Addiction Counselor

substance abuse counselorSo, what is an addiction counselor? This is an excerpt from Sokana

A drug & alcohol counselor is a trained professional who works with addicts to help them better understand and overcome their addictions. Drug abuse is an epidemic all over the world. Many of those who face a daily struggle with addiction eventually seek out help.

Counselors seek to find what triggers an addict’s behaviour in order to help them eliminate such triggers from their life. They take detailed notes which helps to form a better understanding of each person’s unique situation. They ask appropriate questions and offer advice as to which approach is best for treating a particular problem. A drug & alcohol counselor is trained to recognize attitudinal barriers which may inhibit a person’s ability to successfully overcome their addiction. They then work to help addicts remove those barriers.

The main thing an addiction counselor does is listen. Most people with an addiction problem haven’t talked about their problem due to shame and fear of judgement. When a person reaches out for help, a professional counselor offers a safe, non-judgmental sounding board for the person. When someone talks to another person who is understanding and knowledgeable, the solutions often appear within the person with the problem. The counselor usually provides some guidance, but doesn’t tell the client what to think or how to act (of course there are rules for every program of recovery because they’re necessary for the good of everyone in the program, but a person in treatment isn’t given a list of behaviors they must take in their personal life — it wouldn’t work even if we did — in fact, most addicts would likely do the opposite if they thought the counselor is trying to control their life).

A good addiction counselor will provide information about addiction, and the counselor will ask questions that usually help the client find the answers that suit their situation. There are many aspects of addiction that are true for every addict, mostly physiological facts, but the road to recovery is different for everyone. An experienced addiction counselor will allow the client to find his/her way to recovery. The client doesn’t have to like the counselor, and the client doesn’t have to experience some magical connection to the counselor. The client simply needs someone competent and knowledgeable who can listen and ask the right questions.

I have seen charismatic counselors whom everyone loved, and one would think from appearances that this counselor is more effective than others, but unless the charismatic counselor knows how to listen and ask the right questions, the results aren’t likely as good as a competent counselor with a good understanding of addiction with less flair and likability. Likability is not a liability — it can help to get someone to open up, but competence, knowledge and compassion are sufficient for a good addiction counselor.

Opiate Overdose

Fentayl and xanax - opiate overdoseI was watching Morning Joe on MSNBC this morning and saw the interview with Eric Bolling regarding his son’s opiate overdose and death. I’m not fond of Bolling as a political pundit, but I once heard him talking about his son a few years ago – it was obvious that he truly loved his son and that they were not only father and son, but also very good friends. Eric’s son, Eric Chase Bolling, is a famous case of opiate overdose, and it’s good that Bolling’s speaking out about his son’s death — the more people who know the raw facts about opiate addiction the better.

Opiate use is complicated. We don’t want to demonize all opiates. There’s a medical use for opiates and they help millions of people daily. Chase Bolling was buying from a dealer and bought something way more powerful than he expected, from what I’ve read. The mixture Chase took included Fentanyl, and that’s dangerous because it’s so powerful. Fentanyl has a specific medical use and should never be used recreationally. Xanax was in the mixture and it’s also very dangerous to mix Xanax with opiates — this greatly enhances the probability of opiate overdose. Here’s an excerpt from an article about a fake Xanax that’s now sold as a party drug — read the whole article:

Buyer Beware

As with any drug off the street, buyers may not be getting what they bargained for – a counterfeit pill made to look like Xanax has been popping up nationwide.

And while it claims to be the real deal, these pills are really cut with fentanyl, a highly addictive synthetic painkiller commonly prescribed to cancer patients to treat extreme discomfort.

Fentanyl is the strongest prescription painkiller on the market: 100 times stronger than morphine and 50 times stronger than heroin. And according to the Food and Drug Administration, even the smallest dose is enough to cause deadly side effects – especially in those taking it for the first time.

According to experts, a dose of fentanyl equal to the size of three grains of sand can kill. It’s also cheap and easy to obtain, which is music to dealers’ and street manufacturers’ ears – fentanyl is now the ideal ingredient to mix with other drugs.

 

 

Opiate overdose is a huge problem. It affects the rich, the middle class and the poor. If a person has a problem with opiates, help is available.

