Addiction Recovery

Why Recovery Needs Healing Space

Posted on by Christy Weeks

Addiction is a family disease. The Recovery Book advises family members of people in recovery that “Everyone in your family, as well as other people in your lives, has been affected by addiction in some way. Now you all need to work on getting your lives back to some kind of normal.”

Michael Arnold is a recovering alcoholic who now works as an alumni relations manager at the Harmony Foundation. In a recent Facebook Live with her twin sister, Michael and Casey talked about the impact Michael’s addiction and recovery had on their relationship. Both siblings demonstrated how important clear and honest communication is for the family dynamic.

Michael talked about the need to share with “brutal honesty what addiction can do to your family.” Casey talked about how hard it was for her to watch Michael decline in active addiction, realizing there was nothing she could do, that Michael had to save herself.

Michael recalls doing things to her family that “just weren’t nice.” Casey remembers all too well. Seven years ago Michael helped to put her twin sister briefly in jail—just to hurt her. Michael was in such a bad place that to hurt her sister made her feel better.

“I never thought I could be close with Michael again, never thought I could trust her again,” Casey said. But change can happen. Recovery can work miracles. “Michael has changed. She is not the person she was seven years ago,” Casey said. “She is not that selfish person that put me in jail. She’s working very hard at it every day.”

For desperate family members the trick is to be patient and supportive. “Don’t hammer people in recovery about all the mistakes they made in active addiction” all the time. “Show your love,” Casey said. “You need to have grace and patience with them. As family members you have to give them space to recover, the harder you are on them the worse it’s going to be.”

Appealing to people in the audience who have family members with addiction, Casey said, “You have to choose either to be there and support them or walk away. You can’t live in the middle and hold their past wrongdoings against them—that doesn’t help them recover. I have nothing but complete love for Michael now and I’m just so proud of her. It’s been a journey for both of us.”

Michael shared her side of that journey. Only “when I went through rehab did I get the tools to tell myself everyday to have that patience, to be so grateful that I’m sober. I have to know that my family will trust me; that they should realize that I’m a changed person but time is not on my side.”

It’s important to remember that recovery is a process. “I thought simply that Casey and I would be okay now that I’m sober. The relationship would be fine but it wasn’t,” Michael remembers. “Casey gave me that space for about a year to recover, but then she said ‘we need to talk about what happened’ so that we can move forward.”

Casey had to tell Michael what she had done to her and “she took it hard. I love you, I forgive you, but you have to earn the trust back.” That shook Michael, “but now our relationship is even stronger because you have to be able to open up about these things or they will simply fester.”

Making amends is an ongoing process for Michael now and Casey knows it. “Michael is ruthless and relentless about her recovery—she has even written a book about it. She is working hard every single day and that is all you can ask.”

The Insurance Dance with Recovery in Mind by Jim Geckler

Posted on by Christy Weeks
Collaboration

We recently received a Facebook post regarding frustration over Harmony’s handling of payments made through insurance. I wanted to use this opportunity to discuss questions and concerns about our partnerships with insurance partners and how we believe it helps benefit access to treatment.

First and foremost, insurance companies make it easier for us to cover some of the cost of treatment, a service that many of us do not plan for when the time requires it. When we consider our personal relationships with insurance partners, how many of us would be able to have yearly physicals, emergency procedures, or access to treatment? As a provider, Harmony works with our insurance partners to provide the appropriate level of care for the appropriate period of time.

Harmony has a 49 year history of providing a residential level of care; this is the highest level of care for people suffering from substance use disorder. We have a responsibility to our clients to stabilize them medically, assess their conditions, provide them with a diagnosis, work with them to create a foundation for sustained recovery, and construct a comprehensive continuing care plan which will support their recovery. The relationships we have fostered with insurance partners has allowed us to work collaboratively to support access to care along the continuum. Under the umbrella of the American Society of Addiction Medicine (ASAM), together, insurance companies and treatment providers alike are held to the highest standards of care for addiction treatment. This common language, reviewed in tandem with insurance providers determines what level of care an individual requires.

Sometimes there is disagreement.  For example, when Harmony feels that a client would be better served by remaining at a residential level of care and an insurance provider feels they would be successful at the next level.  Other times, a client would like to remain in treatment, however our expert clinical and medical staff believe they are ready to move toward self-management of their own recovery at a level of care which empowers them to practice the early skills of recovery they learned here. In most cases, to arrive at a decision to move a client to the next level of care, involves a conversation with our Medical Director and a physician reviewing the case for the insurance company. We work to keep people at the appropriate level of care indicated by our clinical staff recommendations based on the client’s progress.

Harmony has a dedicated utilization review team, clinical professionals who work with our insurance partners, staff, and clients to keep people at the level of care which will provide them the greatest opportunities for success. When it is determined that funding for residential care has ended, we work to inform the client as quickly as we are able. Unfortunately in this situation the determination for a shift in levels of care is immediate, funding ceases that day. In order to ease the transition for clients and families, Harmony is committed to absorbing the expense of an additional night’s stay for clients. This is not common practice and comes at a fair cost. For example, in the month of July, we provided $28,000 in housing and care at no additional expense to clients. We are able to continue to do this through the generosity of our donors. We recognize the challenge and frustration of learning at 4 pm that one no longer has financing for treatment, however we are dedicated to continue to support our clients during this transition period.

There is nothing magical about 28 days of treatment. We have heard the 28 day timeframe used for many years, growing in public awareness with the Sandra Bullock film. The reality is that proven success is driven by long term engagement in treatment within a full continuum of care, at multiple levels  increasing the opportunity  for self-management.

