I am an addict . . .

Continued behaviors in spite of negative consequences . . . the very soul, if one believes in those sorts of things, of addiction. Does this mean that my addiction has negative consequences? Maybe. But, I would argue that my addiction, at least for a while, provides the safety and comfort of a warm bed on a cold and rainy Sunday morning. My addiction understands me like no one or nothing else can. If I close my eyes I can see its soothing soft light, smell its sweet aroma, and feel its warmth numbing the pain. I can hear its continuous gentle beating like ocean waves crashing on the shore in the distance. I can taste the essence of life itself. My addiction allows me to forget, even if for a short time, the scars of abuse, the loneliness of my existence, the wrongs I have done, the pain I have caused, and the isolation I desperately try to escape. My addiction provides temporary relief, like aloe on a burn, from “an imprisonment so total that the prisoner doesn’t even know he’s locked up” (Kelly, n.d.). But just as fast as the relief appears it fades into guilt, loneliness, and isolation. My addiction has driven away those things and those people capable of providing permanent relief. It has cost me everything. I am left seeking more temporary relief – cold, alone, and feeling.

What is my addiction – alcohol, heroin, cocaine, running, dieting, eating, cutting, web surfing, gambling, sex, or perfectionism – does it matter? Not really.

Finding a healthier way of living is difficult. There are all sorts of 12-step programs – there is probably a 12-step program for people addicted to 12-step programs. These programs provide for a great source of support from like-minded people.   According to many, this writer included, living life according to the 12 steps is not a bad way to live, addicted or not. I am sure there is one for me. Accepting and normalizing events, thoughts, and feelings is part of any healthy lifestyle. Can I find normalization and acceptance in isolation? It is unlikely. I can seek professional help individually or in the form of groups offering hope that my old protective behaviors can be changed and I can find a new path to follow. Learning to problem solve, to be empathetic, to become optimistic and insightful, and to sometimes even laugh at myself and my problems will allow me to let go of yesterday and live today – to get out of the prison of my addiction.

Kelly, D. R. (Ed.). (n.d.). Transcription of the 2005 Kenyon Commencement Address – May 21, 2005 – written and delivered by David Foster Wallace. In Daniel Kelly’s Homepage. Retrieved June 26, 2014, from    http://web.ics.purdue.edu/~drkelly/DFWKenyonAddress2005.pdf.

What is it about the word addiction?

I need to preface this blog post with the fact that I have a firm foundational belief in libertarianism. Now before you go all crazy and ask me about drug legalization or economic issues let me explain. I am bias towards a libertarian point of view in that I support your right to do whatever you want provided you doing it does not infringe on the rights of others – including me – regardless of what “it” is. Now, you might ask, “how is this related to process addictions?” Let me explain.

As I have previously posted I have been dealing with chemically dependent populations for a while. It has been my experience that people seek treatment when the consequences of their behaviors are no longer tolerable or put another way the pain of changing is less than the pain of maintaining.  Addicts do not seek treatment simply because they have reached their limit of heroin or alcohol.  Unfortunately some never reach treatment because the pain of changing is too great.  Addicts seek treatment when their behaviors have infringed on others or themselves enough so that they or others seek treatment or punishment.  As an illustration of this please consider that society is willing to give a person methadone in lieu of another opiate – heroin – as the associated heroin behaviors are not normally present with methadone. Hence, once the behaviors are gone society is no longer as concerned, if concerned at all, with the drug use.

This logic can be applied to Mike and Carol. Mike’s behaviors might not reach the point of requiring change if Carol enjoyed the same sorts of sexual activity – their relationship goals were aligned. This is not to say that I believe Mike’s behaviors to be healthy, I simply avoid bias by focusing on the associated problematic behaviors and misalignment of goals. My view of process addictions is the same as my view of substance addictions. It is not for me to judge a client’s behavior but rather to treat the client with respect and dignity assisting him in finding more adaptive ways of achieving his goals. This line of thinking allows me to avoid biases in treatment, maintain positive regard, and provide the best treatment modality available to assist my clients.

Approaches to treatment . . .