Relapse Warning Signs in Addiction Recovery

Relapse triggersLearning to recognize relapse triggers and relapse warning signs in addiction recovery is critical. Triggers are sights, sounds, people, smells, places and things in general that remind the person in recovery of their drug of choice. Some cocaine addicts in recovery can see powder of any kind and begin craving cocaine. A recovering alcoholic can pass the wine section in a super market and think about the good times years ago when drinking was still pleasurable, even glamorous at times. A heroin addict can see an insulin needle and feel the rush of heroin in her veins. There are ways to deal with triggers. The craving they produce doesn’t  last, if the person in recovery takes action to deal with the craving.

It’s suggested in treatment to have someone who’s in recovery to call when the compulsion of addiction is triggered. Just calling someone and talking about it often changes the feeling. Some people immediately leave the environment, go for a walk, think about the end-result consequences from using or drinking, exercise and burn up the energy — usually any kind of counter action will work — the main thing is to not let the craving linger, fantasizing about using or drinking. 

Then there are warning signs of relapse. Sometimes the warning signs are more subtle than a trigger. The trigger is immediate and powerful, but the relapse warning signs might be difficult to recognize and understand — but it’s usually the unrecognized relapse warning signs that create triggers. Below is a list from Project Know: Understanding Addiction of warning signs that can lead to relapse:

  • Frequenting old using grounds or hanging around drug-using friends
  • Keeping drugs in your home for any reason
  • Isolating yourself from friends or support groups
  • Constantly thinking about using drugs
  • Quitting therapy, skipping scheduled appointments, or veering away from your addiction treatment program
  • Overconfidence or feeling as though you no longer need support
  • Relationship conflicts
  • Being too hard on yourself or setting impossible goals
  • Abrupt or sudden changes in eating or sleeping habits, personal hygiene, or energy levels
  • Feelings of confusion, depression, uselessness, anxiety, stress, or being overwhelmed
  • Boredom or irritability, usually stemming from a lack of structure
  • Refusing to deal with personal problems related to daily life events
  • Replacing drugs with other obsessive behaviors such as gambling
  • Major life changes that cause intense emotion such as grief, trauma, or extreme elation
  • Thinking that “just one time” won’t hurt
  • Physical illness or pain

Some of these changes in attitude and behavior are rationalized in recovery so that the person normalizes isolation, or blames others for conflict, or medicates feelings before trying counseling. If a person doesn’t understand the warning signs and doesn’t take actions to avoid relapse, the odds are the person will eventually use or drink again. It’s important to have a Recovery Management Plan, so that when the person in recovery or someone else recognizes the warning signs, action is taken. Its not a sign of failure when warnings appear — they happen to everyone. What’s important is taking action and doing something about them — avoiding relapse is the goal. Every time a person recognizes relapse warning signs and takes action to deal with the problem, they grow and become stronger in recovery.

Addiction Treatment: Where to Start?

addiction treatment -- getting startedAddiction treatment: where to start? First of all, don’t be intimidated by the word “addiction”. The word has been loaded with negative connotations, but it’s a medical term. Someone who goes to a doctor for chronic pain treatment and is prescribed opiates for pain management can become addicted to the medicine. Basically, it makes no difference how a person becomes addicted to a drug ( and alcohol is considered a drug), the problem’s addiction and there’s treatment for addiction.

Many people start out with Intensive Outpatient Treatment (IOP), if they don’t need inpatient detox. In treatment facilities, we don’t make value-judgements when it comes to addiction. We see addiction as a medical problem that creates emotional and psychological issues that require medical treatment, group therapy and individual counseling. Not all people with an addiction problem go into formalized treatment, but it’s necessary for a great number who suffer from addiction. If person has tried to quit on their own, or with family support, or church, or a local support group, and it hasn’t been successful, then treatment is likely necessary.

There’s nothing of which to be afraid — all good treatment facilities treat clients with respect, dignity and honesty. At NewDay we offer a free consultation if the person’s unsure what they need. The free consultation’s simply to determine the next step. If the person decides they want to enter IOP, and if they have insurance or meet and agree to the financial arrangement, they sit down with a licensed counselor to start the Bio-Psycho-Social Assessment and the development of a treatment plan. NewDay is a private facility and we don’t receive funds from government, so we accept either insurance or self-pay. NewDay doesn’t shy away from talking about money. There’s been a misconception about addiction treatment when it comes to paying for services. For some reason, many people think all facilities are somehow funded by an outside source, therefore treatment is practically free. There are government funded facilities, but even at these facilities it’s based on the ability to pay.