We will always remain committed to providing access to treatment whenever possible, using all means necessary to help individuals receive treatment that can build an early foundation of recovery.  This could look like something as short as a few days or as long as 4 months.  Either way, our partnerships with insurance and our recommendations for treatment will always be the focus in providing individualized care for clients.

Jim Geckler is the Chief Executive Officer for Harmony Foundation.

The Place for Spirituality in Recovery by Mike Lewis, M.A.

Posted on by Christy Weeks

Spirituality is the calling to look more deeply into our lives – into ourselves, our relationships, our communities, and our relationships with the ecological and universal realms. As the Dalai Lama has said many times, “All beings want happiness and freedom from suffering.” We all want to love, be loved, feel peace, be creative, feel connected, and feel fulfilled with our lives. Treading the labyrinth of humanity’s misguided attempts toward achieving these deeper desires leads us down disastrous roads, dead ends, and into pits of confusion and despair. For a while, tasty foods, expensive material items, and prideful accomplishments can trigger the pleasurable neurotransmitters in our brains. Working much like a drug or alcohol, the external stimuli lose their power and we develop dependence and tolerance, needing more and more to get our happiness high. Finally, we are left strung out and unhappier than we were in the beginning. On the path of recovery, we bring spirituality into our lives to help us reconnect in a more sustainable and healthy way – a way that fills our core with contented pleasure and without as much dependence on things outside of ourselves. A quiet walk, taking time to chop the vegetables with precision, prayer, meditation, snuggling with our pets, gazing into the eyes of our loves ones, singing, painting, self-help workshops, religion, planting vegetables, reading, eating slowly and tasting every bite, fellowship, listening to soothing music, and donating time and resources for another’s benefit – these are common examples of how healthy people let go of their frantic pursuits of the insatiable highs and slow down to appreciate this fragile, fleeting, yet incredibly wonderful human life. Take a moment for spiritualty today. Breathe and appreciate this body, this life. Smell the roses – they are all around us if we can learn to see them.

Stop and Smell the Roses; Psychology Today – https://www.psychologytoday.com/us/blog/understand-other-people/201710/stop-and-smell-the-roses
Identify Your True Source of Happiness; Chopra – https://chopra.com/free-programs/awaken-to-happiness/week-1-identify-your-true-source-of-happiness
11 Ways to Appreciate Your Life a Little More; Mind Body Green – https://www.mindbodygreen.com/0-16408/11-ways-to-appreciate-your-life-a-little-more.html

Mike Lewis is a Spiritual Advisor and Detox Counselor at Harmony Foundation
Mike Lewis Bio

Mandatory: Making it Worthwhile by Khara Croswaite Brindle

Posted on by Christy Weeks

“I don’t want to be here. I’m not going to say anything. I don’t know. Why should I talk to you?” You may find yourself thinking or saying thoughts like these in response to pressures to engage from a program, family, or friends. Perhaps you aren’t ready to share what’s brought you here, or what the challenges are that you are facing in this moment. Perhaps you feel like your personal freedom has been taken away, your choice to participate of your own free will. Understanding that you may feel angry, resentful, or withdrawn, please consider the following in support of getting the most out of something that is identified as mandatory.

Blocking or Belonging
You may come from a different background or hold different values from those you come into contact with, so what brings people together in this process? Shared experience around homelessness, financial instability, substance abuse, conflict in relationships, or a lack support can help one feel less isolated and alone in their experience. Although each person’s story is their own, the feeling of connection to others and belonging can go a long way in having an experience feel less mandatory and more voluntary. When you observe others engaging in the program or group, you may find yourself asking:

  • Do I feel I can relate to others in the group?
  • Do I feel this community is healthy, approachable, supportive, and willing to engage me in this process?
  • Do I feel supported by staff and helping professionals to achieve my goals?
  • Do I feel comfortable opening up and working on myself in the presence of others?

For many involved in Alcoholics Anonymous (AA), they speak of the community as an equally powerful element as the 12 Steps in to their ability to actively participate in their own sobriety. Due to the friendships they make, they feel they have a connection to others in ways that feel encouraging and uplifting in moments of challenge or struggle.

Building Perspective
In addition to identifying a supportive community, how you approach the experience for yourself matters. Do you have realistic expectations of what you can accomplish both short and long term? Can you set yourself up for success in your work with others? When starting this process, it is helpful to understand basic needs as the foundation for progress. Educating yourself on how basic needs such as food, safety, and shelter provide the foundation of stability gives you permission to organize goals for success. Abraham Maslow, who identified this relationship in the Maslow Hierarchy of Needs, emphasizes that only when basic needs are met can one focus on higher work around self-esteem, sobriety, and relationships.

Relational Rapport
When exploring relationships, research tells us that therapeutic rapport accounts for more than any other factor when measuring progress towards goals set in therapy. In other words, the therapeutic relationship, unconditional positive regard, and power of feeling seen, heard, understood, and supported has positive results on goal progression. If your past experience involves trust or mistrust, being aware of how therapy and/or relationships have helped or hindered you in the past can put current resistance and reluctance in perspective. A few questions that you may find helpful at ask at the first meeting with a helping professional include:

  • What kinds of clients have you worked with before?
  • How do you work with people who are uncomfortable with therapy?
  • What do you do with feedback from clients?
  • What can I expect from working with you?

All of these questions encourage healthy discussion around the therapeutic process and can provide insight into expectations and measurable goals when engaging a helping professionalin your own growth process.

