Tuesday 28 November 2017

Relapse prevention, recovery management, recovery transcendence

A guest post by William L. White

I have tremendous respect for the work Dr. Alan Marlatt, Dr. Dennis Daley, Terrence Gorski, and others have done pioneering the field of relapse prevention (RP), but I have always been troubled by the relapse language and making RP a focal point in addiction treatment. My concern is threefold. First, the lapse/relapse language is drawn from moral rather than medical discourse and drips with centuries of stigma and contempt that have long been heaped on people experiencing alcohol and other drug-related problems (see earlier blog). Second, characterizing all AOD problems and related disorders as “chronically relapsing” misrepresents the natural course of such problems (grossly underestimating recovery stability and durability) in a way that increases personal, therapeutic, and cultural pessimism regarding the potential resolution of such conditions (see earlier blog). Third, and the focus of the present essay, the RP lens risks inadvertently casting personal and professional attention on deficits and vulnerabilities rather than assets and casting one’s vision backward (to the potential for resurging pathology) rather than forward (toward a flourishing and meaningful recovery). The image is one of running from something (the beast/dragon images often come to mind) rather than being positively drawn toward something of great value of one’s own choosing.

A lens of recovery management (or recovery enhancement) (RM) has advantages not achieved by the RP framework. The RM shift might be cast as “recovering from” to “recovering to,” with the potential for a process of discovery that transcends the recovery experience—a journey traversing from, to, and beyond. The prepositions here are important. We should build on what has been learned within relapse prevention research and practice while focusing on what makes us come alive rather than on what we most fear. At its most practical level, RP and RM are distinguished by a focus on what is not wanted versus what is desired, e.g., debt counseling versus wealth management, disease management (symptom suppression) versus recovery management (facilitation of healing and wholeness), marriage counseling versus marriage enrichment, a focus on correcting defects of character versus expanding character assets, interests, and social contributions. RP might be thought of as “vulnerability (demon) management”; RM might be thought of as “potential management” (e.g., the cultivation and management of a pleasurable, engaged, meaningful, and contributing life).

The RP to RM shift suggested here is part of a larger transition from pathology and treatment paradigms to a recovery paradigm within the AOD policy and service arenas. I am not suggesting that the nuts and bolts of RP be cast aside, only that it be renamed, reframed, and balanced with an emphasis on building personal, family, and community recovery capital. If recovery is more than the removal of alcohol and other drugs from an otherwise unchanged life, then the focus of recovery support interventions should shift from a strict RP focus (a process of problem subtraction) to an RM focus on achieving global health (a process of addition) and increasing one’s potential for a both personal fulfillment and social contribution (a process of multiplication). There is a difference between the prevention of illness and the promotion, achievement, and transcendence of wellness. The field of primary medicine required centuries to discover this simple maxim, and it is still struggling to grasp its full clinical and social implications. Hopefully, the same will not be true for the alcohol and other drug problems arena.

Of Related Interest and Highly Recommended: Krentzman, A. R. (2013). Review of the application of positive psychology to substance use, addiction, and recovery research. Psychology of Addictive Behaviors, 27(1), 151-65.


About the author: William L. White is an Emeritus Senior Research Consultant at Chestnut Health Systems / Lighthouse Institute and past-chair of the board of Recovery Communities United. Bill has a Master’s degree in Addiction Studies and has worked full time in the addictions field since 1969 as a streetworker, counselor, clinical director, researcher and well-traveled trainer and consultant. He has authored or co-authored more than 400 articles, monographs, research reports and book chapters and 17 books. His book, Slaying the Dragon – The History of Addiction Treatment and Recovery in America, received the McGovern Family Foundation Award for the best book on addiction recovery. Bill’s sustained contributions to the field have been acknowledged by awards from the National Association of Addiction Treatment Providers, the National Council on Alcoholism and Drug Dependence, NAADAC: The Association of Addiction Professionals, the American Society of Addiction Medicine, and the Native American Wellbriety Movement. Bill’s widely read papers on recovery advocacy have been published by the Johnson Institute in a book entitled Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement.


Source: Selected Papers of William L. White  (used with permission)


 



from
http://blog.smartrecovery.org/2017/11/28/relapse-prevention-recovery-management-recovery-transcendence/

Tuesday 21 November 2017

Celebrate the Holidays Safely, Comfortably, Joyously

Celebrating the Holidays with Recovering Family Members and Friends
Peter Gaumond, Chief, ONDCP Recovery Branch

Holidays in RecoveryThis time each year can be stressful for anyone, but the holidays present a special challenge for people recovering from a substance use disorder. Those in long-term recovery typically are adept at navigating the minefield of temptation at holiday social gatherings. But many of those in their first year of recovery, their friends, and family members wonder how best to celebrate the holidays safely, comfortably, and joyously.