I talk about the finances only because it’s good to know this before hand rather than get emotionally committed to go into treatment only to find out that a payment is involved. If someone doesn’t meet the financial requirements for treatment at NewDay, we’ll refer them to the right facility. It’s easier, though, to seek a government-funded program to begin with if a person doesn’t have insurance or the ability to make a payment plan. Money seems to always be issue in treatment if there’s a misconception up front. That’s why we’re honest about the financial aspect upfront. I will say this, though — if a person’s serious about treatment, and if they have to pay money out of pocket for their treatment, and if they recover long-term, it’s the greatest investment they’ll ever make.

Once a person has met all requirements, gone through orientation, made it through the assessment and a doctor’s visit to be cleared medically, then the person begins group therapy and individual counseling. In the next post, I’ll describe the treatment program in IOP. If a person has any questions about treatment and doesn’t want to come in, they can always call us — everything is confidential.

 

Addiction Treatment Review

recovery managementA periodic addiction treatment review is helpful, I believe, because many people reaching this blog don’t know much about addiction treatment. There’s a lot of bad information floating around. Because  addiction is difficult to treat, the perception among many is that treatment doesn’t work. So, a lot of people reaching out for help for themselves or a loved one are skeptical. Treatment can and does work. This doesn’t mean a person goes into a treatment facility, completes treatment and never has any more problems with drugs. That does happen, but other times a process starts that can eventually lead to recovery from addiction. 

Recovery from addiction depends on a number of factors — motivation, family support, follow-up with a continuing care plan, attendance at a local support group, environmental factors (Does the person live in an area of high drug use? Does the person have a job that entails a lot of socializing and drinking functions? Are family members using drugs?) A person can recover from addiction under any circumstances if they follow a comprehensive plan and have a strong desire to recover, but it’s harder to recover if conditions are conducive to drug use. As always, when I write “drug use” I’m referring to alcohol as well, if that’s the person’s drug of choice, or if alcohol is the drug that someone uses and then returns to their drug of choice.

Many people believe that if, say, cocaine, is the drug with which they have a problem, then that’s the only drug they need to avoid. The recovering cocaine addict will then substitute alcohol and either develop a problem with alcohol or, more often, while drinking with alcohol impaired judgement, begin craving cocaine and return to the drug of choice. The same goes for a recovering alcoholic who insists that pot is no problem, then while impaired smoking pot makes a bad decision to drink alcohol. Recovery requires clear, sober judgement.

Just like going on a diet, a person can play all sorts of games and rationalize shortcuts and substitutions, but when the half-measures don’t work it’s another lesson. Treatment works, but it’s not a magic cure-all. Basically treatment teaches a person what they have to do after treatment in order to have the best chance at long-term recovery. If a person follows the recovery management plan, they can recover and live a drug-free life. 

Addiction Treatment: Lapse and Re-Lapse

Lapse and relapseIn addiction treatment and recovery, we talk about lapse and relapse. Lapse is when someone is just beginning addiction treatment and starts using again shortly after. Lapsing is common. Think about dieting and how easy it is in the beginning to eat a candy bar when the urge gets strong. The alcoholic or other-drug addict, cocaine addict, opiate addict, etc, in early recovery hasn’t learned how to control the compulsion to drink/use, so, unless they’re following all directions in recovery, they’ll likely give in to the compulsion. It will seem to the person as if they have no control whatsoever over the compulsion that drives them to drink/use. I’ve heard it described by alcoholics as if they went on autopilot, and zombie-like walked into the liquor store, bought the bottle, and before they knew they were drinking. 

If the person returns quickly to recovery to start again and learn why they drank alcohol or used some other drug, then it can be a learning experience. There was a lapse in recovery, the person started back in recovery and went forward. No one has to have a lapse, but it happens. The person will usually feel guilty and beat themselves up, but this shouldn’t last long — the person has to get over it, talk with someone who understands and start again. Addiction recovery is tough in the beginning– lapses happen. I don’t want to make light of a lapse. Some people drink/use again and bad things happen, like a DUI, a fight where someone is seriously injured, the final straw for a spouse who leaves — then the person loses hope and the return to drinking/using turns into the continuance of addiction and down-hill slide. There are much easier ways to learn how to stay sober than going back to alcohol, cocaine, opiates, and suffering consequences. There’s an old saying in recovery communities – it’s easier to stay in recovery than to leave and come back.