Mandatory can feel restrictive and stressful when viewed as a loss of control or freedom. What better way to reframe it than to ask yourself, what can make it worthwhile?

“If you change the way you look at things, the things you look at change.” Dr. Wayne Dyer

Khara Croswaite Brindle, MA, LPC, ACS, is a Licensed Professional Counselor in the Lowry Neighborhood of Denver, Colorado. She received her Masters Degree in Counseling Psychology from the University of Denver with a focus on community based mental health. Khara has experience working with at-risk youth and families, including collaboration with detention, probation, and the Department of Human Services. Khara enjoys working with young adults experiencing anxiety, depression, trauma, relational conflict, self-esteem challenges, and life transitions.

 

The First Call Is Always the Hardest: It Makes All The Difference by Justin Barclay

Posted on by Christy Weeks

I was 29 years old when I went to treatment. It was a nudge from a Judge that drove me to my first introduction to Harmony Foundation when I called asking for help. At that time I couldn’t imagine my life without alcohol, but I did know that I didn’t want to be miserable anymore. Alcohol may have taken away the bad feelings, but it certainly did not take away the misery, it was an unwanted houseguest that had moved in and was planning to stay.

I will never forget that first call. I was scared, uncertain and feeling hopeless. Sharon, a former Union Boilermaker, originally from Pittsburgh, was my lifeline to my new life in recovery. Sharon was kind and understanding, she eliminated barriers, was honest, and insightful. I had tried different feeble attempts of getting sober that all involved managing and moderation. When it was all said and done, Sharon was quick to point out that everything I tried wasn’t working and said, “Try this!” She added that I was allowed to try things once in my life and never have to try them again if I didn’t like it. So, I tried, came to Harmony and by the grace of my God of my understanding, I haven’t found it necessary to pick up a drink or a drug since that phone call.

Whether you’re a friend, family member or just desperately in despair looking for help, making that first call can be overwhelming. Many people perceive addiction treatment likened to Jack Nicholson in “One Flew over the Cuckoo’s Nest.” In truth, most addiction treatment is not straightjackets, lockdown facilities and Nurse Ratchet’s.

In fact, good addiction treatment and working with someone in admissions is built on compassion, empathy, strength and guidance. As a person in recovery who went through the admissions process, I can say that the first call makes all the difference.

What can you expect when calling for help? First and foremost you should expect to be treated with dignity and respect. Someone who is willing to answer every question you have. You should expect to be valued enough as an individual that your questions will be answered honestly even if the Admission Staff knows the truthful answer may not be what you want to hear. Remember, you are making a call to save your life not giving someone on the other end an opportunity to close a deal. Insurance does not pay for flights, waving of fees and deductible only means that the revenue has to be made up from somewhere or someone else, that someone else could be you. If services provided and allowable items are different on the phone than the programs website, you have a right and self-responsibility to ask why the difference without being challenged. One of the most critical elements to a successful treatment experience is honesty. This critical element will be missing if the admission process revolves around any kind of dishonesty. You should also expect to work with an organization that will inform you if they cannot meet your needs and they will provide you with direction to programs they have a collaborative relationship with to best meet your needs.

Today, I am an Admissions Manager and since my first and only admission all those years ago, I have been given the good fortune to not just experience the admission process once, or twice, or even 100 times but thousands of times. I remind myself on every call how I was treated on that first call with Sharon, and I am committed daily to respond the way she did. People calling, no matter what the motivator, just want to be heard without judgment and respected. Admissions staff is the first impression of the organization they establish the trust necessary for the individual to begin a process of a willingness to change. Being dishonest, pushy and unclear about expectations sets everyone up for failure.

Each time I work with an individual or family, it is a privilege to be the resource that helps them begin their new journey of sobriety. No two admissions are the same. I honor and respect the clients allowing them to experience their own journey with the admissions process the same as I was.

So as you consider treatment and you inquire about what program is the best fit for you. Remember that that person on the other line may have the one thing you need to help you begin again. One thing I can say that is true for me, every time I try anything that involves the admission process, I learn from it, I grow from it, and most of all I love it.

Caring for the Queer or Transgender Person in Recovery by Luca Pax

Posted on by Christy Weeks

The Center for American Progress reports that between 20-30% of transgender people struggle with addiction compared to an estimated 9% of the general population. This statistic is significant for those of us who are transgender, and for those of us who support transgender people in our lives. As family members and care providers, even if we have good intentions in caring for queer or transgender people in recovery, we may need to intentionally adjust our actions, in order to have a positive impact.

What can I do as a provider?

Ask, Affirm
When a transgender person shares an intimate part of their identity with you, honor and affirm their identity by using their correct name, pronouns, honorifics, and gendered or non-gendered terms when referring to them. If you ask someone their gender identity or pronouns, do so in a way that is not interrogative or invasive, but rooted in trust and relationship. Make it a normal practice to share your own gender pronouns, and to ask others’, so that transgender folks are not as singled out, or put into vulnerable situations.

Listen, Believe
If you are given the opportunity to learn more about the identities that your client holds, listen to their self-definition and believe what they share with you. Know that LGBTQIAP+ identities are valid and real, and that people who hold these identities deserve to be trusted in their self-knowledge. Remember that each individual is the expert on their own identity, and challenging or disrespecting a client about a marginalized identity contributes to their lack of safety.