Having been counseling addicted populations for almost two years I have become very familiar with several types of therapies. Specific to substance abuse treatment, I have become comfortable with both Motivational Interviewing (MI) and Rational Emotive Behavioral Therapy (REBT) using them to assist clients as they move through the stages of change. As both therapies can be used in brief encounters and require the building of a working alliance with the client I can use them as needed. Motivational Interviewing is ideal for assisting clients who are in the pre-contemplation, contemplation, and preparation stages of change and ambivalent or resistant to change (CSAT, 2011). During these stages clients may believe they do not have a problem or at best be preparing to make a change (CSAT, 1999). MI encourages collaboration with the client in order to draw out his ideas about change and encourages client autonomy in deciding what to change (MI Basics, 2010). MI encourages the counselor to “roll with resistance” rather than challenge the client on behaviors and consequences. MI allows the client if he so chooses to maintain the status quo while the collaborative process develops discrepancies between his stated goals and his behavioral consequences (MI Basics, 2010). It is these discrepancies that set the stage for change and movement into the action stage of change and REBT.

REBT, a cognitive behavioral therapy developed by Albert Ellis, explores the relationship between antecedents, behaviors, and cognitions (CSAT, 2011). CSAT (2011) describes antecedents as an event or something that has happened in the client’s life that he has a strong belief about, possibly failing a test in school. The client then thinks or believes (cognition) that he cannot succeed in this class since he fails at everything, ignoring other tests and possibilities. Finally the client’s behavior is to quit, as there is no point in going back since there is no chance of passing. This is an illustration of the ABC model of disputing client belief systems (CSAT, 2011). If the client’s underlying belief can be changed, other scenarios can be considered and alternative behaviors chosen. This is especially effective if clients are in action stage of change as client ego strength is important, but REBT can be utilized in other stages.

Both, MI and REBT could be utilized in Sahira’s case. The REBT would be especially effective in dealing with her underlying belief systems in areas of relationship repairing, boundary setting, and coping strategies to handle events as they arise. MI could be used to assist Sahira in the titration from buprenorphine. In my two years of work with addicted populations one year of it was spent working in a methadone clinic with clients just like Sahira. The titration from agonist or partial agonist therapy requires a good deal of motivation and change and be quite challenging. Additional to the therapies I bring I have a great deal of familiarity with organizations like Narcotics Anonymous and SMART Recovery. These organizations provide support for recovering addicts in a nonjudgmental atmosphere conducive to newly learned coping strategies. Sahira will require even more support once she has completely titrated from buprenorphine.

Sahira brings with her not only belief systems that are distorted and physiological concerns surrounding titration from buprenorphine but unresolved problems from past traumatic events. Anyone who is reading this blog please share any information you might have on treatment of traumatic events, developmental and event activated, in the context of substance use disorder. I am working to improve my overall competency in this area and others reading will soon need the information if they do not already.

Thanks for reading and as always – One day at a time.

 

Center for Substance Abuse Treatment. (1999). Enhancing Motivation for Change in Substance Abuse Treatment. Washington, DC: U.S. Government Printing Office.

Center for Substance Abuse Treatment. (2011). Brief interventions and brief therapies for substance abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration.

MI Basics. (2010). MI definitions, principles, and approach In Motivational Interviewing. Retrieved June 14, 2014, from http://www.motivationalinterview.org/Documents/1%20A%20MI%20Definition%20Principles%20&%20 Approach%20V4%20012911.pdf.

Hello . . .

My name is Tom  and I am a first year graduate student at Johns Hopkins University.  I completed my undergraduate degree, BA Psychology, at the University of Baltimore in May 2014.  I currently work full-time as an addictions counselor (CSC-AD/P)  in a partial hospitalization setting.  I have also worked at a methadone clinic in an outpatient harm reduction setting.  I have three children and an extremely supportive wife.  I am completing my degree for licensure (LCPC) purposes and would eventually like to work with trauma patients.

My music and reading tastes are all over the place.  Musically, I like Pink Floyd’s Wish You Were Here, MGMT’s Kids, and Foo Fighter’s All My Life.  My favorite books are Tom Clancey’s The Hunt for Red October, Ayn Rand’s Atlas Shrugged, and Suzanne Collin’s The Hunger Games trilogy.  I am also an avid Baltimore Ravens fan.