A re-lapse is when someone has recovered, then gets away from the things that got the person straight and sober to start with, and they return to active addiction. This can happen after a year in abstinence, 10 years of abstinence or 40 years of abstinence. Re-lapse is usually more severe, because the person becomes more confused, guilt-ridden, filled with shame and anger at themselves. It takes quite a lot for someone who relapses after years of recovery to come back into recovery. Many people don’t make it back. The worse thing the person can do is give in to the shame and guilt and wallow in it.

Just remember, if you’re in recovery, it’s much easier to stay in recovery and continue to maintain recovery – however, if you lapse in early treatment or relapse after years of abstinence, quickly get back and learn from the experience. Remember that’s it’s a disease and you’re human – humans don’t always do what’s best for them. We can start feeling healthy and start believing we never really had a real problem after all, then start drinking or using again only to find that we again lose control. Learn about addiction, and once you know the truth believe that the truth doesn’t change, no matter how long you’ve been abstinent or how healthy and powerful you feel.

 

Benzodiazepines And Opioids Are A Dangerous Combination

Benzos and opiatesBenzodiazepines and opioids are a dangerous combination. Used together the combined sedative effect can lead to overdose and death. A large portion of people who overdose  from opioids are also using benzodiazepines, like Xanax or Klonipin. Below is an excerpt from the National Institute on Drug Abuse:

Revised September 2017

More than 30 percent of overdoses involving opioids also involve benzodiazepines, a type of prescription sedative commonly prescribed for anxiety or to help with insomnia. Benzodiazepines (sometimes called “benzos”) work to calm or sedate a person, by raising the level of the inhibitory neurotransmitter GABA in the brain. Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), among others.

Combining opioids and benzodiazepines can be unsafe because both types of drug sedate users and suppress breathing—the cause of overdose fatality—in addition to impairing cognitive functions. In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepines (see graph).1 Unfortunately, many people are prescribed both drugs simultaneously. In a study of over 300,000 continuously insured patients receiving opioid prescriptions between 2001 and 2013, the percentage of persons also prescribed benzodiazepines rose to 17 percent in 2013 from nine percent in 2001.2 The study showed that people concurrently using both drugs are at higher risk of visiting the emergency department or being admitted to a hospital for a drug-related emergency.

It’s amazing that doctors still prescribe these drugs in combination. To be sure, many patients probably get one prescription from one doctor and the other prescription from another doctor, but if a patient is using opioids long term, the prescribing physician should perform a drug screen periodically to make sure the patient is not using a dangerous combination of drugs. Most people don’t know that benzodiazepines and opioids are a dangerous combination. We need more drug use education, and physicians need more training in medical school. It’s a problem that’s getting worse.

Happy Sober Holidays

 

 

 

 

 

 

 

I wish everyone a happy holiday season. Just because I work in the field of addiction treatment doesn’t mean I’m a prude about drinking. For all who enjoy their drink and don’t have a problem — Cheers! For all who seek happy sober holidays, may you experience the best this time of year has to offer.

Motivation and Recovery From Addiction

When considering motivation and recovery from addiction, there are basically three types of motivation: submission to external pressure, calculation, and commitment. A person can recovery through any of these motivations, but they’re not all equally effective.

The first is when someone comes to treatment because a judge orders it, an attorney recommends it because he wants it to look good in court, a spouse threatens to leave if the person doesn’t get treatment, an employer gives an ultimatum of get addiction treatment or get fired, etc. Succumbing to external pressure is the weakest form of motivation. Leverage such as this is a powerful motivator to get someone in treatment, but getting in treatment and getting into recovery aren’t the same. If a person who’s forced into treatment doesn’t realize the severity of the problem and doesn’t get involved in their treatment, then they’re just killing time to meet the requirements of those who forced them into treatment. They aren’t really forced, because they have the freedom to refuse and face the consequences, but many find the consequences too dire, so they agree to go to treatment. Most people forced into treatment don’t do well, but for some it’s a wake up call. When we consider statistics related to treatment success, these clients bring the success rate down because they never intended to recover from addiction to begin with, just satisfy a judge, spouse or employer. Although the motivation to keep a spouse, stay out of jail, or keep a job is strong, once a little time goes by and everyone is off the person’s back, they usually return to the their drug use (remember, alcohol is a drug).