Include, Support
As care providers, our first commitment is to do no harm. Keep this in mind for transgender clients when making room pairings and restroom designations in residential treatment. Consider using inclusive language in your policies and procedures, and in your new client paperwork. Making these changes may require us to deconstruct our own social conditioning about gender norms and stereotypes, in order to best respond to transgender clients’ assessment of their safety. We may also find ourselves in a position to educate, when confronted with discomfort that may arise for cisgender staff or clients.

What can I do as a friend or family member?

Your love and support matters! The 2012 Trans PULSE Project study shows that transgender people with a parent who is supportive of their identity experiences a decrease in attempted suicide rates from 57% to 4%. With a supportive parent, these subjects’ sense of self-esteem increases from 13% to 64%, and their overall life satisfaction increases from 33% to 72%.

Caring for our queer and trans family members in recovery means ensuring that our respect and love for them continues, unaffected by their transition or identities. We can lift some of their burden by explicitly supporting them in the choices they may make to transition or “come out” socially, legally, and/or medically.

As family and loved ones of transgender people in recovery, it is important for us to educate ourselves about what our loved one may be experiencing. It is equally important that we work to maintain clear and healthy boundaries, and that we prioritize our own self-care.

You may consider joining an Al-Anon or ACA group, and utilizing resources from organizations like PFLAG or Trans Youth Education & Support of Colorado (TYES). You may also consider picking up recommended reading like the WPATH Standards of Care, PFLAG’s Trans support publications, and publications by other addiction treatment providers.

For the transgender or queer person seeking recovery, I am here to reassure you that there is community who understands you. Whether you connect with other LGBTQIAP+ folks virtually, through social gatherings, or while receiving therapeutic care, recovering in relationship with others who love and support you is possible.

If you know the pain of isolation, you deserve to discover that freedom is available to you. Connection with people who have walked a similar path as you, and sharing honestly with others, can be your ticket to a life unbound by addiction, and rich in resources that affirm and sustain the health of your truest self.

There will be times when we, as queer or transgender people in recovery, feel very alone. Whether this is a result of an addiction, our environment, or the weight of simply being who we are in a world that often creates no space for us – know that there are people waiting to undertake this work and journey alongside you.

There are many tips online for how you can take small steps throughout your day to regulate and find relief (like 8 Mental Health Tips for Queer & Trans POC, and 5 Awesome, Immediate Self-Care Resources For When You Feel Like Actual Garbage).

You can also get connected to Queer Asterisk Therapeutic Services, a non-profit organization in Colorado run by queer and trans professional therapists and educators who provide queer-informed counseling services, community programming, and educational trainings to promote the inner wellness and social connectivity of queer and trans people. Follow us on Facebook, Instagram, and sign up for our monthly newsletter, to learn more!

Luca Pax (they/their/them), who is nonbinary transgender, holds a BA in Education and Peace Studies from Naropa University, and works as Director of Community Relations for Queer Asterisk Therapeutic Services.

Edited by RP Whitmore-Bard, Communications Specialist.

Queer Asterisk Therapeutic Services advocates for the importance of excellent individual and community-based mental health treatment for queer and trans folks. Our therapists and educators partner with healthcare providers to ensure that queer and trans clients receive the most inclusive, highest quality of care possible.
We have offices in Denver, Boulder, and Longmont, Colorado.

Reference our Etiquette Guide & Glossary of Terms to support your education.

Movement and Recovery

Posted on by Christy Weeks
Walt Hester

by Walt Hester

I came into recovery, like so many, with extremely low self-esteem. The joke in recovery is that I didn’t think much of myself, but I was all I thought of. While I entered my 12-step fellowship immediately, it took me years to realize that one good habit I brought with me would serve me and my recovery for years to come.

The founder of The Phoenix, Scott Strode, states that something happens when we partake in athletic endeavors early in recovery. As we begin achieving goals, our self-esteem improves. As this happens, our identity shifts. We are no longer defined by the substance or disease that nearly killed us. We are no longer addicts. We become people in recovery; Survivors.

This is not an automatic event, not a switch that is thrown. This attitude takes time. It also takes more than movement. Exercise is not a replacement for the 12 Steps or therapy. Exercise is an adjunct, another tool in our recover toolbox. This, as it turns out, is something with which most addicts, in recovery or not, can identify; if one is good, more is better.

Exercise can by meditative. When one is hanging off of a rock face, forearms pumped, grip wavering, all one thinks of is the next handhold. The same is true with swimming or cycling or running. Just get through the next movement. This keeps us in the here and now in ways that we had not been capable of in the past. We don’t worry about the mistakes of the past or the mysteries of the future.

Similarly, movement can be a form of prayer. Perhaps there is an issue, a problem or challenge that I will take onto the bike during a long ride or even a walk with my family. The movement seems to lubricate those parts of my mind that help me solve the issue. I could explain the science, but then you would click on to something, anything, else. Just trust me on this.

Movement, exercise, athletics, can also promote fellowship. Many addicts, myself included, isolated in the latter stages of the disease. Shame and resentment drove me away from family and friends. Like the 12-Step programs, finding groups of like-minded people to share this experience helps us to break out of that isolation. We build friendships instead of walls. We relearn how to be a part of a community, instead of a part from. This promotes that sense of belonging that we craved but seemed incapable of before. It also begins to promote accountability. Like exercise, if one feels obligated to show up, one is more likely to follow through.

Exercise improves the bodies and brains of people recovering from addiction. It is also so much more. Our minds clear and our spirits are lifted as we lift more, run faster and climb higher. We feel better about ourselves as we encourage others to reach their goals. It’s another recovery tool. We can never have too much of that.