If your festivities will include someone with a year or more in recovery, you may simply want to ask if there is anything you can do to make the holiday better for them. They may want to bring a friend who’s also in recovery. They may have beverage preferences or want the flexibility to step out for a short while, either to attend a mutual aid meeting (e.g., Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery), make a call, or get some fresh air.

The holidays may come with expectations, such as shopping, travel, cooking, and multiple social gatherings. People in early recovery are often experiencing difficult personal or financial circumstances while at the same time trying to learn to live without the substance that had become central to their lives. While the holidays are a time to celebrate family and good cheer, they are also a time when other feelings can be heightened. Such feelings can include a sense of loss about a deceased family member, or feelings of hurt, resentment, anger, shame, or guilt about the past on the part of the recovering person, other family members, or both.

Early recovery brings reawakened awareness of the harm one caused oneself and one’s family and friends during the course of the addiction. It is also a time when the brain and body are still actively recovering from the effects of addiction. Those in early recovery are relatively new at learning to experience, process, and manage feelings and to function in social situations without the use of a substance. Alcohol or other drugs may have served the recovering person as a social lubricant during the early stages of their use, helping alleviate social anxiety and feelings of not fitting in while simultaneously lifting their guard, making it easier to speak and act spontaneously.  The social events of the holidays can be challenging in a number of ways for the individual who is new to recovery.

Fortunately, many in early recovery do well during the holidays. The experience of sharing the holidays with family or friends can strengthen their recovery and reinforce the value of the fuller, more authentic way of life they are entering. The holidays can, in effect, be a time to reconnect and restore. To help foster a positive holiday environment for those in recovery, please keep in mind the following:

Tips for celebrating the holidays with family or friends in early recovery:

  1. You are not responsible for your guest’s recovery, even if that guest is your child, sibling, or parent. Behind the scenes orchestration to “help” the recovering person through the event can sometimes be unhelpful. Instead, reach out to him or her to see if there’s anything you can do to help the event  go smoothly. If you do, be ready and willing to accept “No, thank you” as the answer.
  2. Ask yourself if you and your family are ready to celebrate the holiday with the recovering person. Are there unresolved hurts or resentments that could make the holiday difficult for all? Does your family understand addiction and embrace recovery or is the topic shrouded in shame, an “elephant in the room”? Addiction affects not only the addicted individual, but the family as a whole. Denial or shame around addiction, if not appropriately addressed, can make the holiday difficult for the family and risky for the recovering person. So, it’s worth asking: Are you and your family ready?
  3. Ask your friend or family member if they are comfortable taking part in the celebration this year. Make sure they understand that it is perfectly OK to miss the celebration if that is what is best for their recovery. Their recovery comes first. It’s better to miss them this time around in order to increase the likelihood that they will be alive, well, and able to participate in future events.  Think of it as an investment that will pay dividends.
  4. If you will be serving alcohol, check to see if your invitee is comfortable with that. Note, even if you’re willing to host an alcohol-free holiday event, your family member or friend might not be comfortable attending if alcohol is not served simply because he or she is present.
  5. Ask if they’d like to invite someone or invite others who do not drink. Regardless of whether alcohol is served or not, the recovering person may want to invite a recovering guest. If you’re serving alcohol and have family members or friends who are in recovery or who do not drink, you may want to ask your guest if he or she would like you to invite them so that there will be other non-drinkers with whom to socialize.
  6. Ask what kinds of beverages they would like to have. While non-alcoholic “mocktails” may seem like a good idea—and many in recovery do enjoy them—they  may actually be a trigger for some people in early recovery, either because they visually remind the guest of cocktails or because they remind the individual that he or she can no longer drink. Despite all the pain and aggravation that alcohol and drugs may have caused the recovering individual, giving them up can result in a powerful sense of loss. Beverages such as hot spiced cider, hot cocoa, iced or hot tea or coffee are often welcomed. Some people in long-term recovery drink so-called “non-alcoholic” beer and wine. If this works for them, it is of course perfectly acceptable. It should be noted, though, that these beverages generally do include small amounts of alcohol. For people in the early stages of recovery from alcohol addiction, these beverages should be avoided.
  7. Provide time and space to step away from the group, if needed. Being able to take a walk, relax in a quiet room, step away to connect by telephone with another person in recovery, attend a mutual aid meeting, or gracefully depart early can be very important to a person in early recovery.
  8. Listen to them. If they don’t want any special steps taken to accommodate them, and both you and they are comfortable with them taking part this time, then simply go ahead.

Tips for individuals or families in early recovery:

  • Have a plan for the holiday, including mutual aid meetings and calls to sponsor, mentor, recovering peer, counselor, clergy or others central to your recovery.
  • Identify risk factors that should be avoided and know how you will respond if they’re encountered.
  • Know your signs of potential relapse and take steps to address them.
  • Stay in touch with your key supports, such as counselors, sponsors, mentors, or recovering peers.
  • Keep it all in perspective: Nothing that happens, no matter how painful or unpleasant, is worth giving up one’s recovery.
  • If relapse does, occur, don’t delay acting out of shame or guilt. Get help immediately. There is still an opportunity to build on the progress you’ve made.

