Addiction

How Addiction Affects Body, Mind, and Spirit

Posted on by Christy Weeks

By Michael Rass

Addiction cannot simply be reduced to substance use, chemically caused by drugs and alcohol in the human body. Addiction is a complex biopsychosocial and spiritual disorder with many interlocking conditions and mechanisms. Many addiction professionals view it as a disease of the mind, body, and spirit.

A Disease of the Body:

Most psychoactive substances are regarded as toxins by the human body and its defense system. A healthy liver will try to purge any amount of alcohol as soon as possible, for example. Different substances have different effects on the body. Alcohol destroys brain cells and depresses the central nervous system, while cocaine is a stimulant, raising blood pressure and heart rate. Both substances, like others, trigger the release of certain chemical messengers in the brain, known as neurotransmitters. The main ones are dopamine, which elicits pleasure, norepinephrine causing arousal and focus, and serotonin, which causes feelings of happiness, counteracting negative emotions.

The repeated, artificially elevated release of these neurotransmitters will eventually cause changes in the brain of the addicted individual, providing the increasingly rigid neurological structure for the psychological aspects of addiction. In addition to slowly changing the mind of the addicted person, substances like alcohol, crystal meth, cocaine, and others will have a pathological impact on the physical body, damaging major organs, the cardiovascular system, the skin, and teeth as well as causing dangerous infections, malnutrition, and chronic pain conditions. Most people suffering from a severe substance use disorder (SUD) have been neglecting their physical fitness for a long time, having completely given up on anything resembling a healthy lifestyle.

A Disease of the Mind:

For psychiatrists, addiction is primarily a disease of the mind. The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the diagnostic manual widely used by psychiatrists in the United States—states that “all drugs that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviors and the production of memories.” These psychoactive substances “produce such an intense activation of the reward system that normal activities may be neglected.”

Eventually, this “intense activation” may trap the user in an addiction cycle of craving, using, and withdrawal, leading to renewed craving. In the psychiatric jargon of the DSM-5, “the essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.” In other words, compulsive substance use, despite negative consequences. The user is now caught in a cycle of drug or alcohol use that requires ever-increasing amounts of the substance just to feel “normal.”

The question is, how did the addicted person get there? Why the “intense activation” in the first place? And then again and again? This is where other mental health issues typically play a crucial role. Most addiction professionals now believe that substance abuse is not simply caused by irresponsible pleasure-seeking but should, in most cases, been seen as an attempt to self-medicate serious mental health conditions like posttraumatic stress disorder, major depression, or anxiety. And those are often connected to highly traumatic life events the individual is unable to handle in a healthy way. The “intense activation” is supposed to numb intense emotional pain.

Due to the phenomenon of tolerance this numbing can only be maintained with ever-higher doses of drugs and alcohol while the brain tries to counteract the unnatural surges of neurotransmitters in an effort to rebalance its hormonal setting. At the same time, more and more toxins will do more and more damage to the well-being of the user. Meanwhile, the continual degradation of the physical body causes more stress and emotional pain, providing further motivation to continue with substance misuse. Body and mind are caught in a deadly down spiral: the addicted mind will make the body sicker, and the degraded body will exacerbate the cravings driving the addiction.

A Disease of the Spirit:

For many addiction professionals, addiction goes beyond this body-mind interaction, though. They also view it as a disease of the spirit. In his influential study, Canadian physician Gabor Maté compared addiction to the “realm of hungry ghosts,” one of six types of rebirth in Asian mythology. It is said to be the abode of restless spirits suffering from insatiable cravings and unhealthy attachments, condemned to inhabit dismal places.

At the heart of the addiction problem is a deeper malaise: the disconnection from the Higher Power—whatever that might be, a missing sense of purpose, a failure at authentic self-actualization, the highest level in Maslow’s pyramid of human needs.