Nature and Mental Health at Harmony

Posted on by Christy Weeks
Mental Health and Nature

On any given day at Harmony you can witness life’s challenges and know that a compassionate soul is there to help along the path of healing. The mental health professionals are part of a team at Harmony and work with clients in a way that combines the natural beauty of our campus with the intrinsic values of each client.

To further explain how we know being in nature can help heal, I’d like to share a study out of Stanford University which suggests that time spent in natural settings may improve brain health.

“As more and more of us live in cities, we spend less time in natural settings, including parks. Studies also show that people in urban settings without access to green spaces have higher levels of psychological problems than those with access to green spaces. Is there a definitive connection between time spent in green spaces and mental health? The answer is yes. In a series of two studies, Stanford researchers believe there is a connection between time spent in green spaces and a decrease in “morbid rumination,” what is more commonly thought of as brooding over the negative aspects of our lives.”

“This study investigated the impact of nature experience on affect and cognition. We randomly assigned sixty participants to a 50-min walk in either a natural or an urban environment in and around Stanford, California. Before and after their walk, participants completed a series of psychological assessments of affective and cognitive functioning. Compared to the urban walk, the nature walk resulted in affective benefits (decreased anxiety, rumination, and negative affect, and preservation of positive affect) as well as cognitive benefits (increased working memory performance). This study extends previous research by demonstrating additional benefits of nature experience on affect and cognition through assessments of anxiety, rumination, and a complex measure of working memory (operation span task). These findings further our understanding of the influence of relatively brief nature experiences on affect and cognition, and help to lay the foundation for future research on the mechanisms underlying these effects.”

The study further asks, what does this mean for everyone?

1. “Spend Time in Natural Settings – What can it hurt to take a daily walk in the park or spend time sitting on your back porch looking at the creek (if you’re lucky enough to have that situation)? Take your lunch to a natural setting and spend vacation time at least partially in the outdoors. Doing so will immediately improve your mental health.
2. Move – Movement is good for us. No doctor in the world says that it’s healthy to sit at home and do nothing. But instead of going to the gym, find a nature trail to hike or bike, golf, or take a stroll in the green belt. Even if you don’t get your heart rate up to aerobic activity levels, you’ll still mentally benefit from the movement.”

The healing journey for a client at Harmony can include a client expressing their emotions in a calmly lit room, moving forward on a walk to the river at Rocky Mountain National Park or learning a really cool coping skill. One of many examples of coping skills taught to clients is called 5,4,3,2,1 where one is taught to evoke all five senses. This is a great coping skill where a client is taught to tap into all 5 senses within as a viable resource. Another experience often happening at Harmony is witnessing clients as well as staff simply spending time with Cooper, our therapy dog.

As a mental health provider at Harmony, I have noticed clients seemingly more calm during sessions when we are taking a walk together in nature. I believe they appreciate the fact we are walking and talking side by side as opposed to sitting across from one another. Clients have stated, “Wow, this is better than sitting in an office, this is a nice place to get treatment.”

Since Harmony offers outings each week at an indoor climbing gym or hike in the park, depending on the weather, clients are able to take advantage of the natural beauty and the healing attributes of moving Harmony has to offer.

Harmony is a special place that helps client’s feel safe, accepted and cared about. For some on their path of healing it is a beginning, for others it is a renewal; for all whose path includes a stay at Harmony, it is a step toward healing in the arms of nature’s embrace.

Kelly Baker, MA, LAC, LPC, NCC
Mental Health Professional, Harmony Foundation, Inc.

References:
http://well.blogs.nytimes.com/2015/07/22/how-nature-changes-the-brain/?mwrsm=Facebook&fb_ref=Default&_r=0
http://www.pnas.org/content/112/28/8567.abstract
http://www.sciencedirect.com/science/article/pii/S0169204615000286
http://www.girlscouts.org/

Does Treatment Work? Why Outcomes Matter…

Posted on by Christy Weeks
Does Treatment Work

by Dr. Annie Peters: Harmony Foundation’s Chief Clinical Officer

Harmony has been helping people who are struggling with addiction to find recovery since 1969. While Harmony is well-known in Colorado for providing clients and families with support and quality services for many decades, reputation means little without demonstrating that people do, in fact, get better.

Defining what recovery is, and demonstrating that people who use Harmony’s services begin finding recovery, are essential components to the provision of ethical and effective care. Harmony’s mission is to provide the foundation for recovery from the diseases of drug and alcohol addiction. If clients leave treatment and begin re-developing lives of purpose, satisfaction, and rewarding relationships, we know we have helped to provide the foundation for a journey toward wellness.

Harmony contracts with an external research organization, OMNI Institute, to examine treatment outcomes regarding substance use, psychological well-being, and improvement in life satisfaction.
Data collection for the most recent outcomes study performed by OMNI began in March 2015, and the study was finalized in 2017. One hundred and forty eight (148) Harmony clients were assessed upon admission, at discharge, and at 1, 6, and 12 months post-discharge. The percentage of clients who responded at these time points were, respectively, 100%, 94%, 63%, 61%, and 64%. While results cannot be generalized to clients who were unable to be reached for follow up, a number of statistically significant findings can be reported and provide valuable information about the effectiveness of care provided at Harmony.

DEMOGRAPHICS

Understanding the people we serve helps us provide the highest quality of care by tailoring treatment interventions to the specific needs of our clients. In this study, the average age of clients was 38, with a range from 18-65. Sixty-four percent (64%) of clients identified as male, and 36% identified as female. All clients were asked to identify their “primary drug.” The majority of clients (74%) identified this as alcohol, followed by heroin (10%), methamphetamine (6%), other opiates/painkillers (5%), and marijuana (3%).

