitters can apparently be reduced through long-term use of substances including alcohol, cocaine, amphetamines, opiates, and marijuana. The continuous use of addictive substances combined with poor lifestyle and eating habits and choices (psychosocial dysfunction) disrupt brain neurochemical functioning to the extent that when the use of addictive substances ceases, abstinence symptoms arise that further interferes with an individual’s ability to maintain abstinence. These symptoms-hypersensitivity, overreaction to stress, restlessness, anxiety, lack of satisfaction, difficulty concentrating, working memory problems, sleep problems, depression, and so on-create an uncomfortable sobriety and often leads to craving and relapse. The question is, “What do we do about this”?

One alternative is to bring the NT levels back to normal through supplementation with amino acid precursors needed for NT synthesis. Amino acids derived from protein intake or through supplementation in a concentrated form, or both, are necessary precursors for the production of the NT’s dopamine, serotonin, norepinephrine, enkephalins, as well as GABA. While amino acid supplementation for the purpose of replenishing NT’s has been a controversial topic in the medical and research community for years. In our clinical practice and as reported by Dr. Gant and others, there have been positive responses to oral amino acid supplementation for addictive disorders, autism, ADHD, and other above-mentioned disorders.

Results at Awakening Recovery Center and at other treatment centers including Bridging the Gap, St. Gregory’s and the Holistic Addiction Center have shown rapid reductions in Post Abstinent Withdrawal Syndrome (PAWS) with amino acid supplementation coupled with a plan of wellness that includes regular sleep (>6hrs), high levels of exercise, and good nutrition.

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There is a definition of grief that is so descriptive that we often find it included in many books that discuss grief. It is a piece of language that is non-attributable to any one person but is often quoted. “Grief is the feeling of reaching out for someone who’s always been there, only to discover that when they are needed one more time, they are no longer there”. In addition to this definition there is another one often quoted, ”Grief is the conflicting feelings caused by the end of or change in a familiar pattern of behavior.”

You might ask, how do these definitions relate to stopping the use of mood altering substances? It is our contention that in all cases of abstaining from substance use, one must experience and live through a grieving process. Why? Because a person must grieve the loss of the substance and the loss of the lifestyle.

In the case of the second definition given above, when we lose someone important to us, it represents an end to what has been familiar and we must adapt to the new-usually unwanted-reality. The concept of “conflicting emotions” makes sense when putting it in context of someone close to you who dies of something such as terminal cancer. Initially the primary emotion is tremendous sadness. Part of the sadness is about the irrevocable fact of death and another aspect is that a miracle didn’t happen to cure the illness to allow more time together. In addition to the sadness, sometimes there is a sense of relief that the person who has passed is no longer in pain and relief from the frustration of not being able to cure them or ease their pain.

The same conflicting feelings are true when one gets married. Anyone who’s ever gotten married, there are conflicting feelings. There’s the love and excitement on the one hand, and the loss of freedoms and independence on the other. Even if it’s a good trade-off, it still represents a loss.

When one gives up their substances and the lifestyle associated with the use of these substances, there are conflicting emotions. Anyone who’s ever utilized a substance or substances has many feelings of excitement, reward and even love in their repertoire of remembrances. On the other hand, there are the memories of consequences, embarrassment and shame associated with the mood altering chemical and the associated lifestyle.

With regard to the first definition given above,”… reaching out for someone who’s always been there”, this also makes sense in terms of grieving the loss of one’s substance and/or the associated lifestyle. This definition is poignant and profoundly emotional and exceptionally clear in its meaning. It seems obvious that the person who coined it was referring to the death of a long-term spouse, but it could just as easily apply to the loss of a substance that has been an integral part of one’s life for a long period of time. As poignant as the statement is in giving words to feelings, it can be used in a different painful situation; as when a long-term relationship has never been that good. In this case it could be stated as, “Grief is the feeling of reaching out for something that has been there for me at one point in time, only to discover that I cannot return to it for help or comfort anymore.”

Discovering a new way to live means learning how to grieve the loss of the substance and lifestyle and accept a new way of living.

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White and All discuss William Miller’s (Rethinking Substance Abuse) critique of the word relapse and conclude that while the term may be useful in certain applications, it might be better to abandon the term and focus instead on concepts more descriptive of normal behavior change such as reuse.

