Addiction & Recovery

I know the heartbreak and effects of addiction and substance abuse up close. I believe that an individual needs a safe & supportive environment to begin to make changes in one’s life. The impact of substance abuse can be devastating, affecting one’s everyday functioning and one’s relationships in both personal and work settings. I am passionate about helping others to recover and find a meaningful life without addiction or substances. I have training in addiction & recovery and have clinical experience in working with this population in a variety of settings. I specialize in issues with alcohol and prescription medication abuse along with those struggling with food issues. I operate from the tenant that addiction commonly develops as a ‘survival’ (coping) skill in response to trauma or mental health issues. Thus, both need to be addressed in order for the person to move towards recovery, health, and wholeness.

Addiction Defined

There are various definitions of addiction and it is best understood as a confluence of a number of factors with complex or multiple pathways that lead to the addiction. There may be genetic influences, parental role modeling, history of trauma, or emotional disorders that factor into the mix that leads to addiction. In Grace & Addiction, it is stated, “Addiction is any compulsive, habitual behavior that limits the freedom of human desire.” According to the disease model of alcoholism it is a progressive chronic illness that affects the mind, body, and spirit of the individual. Likewise, with addiction there is a loss of control which results in physical, psychological, social, and spiritual problems; the total person is affected.

One of the hallmarks of addiction is denial or self-deception, “the exquisite inventiveness that the mind can demonstrate in order to perpetuate addictive behavior” stated by Gerald G May, M.D in Grace & Addiction. Other aspects of addiction beyond denial include secrecy, tolerance & withdrawal, and negative consequences. Also worth noting is the element of brain chemistry and the pleasure center that gets activated with addiction. Another common element is that the addictive behavior tends to gradually consume more of a central priority in one’s life. Last, all addictions medicate an internal affective state.

It is helpful to think of addictions along a continuum from moderate excess to severe compulsion.
Addictive behaviors also include eating disorders, compulsive sexual behavior, shopping, and self-injury. Addictions to mood-altering substances such as alcohol or drugs are called substance addictions and addictions to mood-altering behaviors are called process addictions. As with substance use disorders, prolonged use of these behaviors leads to tolerance and more is needed for the same effect.

Abstinence from mood altering chemicals or the addictive behavior is the first requirement towards sobriety. “Sobriety is a way of thinking, a way of acting, a way of relating to others. It is a philosophy of living. It requires the daily effort of working a recovery program. In recovery we move from a destructive dependence on alcohol or other drugs toward full physical, psychological, social, and spiritual health. Recovery means change and is a developmental process.” —Passages Through Recovery by Terence T. Gorski.

My Treatment Approach

There are two parts to the treatment process for substance abuse in particular to include assessment and then psychotherapy. The initial first step involves establishing what the individual needs in terms of the addiction or substance use concerns. The assessment identifies any co-occurring conditions and the most appropriate level of service (eg; outpatient, residential, medical detoxification). I may use an assessment instrument such as the Substance Abuse Subtle Screening Inventory (SASSI) or the Identification Test (AUDIT). The psychotherapy process may also involve working a 12 step program and being a part of support groups.

I have an eclectic approach which includes cognitive behavioral therapy (CBT), psychodynamic, addiction psychoeducation, and somatic and expressive arts interventions. Within the various types of interventions there are some common principles I subscribe to. Safety and stabilization is the priority in the initial phase of treatment. Sobriety is usually a prerequisite for safety and self-care as the addiction often has led to various negative consequences in one’s life. I adhere to the philosophy of addressing both the PTSD/trauma activation and the addiction/substance abuse issues in an integrated manner (as they affect each other and are interrelated). And, as mentioned earlier, I value 12 step work and the inner changes that may be brought about in working the steps. As addiction affects the totality of the person, I use a holistic model for healing; that is, physical, emotional, cognitive, psychological, and spiritual aspects need to be targeted as areas for change and recovery.

Stages of Recovery

There are progressive stages of recovery. In the transition stage there is acknowledgement that there is a problem but the person thinks that it can solved by learning how to control the use. This stage ends when the person recognizes that he or she is not capable of control. In the stabilization stage, the individual is recuperating from acute withdrawal and learning to abstain from the substance ‘one day at a time’. The person is not in denial anymore and there is some level of acceptance that he or she has a problem with substance abuse/dependence.

The next stage can be divided into early, middle, and late phases of recovery. In the early stage of recovery there are significant internal changes going on. There is some reduction in cravings and a beginning understanding of the impact of the addiction on one’s life; an identification of some of the negative consequences. In middle recovery there is further balance that is restored to the person’s life and a repair of past damage. In the late recovery phase there is a focus on overcoming obstacles to healthy living and learning new skills to deal with life’s challenges. In the final maintenance stage there is an active practice of a daily recovery program in which there is sustained sobriety and healthy living. There is continued growth and development.