Clients under the age of 25 typically used more substances – the average number was four. The primary drug differed by age as well; clients under 25 identified heroin or alcohol (38% for each), followed by marijuana (13%).

REASONS FOR DRUG/ALCOHOL USE

Clients were asked about the reasons they used alcohol and drugs, and their responses help us understand how to help people better. Many clients (30%) said they used substances for “self-medication” or emotional pain/mental illness (28%). Other common answers were using for pleasure (22%), to escape reality (15%), habit (13%), or pain (5%).

PREVIOUS TREATMENT AND REASONS FOR SEEKING TREATMENT
About a third of clients had been to a detox treatment before, and about a third reported a prior treatment for substance use. Another third reported never having any treatment for drug or alcohol use.

About half of clients surveyed reported a prior diagnosis of a mental health disorder, with the most common diagnoses being depression (37%), anxiety (25%), ADHD (11%), PTSD (7%), and bipolar disorder (6%).

Most clients said that coming to treatment was a personal decision (71%). Other common reasons given for seeking treatment were a family situation, health reasons, a legal situation, or a job-related reason.

POST TREATMENT OUTCOMES

After leaving Harmony, clients were asked at 1, 6, and 12 months about their drug and alcohol use. They were asked whether they had been continuously abstinent from drugs/alcohol since discharge, and they were also asked if they had been clean/sober for the previous 30 days. As can be seen in the table below, over half of clients at one year post-discharge had been continuously abstinent since coming to Harmony, and 71% of them had been abstinent for the past 30 days.
Follow-up     %Abstinent for      %Continuously Abstinent
     Time            Past 30 Days                   since Discharge
1-month           77% (n=88)                            68% (n=91)
6-month           64% (n=90)                           57% (n=91)
12-month          71% (n=90)                            54% (n=95)

Abstinence since treatment is not the only outcome that demonstrates that clients are recovering and have improved their lives. In this study, we also wanted to determine how quality of life had improved for people who had come to Harmony. So all those surveyed were asked questions about relationships with family and friends, physical/emotional health, and other factors. Clients reported significant improvements over time in their family relationships, friendships, spiritual connection, physical health, emotional health. They also reported significant positive changes in their ability to handle finances and handling problems or conflicts, as well as improvements in self-respect. There were also significant reductions in arrests and other legal problems post-discharge, as well as improvements in employment status.

Because so many of our clients have co-occurring mental health issues, we also asked questions about symptoms of anxiety and depression. There were statistically significant reductions in symptoms such as hopelessness, fatigue, nervousness, restlessness, sadness, and feelings of worthlessness.

WHAT PREDICTS ABSTINENCE

In order to continuously improve Harmony’s services, we wanted to determine if there were factors that were associated with post-treatment abstinence. For example, do older clients have better abstinence rates than younger clients? Is primary drug related to abstinence rates, such that clients who primarily used alcohol do better than clients who primarily used heroin?

Interestingly, the only variable that predicted abstinence was the reduction in mental health symptoms during treatment. In other words, the more clients’ symptoms of depression and anxiety decreased during their time at Harmony, the more likely they were to remain abstinent after leaving treatment.

WHERE DO WE GO FROM HERE

One of the most compelling and recurrent themes in this study was the importance of mental health care and support. As mentioned above, self-medication of emotional pain and mental health issues were primary reasons clients reported for using drugs and alcohol. Half of our clients had co-occurring mental health diagnoses. And the single best predictor of post-treatment abstinence was the reduction in symptoms of depression and anxiety that clients reported during their treatment at Harmony. For the past few years, Harmony has worked to improve the quantity and quality of support provided for mental health issues. We have added mindfulness groups, a trauma coping skills group, and education groups on a variety of mental health topics. Clients can receive both addiction-specific counseling at Harmony and counseling specific to psychological issues. Given the results of this study, Harmony plans to continue enhancing the services provided to help people recover not just from chemical use, but from underlying emotional issues that can increase risk for relapse.

While the results of this study show that Harmony clients do, overall, have improved lives and decreased drug and alcohol use, we want to help more individuals and more families to recover, with more significant reductions in substance problems and more improvement in life functioning. Harmony is committed to continuous improvement in our services to provide even better care and help more people find their way to recovery. Studies such as this one remind us why this work is so important and why we need to always examine ourselves and find areas for improvement.

CLIENT FEEDBACK

At the end of each survey, clients were asked if they had any feedback about the Harmony experience. Common answers were that they appreciated the support provided by staff as well as the community they built with the other clients. While data can provide us with important feedback on who we serve and how we can continually do better at helping people find recovery, it is these comments that remind us why we do what we do at Harmony:

“I have come to better understand myself, my need to use, and what I am struggling with so that I won’t need to turn to drugs and alcohol to deal with my problems.”

“I’m really grateful to Harmony…it helped me a lot… I was in really bad shape. If I would have went somewhere else, I probably wouldn’t still be clean.”

“The staff here was absolutely amazing and seemed to truly care about me and my recovery. They were instrumental to my time here and truly helped me recognize qualities and worth in myself that make my sobriety worth fighting for.”

 

Are You in a Codependent, Avoidant, or Securely Attached Relationship?

Posted on by Christy Weeks
codependency

by Lana Isaacson, LCSW, CAC III, Certificate in Marriage and Family Therapy, PACT Level I

Codependency is one of the most confused and contested words in the couples therapy field today. There could even be a debate between couples therapists and addiction counselors on whether or not codependency (and even the cartoon above!) is healthy or unhealthy.