This ethereal aspect of the disease is often a hard sell in an increasingly agnostic society. It doesn’t easily correspond to medical and scientific concepts and spirituality can mean very different things to different people. Whatever it is, Americans are increasingly identifying with it.  “About a quarter of US adults (27 percent) now say they think of themselves as spiritual but not religious, up 8 percentage points in five years,” according to a Pew Research Center survey conducted in 2017.

Many of them see spirituality as a personal search for the meaning of life, for connection with the entire universe—with a Power greater than ourselves. They do not necessarily seek a religious practice defined by mandatory observances, rules, and prohibitions. Instead, they want to connect with a Higher Power rooted in love and compassion—a Power that gives human beings perspective, meaning, and a life of purpose.

It is a perspective of the utmost importance to people in recovery. Many succumbed to a life of despair because they lacked a spiritual outlook. Sadly, our current culture seems to promote mostly vanity, instant gratification, zoning-out, and craving for material distractions, all things that are dangerous for a person in recovery. Addiction is a demon trying to disconnect us from our spirituality, the Higher Power, and our fellow human beings. To recover fully from addiction we must strengthen the body, heal the mind, and reconnect to our spirituality. This takes time and effort. A lot of time and effort. That is why recovery is a life-long pursuit.

Addiction Reaches Sesame Street

Posted on by Christy Weeks
Sesame Street

America’s addiction crisis is now so pandemic that it features on one of the most popular TV programs for children. As was revealed in a recent episode, one of the Muppet characters on “Sesame Street” is struggling with a big, “grown-up” problem. Show producer Sesame Workshop created a series of videos in which young Karli talks to her friends about her mom’s struggle with addiction. Karli came to “Sesame Street” in May to stay with a foster family because her mother was “having a hard time.” Continue reading “Addiction Reaches Sesame Street” →

Beware the Early Signs of Alcoholism

Posted on by Christy Weeks
Early Signs of Alcoholism

by Michael Rass

Addiction can sneak up on you. You may be unaware of it, but you might be genetically predisposed to develop a substance use disorder (SUD) more easily than other people. The alcohol-related SUD listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is termed alcohol use disorder (AUD), featuring eleven diagnostic criteria. The presence of six of those criteria indicates a severe AUD or an alcohol addiction.

Early Warning Signs

Several of the DSM-5 criteria can be regarded as early warning signs. Is alcohol taken in larger amounts or over a longer period than was intended? And has there been a persistent desire or unsuccessful efforts to cut down or control alcohol use?

Many alcoholics remember periods early on when they tried to slow down their drinking, only to find that it didn’t actually happen. According to the DSM-5, the presence of these two criteria already indicates a mild alcohol use disorder. If these early warning signs are ignored, the AUD is likely to escalate. More and more time could be spent on obtaining alcohol, drinking alcohol, or recovering from its effects, and “continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol” may ensue.

The Drinking Escalates

Continued, excessive alcohol use despite negative consequences is a serious red flag that should not be ignored. Take a step back and honestly ask yourself, why is this happening? Why are you drinking more than you should? For many recovering alcoholics the answer is that they were self-medicating emotional pain or intense stress.

Do you drink to reduce social anxiety? Are you suffering from an anxiety disorder or depression? Then you should not drink alcohol in an attempt to reduce the symptoms of those conditions. While drinking may initially suppress symptoms of mental health disorders, it will eventually make them worse. If you suffer from too much stress, you need to address the cause of that stress instead of fleeing into alcohol misuse.

Unfortunately, many users start to rationalize their excessive alcohol consumption at this point and deny any warning signs to themselves and to others. They keep on drinking even though it is beginning to cause serious problems in their relationships, for their professional career, and physical health. They start to experience craving, or a strong urge to use alcohol, as their alcohol use has begun to hijack the reward cycle of the brain. They need alcohol just to feel normal.