The second form when considering motivation and recovery from addiction is calculation. This is when a person looks at what drugs have done to them and makes a rational calculation that it’s costing too much money, they’re taking to many risks legally and healthwise, they’re spending too much time away from family, so on and so forth. This motivation is stronger because at least the person’s considering recovery and has given addiction recovery some thought. Most people who talk with someone who’s calculated the risks and decides to give recovery a try think this person is doing great and is ready to change for good. Calculation is stronger than submission to pressure, but it’s still not enough for most addicts who’ve been using for a long time. What happens is that as long as the calculation proves to be a wise move, then all is well, but once there are bumps in the road, and there will be bumps, the person re-calculates and might say something like “things are worse in recovery” – they might start thinking about using/drinking again. Just because someone stops drinking alcohol or using some other drug doesn’t mean every thing will progressively get better with no problems. Life’s full of problems whether someone’s an addict or not. A person can get into treatment and everything can be fine, but then a spouse can tell the person they want a divorce. The person in early recovery can get fired. Something the person did before might catch up with them and they get into legal trouble. If a person gets sober and straight because they calculate everything will always be good and positive, then they’re setting themselves up for disappointment and likely a relapse.

The third form when considering motivation and recovery from addiction is commitment. This is when a person accepts they suffer from a chronic brain disease and commit to recovery no matter what happens. This person usually knows that it will be hard but they commit to follow directions and do all the things necessary to recover and deal with life as it is, not how they imagine it should be or pretend it is. This person knows no matter how bad things get, drinking or using only makes it worse. The person who commits to recovery from addiction accepts help and realizes he/she can’t do it alone. The person who commits follows through and decides to stay sober and straight one day at time, knowing they might still crave the drug, but choosing to use all the recovery tools to not take the first drink or first hit, or first snort, or first pill, whatever drug changes their perception of reality.

As I wrote above, a person can recover from any form of motivation, but it usually has to progress to commitment for the recovery to be strong and lasting.

Atheists & Agnostics in Alcoholics Anonymous

Atheists & agnostics in Alcoholics Anonymous (AA) is a controversial subject among some in AA. The concept of a Higher Power is alien to an atheist and often not viable for the agnostic. Depending on where a recovering alcoholic first tries AA, the subject of “God” might be too much for someone who doesn’t accept God as real. AA literature is loaded with references to God, yet AA states that a belief in God is not necessary to join AA. Many AA members who are Christians don’t understand how someone who doesn’t believe in God can stay sober.

Can an alcoholic who is an atheist or agnostic stay sober? This is how some have solved the problem – this an except from AA Agnostica:

AA Agnostica is meant to be a helping hand for the alcoholic who reaches out to Alcoholics Anonymous for help and finds that she or he is disturbed by the religious content of many AA meetings.

AA Agnostica is not affiliated with any group in AA or any other organization.

Contributors to the AA Agnostica website are all members of Alcoholics Anonymous, unless otherwise indicated. The views they express are neither their groups’ nor those of AA, but solely their own.

There is an increasing number of groups within AA that are not religious in their thinking or practice. These groups don’t recite prayers at the beginning or end of their meetings, nor do they suggest that a belief in God is required to get sober or to maintain sobriety. If the readings at their meetings include AA’s suggested program of recovery, then a secular version of the 12 Steps will often be shared.

If you asked members of AA who belong to these non-religious groups about their vision of the fellowship, they would probably describe it this way:

ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others recover from alcoholism. The only requirement for AA membership is a desire to stop drinking. There are no dues or fees for membership: we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution: neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

AA Agnostica does not endorse or oppose any form of religion or atheism. Our only wish is to ensure suffering alcoholics that they can find sobriety in AA without having to accept anyone else’s beliefs or having to deny their own.

For those who think this is against the true purpose of AA, this a quote from Bill W., an AA co-founder:

 

 

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