Addiction counselors would likely say that codependency originates in childhood and manifests as an unhealthy relationship with oneself and a dysfunctional interpersonal pattern in adulthood between the codependent and his/her partner, children, and others that involves controlling, excessive caretaking, and enmeshment. Codependency and enabling are often used synonymously to refer to the dynamic between a partner with an addiction and the codependent who “loves him/her to death” through enabling. Addiction counselors might also contend that any level of dependency or too much “connection” to one’s intimate partner is unhealthy and recommend that individuals in recovery wait at least one year before beginning an intimate relationship.

On the other hand, couples therapists are more likely to conclude that codependency stems from the couples’ current dynamic, which includes one partner displaying an avoidant attachment style, which influences the other partner to feel tremendous anxiety and want to cling to her/his partner, and appear as codependent. These therapists might also underscore how partner’s emotional dependence on one another is a normal human need, and therefore should not be shamed. Or, couples therapists might elevate a codependent relationship as the ideal because they attest that partners are more resilient when they have a “secure base” or emotional anchor and will possibly point to the 2006 MRI study by Dr. James Coan that demonstrated how partners can regulate each other’s psychological and emotional well-being. Finally, some couples therapists, especially those who subscribe to attachment theory, might deny that codependency exists as in Amir Levine, MD and Rachel Heller’s well-respected book, Attached, in which they assert that “codependency is a myth”.

As with couples in therapy, often the truth lies somewhere in the middle. Because I am both an addictions counselor and couples and family therapist, it seems to me that this argument is a semantic one and that codependency means very different things to both professionals. In order to best serve our clients, it is important to distinguish the difference between codependency and interdependency or a secure attachment.

First, what is codependency?

This answer can greatly differ based on the source. I will share a definition by marriage and family therapist, Beverly Berg, PhD who wrote Loving someone in recovery; The answers you need when your partner is recovering from addiction.

“Codependency is an emotional and psychological state in which one is excessively preoccupied with taking care of or controlling another person at the expense of one’s own needs… The codependent’s excessive focus on caretaking does not only occur with his or her primary partner; it can also apply to work relationships, friendships, and relationships with extended family. People with codependency have a hard time leaving relationships that are abusive or depriving, tend to stay in jobs that are stressful, and are prone to ignoring their medical needs. Because of their high tolerance for denying their own needs, codependents tend to wait until they have experienced serious consequences before seeking a path of recovery” (2014).

Internally, codependents tend to struggle with thoughts of not feeling good enough, excessive worry about what other people think of them, and constant waiting for disaster or the other shoe to drop. They may perceive neutral or even positive situations as negative. I know some very “high functioning” codependent people who (similar to some addicts prior to recovery) may look great on the outside, but are internally suffering. Fortunately, treatment/help for codependency addresses both one’s internal and external world.

Lastly, codependency affects people from all walks of life- both men and women, addicts and non-addicts, and should not be assigned to every partner of an addict. To see if you or someone else meets the criteria for codependency, one assessment can be found on The Bridge to Recovery’s website (an outstanding treatment program for codependency)

Second, how does codependency develop & manifest in adult relationships?


Stan Tatkin, PsyD, creator of PACT (Psychobiological Approach to Couples Therapy), which incorporates attachment theory, neuroscience/arousal regulation, and experiential therapy, explains the origins of codependency in the foreword for Berg’s book. Tatkin’s former supervisor was John Bradshaw (the latter was a leader in the addiction and codependency treatment field).

“[…] Codependent men and women tend to bond in love relationships in a way that makes them both angry and resistant…because during their childhood, at least one of their important caregivers was preoccupied as a result of feeling overwhelmed, unsupported, and unloved by his or her own parents” [or spouse]. Preoccupied caregivers tend to alternately reward their children for depending on and supporting them, and rejecting, punishing, or abandoning them. This inconsistency tends to make the children angry as well as suspicious of and resistant to affectionate approaches from the caregiver [and later spouse] (2014)”.

“[…] Fast forward to adult relationships with a partner preoccupied with addiction [a mental health condition, or something/someone else] and you find a familiar situation. Your partner knows how to feel good without you [or is unaware of your needs], but you need your partner to be present, loving, and caring to feel good. Even though you feel ignored, abandoned, and alone, you STAY in the situation. Why? Because you are insecure and fear abandonment” (2014). And of course, many partners would also say, “because I LOVE him/her.”

Third, what do different attachment styles look like in children and adults?

Tatkin’s (2016) work draws from researchers who discovered that children and adults typically have one of three distinct attachment styles: secure, avoidant, or anxious (codependent). There is also a small portion of adults who have a disorganized attachment style due to severe unresolved trauma. Adult’s attachment (or “relationship”) styles are primarily influenced by the attachment relationship they had with their primary caregivers when they were children and secondarily by one’s intimate relationship history.
In a nutshell:
Children who felt their parents would respond consistently and appropriately when they called out for help or reached out for emotional comfort tended to develop a secure attachment style as adults. As adults, these securely attached folks find it relatively easy to get close to an intimate partner and are comfortable depending on their partner and having the partner depend on them. These relationships are mutually reciprocal. These partners have each others’ backs!
Children who felt their parents minimized, scolded or ignored their emotional needs or did not know how to appropriately emotionally comfort them tended to develop an insecure/avoidant attachment style as adults. As adults, they have disowned their emotional needs and thus struggle to identify what they need from their partner or over rely on themselves for comfort, and do not know how to adequately meet their partner’s emotional intimacy needs.
Children who felt their parents inconsistently responded (sometimes expert soothers and very loving and other times overwhelmed and either ignored the child, got angry, or guilt-tripped the child) when they called out for help or comfort tended to develop an insecure/anxious (codependent) style as adults. As adults, they worry that their partner does not really love them, won’t want to stay with them, or cannot meet their emotional intimacy needs.