Recognize the Real Drivers

Stress (especially if caused by a traumatic experience) or any mood disorder, combined with frequent alcohol use and a possible genetic predisposition may now unleash a severe alcohol use disorder or alcohol addiction. Individuals may experience blackouts after heavy alcohol use. Uncontrolled, persistent drinking will eventually lead to tolerance—more and more alcohol is needed to achieve the same effect—and withdrawal symptoms will increase if alcohol consumption is discontinued.

Don’t let it get that far. Heed the warning signs. Be mindful of the real reasons you’re drinking excessive amounts of alcohol. Seek professional therapy for any mental health condition you might have and counseling for any trauma you may have suffered. Be aware of people with alcohol use disorder in your family and be extra-cautious if close relatives have an AUD. Engage in activities that relieve stress but don’t involve using addictive substances.

If you are unsure if you have developed a substance use disorder, seek an evaluation to assess your drinking behavior. Don’t despair and don’t drown in your addiction. Help is available and recovery is possible!

When Gray Drinking Leads to Long-Term Sobriety

Posted on by Christy Weeks
Gray Drinking

by: Michael Rass

Sobriety is no longer just the earnest goal of recovering alcoholics. As of late, it has also become the holy grail of so-called “gray area” drinkers.

According to former social drinker Amanda Kudo that gray area is the “place where you’re not a super-casual, once-in-a-while drinker, but you’re also not a hit-rockbottom, time-to-get-help drinker, either. You’re just there, somewhere in the middle, drinking in a way that is still deemed socially acceptable if not socially necessary.”

Or as health coach Jolene Park put it in her TED talk, “from the outside looking in, my drinking did not look problematic, but from the inside looking out, I knew, the way I was drinking was a problem for me.” Many people like Kuda and Park say they never had a real drinking problem, but they had a problem with drinking.
One of those “gray area” drinkers was British expat Ruby Warrington, currently living in Brooklyn, who— according to the New York Times—”spent her early career quaffing gratis cocktails at industry events, only to regret the groggy mornings.”

“After moving to New York in 2012, Ms. Warrington tried 12-step programs briefly but decided that ‘Ruby, alcoholic’ was not the person she saw in the mirror,” wrote Alex Williams in the Times feature about a new sobriety trend spreading across the nation. “Three years ago she started Club Soda NYC, an event series for other ‘sober curious,’ as she termed them: young professionals who were ‘kind-of-just-a-little-bit-addicted-to-booze.’”
Being “sober curious” has caught on and Warrington wrote a whole book about this latest health fad. “For these New Abstainers, sobriety is a thing to be, yes, toasted over $15 artisanal mocktails at alcohol-free nights at chic bars around the country, or at ‘sober-curious’ yoga retreats, or early-morning dance parties for those with no need to sleep off the previous night’s bender,” wrote Williams.

But there is a serious side to avoiding alcohol use, of course. It is after all an addictive substance without any health benefits that physicians would acknowledge. And while the sober-curious vogue may well be short-lived, reducing or giving up alcohol consumption is certainly laudable since it comes with all kinds of health benefits.
When Jolene Park described her alcohol use as knowing “the way I was drinking was a problem for me,” she was actually paraphrasing the first diagnostic criterion of alcohol use disorder (AUD) in the of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which reads: “Alcohol is often taken in larger amounts or over a longer period than was intended.” And when she said in the same TED talk that she had no trouble stopping but couldn’t “stay stopped,” she was paraphrasing the second AUD criterion in the DSM-5. Two criteria (out of eleven) indicate a mild alcohol use disorder.

Park probably wasn’t aware of the DSM-5 criteria at the time but she read the warning signs correctly and realized that she was “kind-of-just-a-little-bit-addicted-to-booze.” She understood that her alcohol use could escalate further and made the right decision. She embraced sobriety.

She also realized that her alcohol use was a coping mechanism for her anxiety issues and designed a new coping strategy for herself based on connecting with nature and other people, exercise, and meditation. Park now shares this healthy approach to life with other people.