The 12 Steps for Recovery

I’m a believer in the 12 Steps and this comes from personal experience. The 12 Steps may be viewed as a spiritual pilgrimage leading one out of addiction into recovery in which there is a renewed relationship with oneself, others, and God. It is a way of life in which the person experiences physical, emotional, and spiritual well-being. Being in a 12 Step group also provides immense support for the recovery journey.

Step 1: We admitted that we were powerless over alcohol – that our lives had become unmanageable.
Step 2: Came to believe that a Power greater than ourselves could restore us to sanity (wholeness).
Step 3: Made a decision to turn our will and our lives over to the care of God as we understood Him.
Step 4: Made a searching and fearless moral inventory of ourselves.
Step 5: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Step 6: Were entirely ready to have God remove all these defects of character.
Step 7: Humbly asked Him to remove our shortcomings.
Step 8: Made a list of all persons we had harmed, and became willing to make amends to them all.
Step 9: Made direct amends to such people wherever possible, except when to do so would injure them or others.
Step 10: Continued to take personal inventory and when we were wrong promptly admitted it.
Step 11: Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Step 12: Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

12 Step groups come in many forms to include AA (Alcoholics Anonymous), ACA (Adult Children of Alcoholics and Dysfunctional Families) and Codependency Anonymous along with many others.

AA views alcoholism as a disease and asserts that only a spiritual experience with a Power greater than oneself can bring about inner and outer changes in recovery. The disease is believed to be progressive. Recovery is the “high road to a new freedom.” It asserts that more than human power is needed to bring about the “psychic change.” Some of the ingredients for transformation in AA include a willingness, honesty, and humility.

Trauma & Addiction

There has been found to be a high comorbidity between PTSD/trauma and substance abuse disorders. That is, trauma related problems are common in those struggling with addiction or substance abuse, particularly with women. Trauma leads to emotion dysregulation and one of the ways to deal with this is through tension-reducing behaviors which often become addictions. With regard to addictions and trauma, I adhere to the theory that addictive behavior arises not as a pleasure-seeking strategy but as a survival strategy to help regulate the nervous system, self-sooth, numb painful emotions, and ‘treat’ symptoms of depression or anxiety. Whether it is through substance abuse or behavioral addiction, there is often an attempt to modulate trauma responses. This does not negate the premise that there are genetic and familial links with addiction (or as AA asserts that it is an ‘illness’ (disease model)). However, in the model I subscribe to, there is acknowledgment that addiction often develops as a way to cope with negative affective states.

Adult survivors of trauma become adept at inventing compensatory strategies at self-regulation. The addiction could be viewed as misguided attempts at mood management. Substances can help “medicate” PTSD trauma symptoms which includes hyperarousal or hypoarousal states. Various substances help with different symptoms. Another benefit of the substance use (or behavioral addiction) to control symptoms is that the person does not need to depend on or trust anyone. It is important to respect the adaptive value of how the addiction helped the individual to survive. Sometimes the trauma symptoms get worse initially with abstinence and thus it is imperative to work with both issues at the same time.

In my clinical work with individuals, treatment addresses the relationship between the trauma and the addictive behavior. That is, there must be identification of the role of addictive behavior in “medicating” traumatic activation (understanding the link between trauma and addiction). Initially sobriety often brings heightened trauma symptoms when a person is triggered. Some of the work in therapy is developing ways to self-regulate that are healthy and move away from the addictive behavior. Relapses are framed as spiritual opportunities that are sending a message to the person in recovery. New learning from the relapse is celebrated.

Addiction, Codependency, & Recovery Resources

A Woman’s Guide Through the 12 Steps by Stephanie Covington, PhD
Mindfulness & The 12 Steps by Therese Jacobs-Stewart
Healing the Shame that Binds You by John Bradshaw
Codependent No More by Melody Beattie
Passages through Recovery – An Action Plan for Preventing Relapse by Terence T. Gorski
Addiction & Grace by Gerald G. May, MD
Drop the Rock by Bill P., Todd W., & Sara S.
The Addiction Recovery Skills Workbook by Suzette Glasner-Edwards
Elephant in the Living Room – The Children’s Book by Jill M. Hastings – official website of Alcoholics Anonymous – Addiction & Recovery Information & Resources – official website for Codependency Anonymous – official site for Adult Children of Alcoholics & Dysfunctional Families – National Institute on Alcohol & Alcohol Abuse – Substance Abuse & Mental Health Services Administration – Substance Abuse Treatment Facility Locator – 12 Steps for Recovery

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