The GOAL- A Secure Attachment Style!

Tatkin’s (2013) description of a “secure functioning relationship” is his unique terminology for a secure attachment:
“We have each other’s backs. We soothe each other’s distress and amplify each other’s joy. We protect each other in public and in private. We have each other’s “owner’s manual” and thus are experts on one another. We are as good at our partner as we are at our job! Our relationship is based on true mutuality.” We work on our own recovery and support each other’s recovery.

Fourth, how does an avoidant attachment style affect partners?

Although avoidantly attached partners and relationships are not nearly as vilified as codependents, they are of equal concern because they evoke in their partner a deep loneliness, often feelings of betrayal (when they seem preoccupied with their work, their family of origin, or other people or activities, including their alone time) and emotional deprivation. Perhaps the lack of widespread concern about avoidance is that our American culture places independence and stoicism above collaboration and vulnerability as well.

Yet, what I see as a couples therapist is as many or more relationships suffering when partners balk at mutually making it their sacred responsibility to put their partner’s emotional well-being first. Although this blog focuses more on codependency in intimate relationships, I have included resources at the end that can help folks interested in healing from and transforming their avoidant attachment style into a secure style.

Fifth, how can we integrate the wisdom from the Couples Therapy and Addiction Counseling fields on the topic of codependency?

The couples therapy field, especially attachment theorists, offer us a unique perspective on codependency that doesn’t blame or shame the partner being labeled codependent by explaining that the codependent is behaving in a normal way to an abnormal situation, which is his/her partner disconnecting from the relationship to connect with something else, ex. an addictive substance or behavior. This distancing from the codependent’s partner will likely propel the codependent to take extreme measures in an attempt to reconnect with his/her loved one because it has been found in research that adults, similar to children, experience “primal panic” when they cannot emotionally reach their loved one and/or their loved one stops emotionally responding to them.

Attachment couples therapists also normalize our biological need to attach and bond to others and to be emotionally dependent on significant others from the cradle to the grave. Couples with a secure attachment style and/or an interdependent dynamic have been found to feel the most loved, safe, and secure with their partner, have the happiest and longest relationships, and are more successful in the world because they are launching and landing each day with a partner who serves as their “secure base” or emotional anchor.

Addiction counselors provide a different type of expertise and often more personal and professional experience with codependency, which can bring a level of wisdom that is invaluable. Addiction counselors tend to better understand the gravity of codependency, ex. being the spouse or child of a codependent can be extremely challenging because the codependent limits others’ growth and unconsciously disables them. These counselors are also often aware of the internal pain that codependents experience and feel compassion for the codependent’s inability to stop (cold turkey) his or her codependent behaviors, thoughts, and feelings. Some codependents describe their experience of enabling or helping (anyone with anything) as a “HIGH”, refer to themselves as “self-sacrificing martyrs” or “rescue warriors”, yet by the end of an enabling spree, they need to crash from emotional and physical exhaustion, and later they feel intense hurt and/or resentment from having given too much and sacrificed themselves for others who continually neglect their needs. This cycle repeats until help is attained by a professional who can provide appropriate treatment.

Thus, by acknowledging that codependency is a REAL condition and explaining the research-based recommendations for treatment, addiction counselors can offer validation, empathy, and hope to their clients who previously felt hopeless about their internal suffering and compulsive behaviors. These counselors also go far beyond normalizing the couple’s dynamic to helping the couple navigate out of an insure attachment style into a secure one.

Finally, Moving Forward~ Recovery from Codependency or Avoidance to a Secure Attachment Style and Relationship

​Tip #1 Strengthen your individual recovery program (if applicable, ex. CoDA, Al-Anon, AA/NA &/or individual therapy, meditation, etc.) and your ability to know your autonomous self (the ability to be emotionally close to someone while at the same time, not lose yourself). One outstanding book to guide you is Loving someone in recovery by Beverly Berg, PhD, which explains the stages of recovery from codependency, emotional relapse indicators, and teaches missing interpersonal skills. (in addition to a comprehensive overview of how couples in recovery can change a dysfunctional dynamic into a securely attached relationship.)

Tip #2 Learn how to develop a secure attachment with your partner that addresses how to transform both insecure styles (codependent and avoidant) into a “secure functioning” relationship. Three outstanding books to guide you are Wired for love by Stan Tatkin, PsyD, MFT, Attached by Amir Levine, MD and Rachel Heller, MA. & Berg’s book mentioned in Tip #1.

Tip #3 Seek couples therapy, with a counselor who has training in helping couples develop a secure attachment and recovery from addiction and codependency if applicable. And, if you are a couple in recovery, develop a couple recovery program, ex. participate in RCA- Recovering Couples Anonymous and AA/Al-Anon/CoDA speaker meetings).
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If you would like help navigating out of an insecure attachment style into a securely attached relationship, Contact Lana Isaacson, LCSW, CAC III, Certificate in Marriage and Family Therapy, PACT Level I Therapist, at 720.432.5262 to schedule your appointment today.

www.lanaisaacson.com