Amanda Kuda also realized that she needed to drink in order to relax. “But there was a bigger part of me that wanted to feel happy, joyful, vibrant, inspired, energized, motivated, fulfilled. Once I realized that alcohol was not only failing to contribute to those feelings, but was actually dragging me further and further away from them, I no longer wanted to drink.” Neither Park, Warrington, or Kuda sought detox or residential addiction treatment for their alcohol problem, and only Warrington briefly tried a 12step program. This low level of care for a mild or moderate alcohol use disorder may not be the right choice in all cases, though. Some patients might require an intensive outpatient program or even partial hospitalization. Only a careful assessment of the patient’s individual needs can determine the appropriate level of care.

Although none of the three “gray-drinking” women made use of a treatment program, they nevertheless realized a core principle of recovery. Stop using and change your life! Real recovery goes far beyond giving up substance misuse. It is a life-changing journey to long-term wellness that should make you feel happy, joyful, and inspired.

IF YOU OR A LOVED ONE IS STRUGGLING WITH SUBSTANCE USE DISORDER, OR YOU HAVE QUESTIONS ABOUT OUR PROGRAMS, CALL HARMONY TODAY AT 970.432.8075 TO GET THE HELP NEEDED AS SOON AS POSSIBLE

Harmony Fights Opioid Epidemic with HOPE

Posted on by Christy Weeks

More than two-thirds of drug overdose deaths in the United States in 2017 involved opioids, according to the Centers for Disease Control and Prevention, escalating an epidemic the CDC says “continues to worsen and evolve.” From 2016 to 2017, opioid-related overdose deaths increased 12 percent overall, surging among all age groups 15 and older.

The CDC report’s recommendations for curbing opioid-related overdose deaths include “increasing naloxone availability, expanding access to medication-assisted treatment, enhancing public health and public safety partnerships, and maximizing the ability of health systems to link persons to treatment and harm-reduction services.”

Naloxone is a medication often used by first responders because it can rapidly reverse opioid overdose. It is an opioid antagonist—it binds to opioid receptors and can reverse and block the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain relievers.

Medication-assisted treatment (MAT) is used to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. Medications used for the treatment of opioid use disorder are buprenorphine (Suboxone, Subutex), methadone, and extended release naltrexone (Vivitrol). Some of these drugs are controversial in the recovery community because they are themselves opioids.

The National Institute on Drug Abuse, a US government research institute, clarifies that contrary to what some critics say, “methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.”

The use of these medications should always be combined with behavioral counseling with the ultimate aim of ceasing all substance misuse.

HOPE – Harmony’s Opioid Programming Experience

Harmony has provided all clients with medication-assisted treatment for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce cravings, and give the patient time to heal from the psychological, social, and spiritual wounds of addiction.

“It’s important to remember that MAT is only a small part of the picture,” says Harmony’s medical director Christopher Reveley. “That is why we call it ‘medication-assisted’ treatment, because by itself it is not the treatment. Used alone it has a low probability of being successful.”

At Harmony, HOPE begins with thorough medical and psychological evaluations. Collaboration with the patient, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly support groups led by a professional addiction counselor. These groups address the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid relapse. In this setting, clients support each other and are educated about the process of recovery.

Medication-assisted therapy may help stabilize the patient for these challenges in early recovery. “It gives people an opportunity to step out of the chaos of addiction and consider other ways of being,” says Dr. Reveley. “I never felt that buprenorphine was meant as a lifelong or even long-term solution.” Although there may be exceptions. It all depends on the individual needs of the patient. Reveley remembers a patient who had been on methadone for 46 years. “He tried to taper off a dozen times and relapsed to heroin use every single time. His family was initially very opposed to him being on methadone but eventually they told him ‘this is working, your life depends on it.’ So there are people on either end of the bell curve but in most cases buprenorphine is only a small but important part of the solution.”