In their 2010 review, White and Ali question whether the terms lapse/relapse described a health condition or a moral choice. Their concern is that persons who lapse/relapse seem to be treated as persons who have seriously and morally erred as opposed to simply being people in transition between active addiction and stable recovery. Their expressed concern is that the potential moral judgment associated with the term relapse could set the stage for clients to be administratively discharged from treatment for becoming symptomatic during care; not being allowed to reenter treatment care until after some arbitrary time; may be labeled as a “chronic relapser” and may be required to commit to a longer (and more life disruptive) period of treatment although it may be the same type of treatment previously received. This would suggest that the responsibility for post- treatment resumption of AOD use may be viewed as a personal failure and not the failure of the treatment provided or the lack of post-treatment support. Additionally, some even call addiction a “chronically relapsing disease.” This assumes that people will return to AOD as a part of their condition. Does this mean treatment providers are powerless to battle this disorder? Serious questions indeed.

In their penultimate summary, White and Ali accept that in AOD discussions and in AOD literature, the term lapse/relapse captures the essence of the fact that the act of stopping AOD use is often not the end of the addiction story. They note that it is more likely a point on the continuum between AOD use and long-term recovery. Hence the term does have a place. Their point is that the lapse/relapse language may have harmful side effects. Their point is, “The use of a morally-based language to depict the prolonged cyclical course of substance use disorders misidentifies the essential etiology of these disorders (as a problem of moral character rather than brain disease), and fails to look at contextual (e.g., treatment-related, environmental) factors that also influence in-treatment and post-treatment AOD use.”

They ultimately summarize by calling for a potential change in the vernacular used by the addictions field. They suggest that language for returning to AOD use be developed that works across the spectrum of persons involved in addiction-from users to families to professionals and communities. The proposed language change would ideally communicate the following:

• Brief episodes of abstinence are simply respites in an addiction process, not a milestone of recovery.
• Development of new language alternatives should apply only to a return to AOD use AFTER evidence of stabilization of the substance use disorder-after 90 days of voluntary cessation.
• Recommend that focus be on “recovery support programs” as opposed to “relapse prevention programs”.
• Abandon the contention that “relapse is a part of recovery” so that all accept that a resumption of AOD use is an expression of the disorder, not of the recovery process.

Is there a need for reviewing the use of the term Relapse?

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But now, more light is being shed on just how complex are our brains and how different parts of the brain interact. Scientists are now also calling dopamine “the anticipation molecule” because it has been shown that dopamine is also released in large amounts when we anticipate a pleasurable experience.  We actually release dopamine in the nucleus accumbens and get a sensation of pleasure by just thinking about having one of these experiences. Additionally, having uncomfortable thoughts (lonely, anxious, fearful, etc.) can cause one to shift to a conditioned response that includes thinking about something to help overcome the discomfort. Actually, just thinking about having a pleasurable experience is not quite enough to release excessive dopamine. The process of releasing higher amounts of dopamine is exacerbated when we are someplace where sensory stimuli are involved, such as a party, bar, concert, etc., The large amount of dopamine is released when multiple things happen – we are uncomfortable “in our own skin” and anticipate how we have been able to change the “mood” in our past, think about how this pleasurable experience has previously “worked,” be in an environment where our senses are stimulated and there is a realistic opportunity that we will be able to have the pleasurable experience – true anticipation.

We can all relate to this and know that this is true.  Let’s say we are quite hungry and someone brings out a plate of warm chocolate chip cookies.  We are suddenly presented with the opportunity to eat one of our favorite comfort foods.  In this situation our brains will actually release a small amount of dopamine and we will experience a thought – “maybe I should have one cookie.”  We start to process this situation and think about the different possibilities. We could refuse the temptation and not have the cookie, or maybe we think that we could have just one. Our thoughts about the cookies begin to become a little more like a desire.  We analyze the pros and the cons.  Combining the visual stimuli with the anticipatory thoughts causes our thoughts to switch towards making the decision that one cookie wouldn’t be so bad, and “What the heck – I will just eat one.” As these thoughts increase, we start to anticipate how good the cookie will taste!  Our old memories kick in.  At this point, our pleasure center is releasing so much dopamine, we are getting very excited and we can’t wait to eat that cookie. We know how good it is going to be! We anticipate (dopamine response) the pleasure. We bite into the cookie, and it happens –it was good but not quite good enough. So, what do we usually do? HAVE ANOTHER, of course. The thought pattern is the second one will be better!! It is amazing to know we actually got more dopamine from anticipating the cookie than we received from the cookie itself.