Buprenorphine can be an important tool, especially in early recovery from opioid use disorder. The medication offers patients the opportunity to start living a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin and other opioids. People are dying every day from opioid overdoses, especially in the age of the fentanyl scourge. Buprenorphine may provide the buffer that enables them to launch into sustained recovery. It is a buffer that can save people with addiction from a potentially lethal overdose.

Harmony has been treating addiction for 49 years and HOPE is now offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opioid use disorder and needs help, call Harmony at 970-432-8075 and one of our admissions specialists can discuss next steps.

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 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.

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

 

 

 

 

 

 

 

 

 

Should You Put Recovery on Your List of New Year’s Resolutions?

Posted on by Christy Weeks
Future

By Michael Rass

About forty percent of Americans make New Year’s resolutions around this time. They typically resolve to live healthier in the new year or improve their lifestyle in other ways. Popular resolutions include staying fit and healthy, losing weight, enjoying life to the fullest, getting organized, and traveling more.

The good intentions listed above all share the same problem: they are rather vague. That is probably why most people give up on their resolutions by February. Most resolutions are not kept. As Nielsen.com notes, “43 percent of Americans say they plan to lose weight by making healthier food choices, but 76 percent said they did not follow a weight loss or diet program in 2014.”

So, if you have a substance use disorder, should you put recovery on the list? Should fighting a serious disease like addiction be a New Year’s resolution?

Don’t Set Yourself Up for Failure

Yes and no. It’s not a bad idea to have goals for the new year, but they should be SMART—specific, measurable, agreed, realistic and time based. In other words, your resolution should not be “drink less” or “cut back on smoking marijuana,” because those intentions have no time frame and cannot be measured effectively.

Goals are important to achieving recovery but ideally they are objectives agreed with a therapist or sponsor as part of a treatment program. They should not be the vague declarations of intent that New Year’s resolutions tend to be.

Goal-Setting Can Make You Heal Faster

When done right, setting specific goals can be surprisingly effective. In his 2012 book, The Power of Habit, author Charles Duhigg describes a Scottish study that examined the power of goal setting for patients recovering from knee or hip surgery. Mobilization and exercise are very important for these patients but the pain can be so extreme that many skip rehab sessions and refuse to get on their feet. Participants in the study had to set weekly goals, writing down exactly what they were going to do. Patients in a control group did not have to set any goals.

“It seems absurd to think that giving people a few pieces of blank paper might make a difference in how they recover from surgery,” writes Duhigg. “But when the researcher visited the patients three months later, she found a striking difference between the two groups.The patients who had written plans in their booklets had started walking almost twice as fast as the ones who had not. They had started getting in and out of their chairs, unassisted, almost three times as fast.”

Goal-setting is an important tool in addiction treatment as well. The right goals formulated in small achievable steps combined with appropriate therapy can improve clients’ chances of a successful recovery, but they should not just settle for a generic “I want to be sober.” They should formulate specific steps on how to achieve sobriety on a day-to-day basis.

For many people with addiction, pledges like “I will never use drugs again” often seem frighteningly daunting in early recovery. It is mentally easier for them to commit to the much more modest “I will not use today” and have that same goal every day. One patient in the Scottish study had the goal always to take a second step and not sit back down after the excruciatingly painful first step when getting up. Presumably, that was more effective for him than “keep walking.”

New Year’s resolutions like “enjoying life to the fullest” fail because they are too global. You wouldn’t even know at what point you have achieved it.

No Need to Wait

New Year’s resolutions also involve the risk of delay. Drugs and alcohol can kill you, often sooner than later, and waiting for New Year’s Day to come along to get better can be dangerous.

If you are battling a severe substance use disorder, your recovery should start as soon as possible.

Don’t resolve to quit drinking or using drugs next year and then go on a binge before New Year’s Eve. There is absolutely no need to wait until New Year before enjoying sobriety. The time to quit is right now. Get help before it is too late. Your life depends on it.