Being in an environment that causes one to anticipate “enjoyment” is just the same. Thought patterns and sensory inputs can cause anticipatory dopamine release. This means that it is critical to learn the thought patterns which can create anticipatory release of dopamine as a means of helping deal with the situation at hand. Learning one’s uncomfortable thought processes as well as the sensory inputs that influence the hippocampus and nucleus accumbens becomes critical for controlling the use of mood altering chemicals. The CBT/DBT technique of quiet time and journaling for reflection becomes critical to prevent a remission to excessive substance use.

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At Awakening, we believe that a major goal of treatment should be to help clients discover, learn and implement healthier ways to accomplish whatever they had been previously hoping to achieve through their use of mood altering substances: relaxation, feeling “better,” self confidence, turning one’s brain off, escape, numbing, etc. With that in mind, Awakening uses a dialectical behavior therapy (DBT) group designed specifically for the purpose of learning and utilizing mindfulness based prevention practices designed to prevent a return to mood-altering chemical use.

Simply stated, mindfulness means maintaining a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment without judgement. This practice is intended to foster increased awareness of urge triggers, destructive habitual patterns, and “automatic” reactions that seem to decrease a person’s ability to remain abstinent. In our DBT group, clients learn Mindfulness practices to help them pause, observe present experience, and bring awareness to the range of choices before them in their daily activities.  We want them to learn to respond in ways that foster their growth, rather than react in ways that are detrimental to their health and well-being. Ultimately, we want them to work towards freedom from deeply ingrained habitual patterns of behavior that have caused them to seek a substance or chemical to alter their mood and/or meet their psychological and/or physiological needs.

Similar to cognitive therapy for depression, DBT is designed to integrate mindfulness practices and principles with cognitive-behavioral reuse/recycle prevention practices. The primary focus of DBT is to support clients who have made treatment gains and wish to develop a lifestyle that supports their well being and path to Discovering a new life free from mood-altering substances.

The primary goals for this new group are to help clients learn to quiet their mind and sooth their emotions in order to learn how to deal with anxiety, depression, resentful thinking, circular and repetitive thinking in order to develop inner peace and solitude as they learn to live life without mood altering chemicals. In other words, Discovering a new way of thinking and living.

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A common question we hear is, “What treatment does my spouse, significant other, or child need to help them overcome their addiction issue?” Those of us who work in the addictions field struggle with the answer to this question. We are trained that the individual should be encouraged to utilize the least restrictive level of care prior to advancing to more restrictive levels. Even though this is the academic approach, it seems that when faced with someone who is obviously severely struggling with addiction issues, there is a tendency to encourage him or her to go to a “rehab”, i.e. 30 or more days’ inpatient as opposed to a less restrictive setting such as Outpatient or Intensive Outpatient.

Recently, Dennis McCarthy, PhD and a team of PhD researchers assessed the long-term value of Intensive Outpatient Programs (IOP) compared to inpatient programs. In their 2014 article, Substance Abuse Intensive Outpatient Programs: Assessing the Evidence, they concluded that there were insignificant differences between IOP and inpatient treatment services regarding patients who remain abstinent. They reported that reductions in substance use and increases in abstinence were basically the same when comparing types of treatment settings. They did note, however, that patients with significant impairment might do better in an inpatient setting but that a conclusive point was elusive.

In summary, McCarthy et al. reported that IOP services have advantages for individuals who do not meet ASAM Portal of Entry Criteria for residential treatment or those who need more support than weekly sessions provided in traditional outpatient care. The positive advantages for IOP treatment that they discussed were:

1. Individuals can live at home which allows them the opportunity to practice newly-learned abstinence support skills in their normal environment and
2. Increased duration of care while allowing the individual the opportunity to learn abstinence-based skills in their home support system as well as develop personalized post-treatment support groups for long-term abstinence.

It is difficult to determine what level of treatment a person needs. What this article is effectively saying is that rather than a rush to judgment that someone needs inpatient care, perhaps IOP treatment should be considered as a least restrictive level while a person is able to continue to work and live at home.

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