    Source: The Whitehouse ONDCP Blog



from
http://blog.smartrecovery.org/2017/11/21/celebrate-the-holidays-safely-comfortably-joyously/

Tuesday 14 November 2017

How to improve your sleep while in addiction recovery

Sleep disorders are a common struggle in recovery from addiction

Guest blogger, Alisa, Nestmaven.com

According to a study in the Journal of Addiction Medicine, the incidence of insomnia is five times higher in early recovery than in the general population. Insomnia is not the only sleep disorder associated with addiction; contribute to the development of circadian rhythm disorders, parasomnias and sleep apnea.

The relationship between sleep and addiction goes both ways: while the mechanisms of addiction and withdrawal cause sleep disorders, the resulting sleep deprivation can inhibit the recovery process. The consequences of sleep deprivation include low mood, impulsivity, and poor emotional regulation which increase the likelihood of relapse.

The SMART recovery approach can be used to identify areas in your life where you are lacking balance. If you are experiencing sleep issues while recovering from an addiction, making changes in your lifestyle and environment can dramatically improve your symptoms.

Light Exposure

Light is the most powerful cue for our circadian rhythms which are responsible for guiding the sleep-wake schedule.

Timing light exposure for the correct times of day, while avoiding unnecessary light sources as bedtime approaches. Basking in light — especially sunlight — first thing after waking up can help combat sleep inertia; while dimming house lights in the evening signals that it’s time to start winding down for sleep.

Blue light is emitted by electronic device screens (including computers, laptops and smartphones) and is responsible for blocking the release of the sleep hormone melatonin. These devices should be avoided at night, and, when their use is necessary, nightmode should be activated.

Light Therapy is used to treat circadian rhythm disorders and insomnia, the two disorders with the highest incidence in recovery. Light therapy is also a useful tool in treating the depression which frequently occurs alongside drug addiction.

Diet

Diet, while an important part of any healthy lifestyle, lends additional benefits to those struggling with sleep disorders.

Foods that inhibit sleep include those high in sugar and refined fats, as well as spicy foods and chocolate depending on its caffeine content. People suffering from sleep disorders should avoid these foods, particularly after midday.

Foods that promote sleep do so by either inducing drowsiness or through inducing muscle relaxation to relieve discomfort. Experts recommend natural sources of magnesium, potassium and B vitamins such as legumes and leafy green vegetables. Dairy products and animal proteins contain tryptophan — a precursor to the neurochemicals serotonin and melatonin which are essential to sleep.

The timing of meals is just as important as their content. It’s recommended to avoid eating — especially large, heavy meals — late at night as it can make falling asleep difficult. Additionally, consuming regularly spaced meals and snacks throughout the day can help prevent dips in energy level.

Exercise

Both physical and mental exercise play an important role in regulating circadian rhythms and increasing relaxation.

Studies have shown that performing aerobic exercise 3-4 hours before bed has the greatest effect on sleep: reducing sleep latency and increasing overall sleep time. A short workout of 15-30 minutes per day is sufficient to see an effect.

Meditation is exercise for the mind and with consistent practice has been proven to reduce stress and promote restful sleep. One popular form of meditation, called mindfulness, focuses on bringing attention to the present moment and foster a nonjudgmental mentality.

Sleep Environment

The bedroom environment should be designed in a way to promote comfort and relaxation, while simultaneously reducing factors which inhibit sleep.

Bedding should be selected to fit each individual’s needs. One must consider sleep position, weight and physical complaints when choosing a mattress and pillows. It’s likewise important to replace items within the recommended time frame to ensure that the body is properly supported during sleep.

Temperature plays an important role in circadian rhythms. During the night, body temperature drops to its lowest point, before steadily rising again by morning. Setting the thermostat lower at bedtime (around 60 – 70 degrees Fahrenheit) promotes more restful sleep.

Noise at night, particularly for light sleepers, can make it difficult to drift off and stay asleep. Even when not consciously perceived, environmental sounds can cause restlessness. White noise can be used to dampen these sounds, whether played through a dedicated machine or a mobile application.

Colors have influence over mood and energy levels. Research indicates that those who sleep in a blue colored room tend to get more sleep and wake up feeling more refreshed. Experts recommend choosing a color scheme which instills an atmosphere of calm in the bedroom.

Bedtime Routine

According to leading sleep specialists, maintaining a bedtime routine is one of the most effective strategies for combatting insomnia and promoting quality sleep.

A relatively set sleep-wake schedule should be adhered to every day (weekends included). This allows your circadian rhythms to adjust to a regular pattern, preventing desynchrony that results in sleep disorder.

Reserve the bedroom for sleep and intimacy only. Sleep experts warn against using the bedroom for other activities as these habits can inhibit the association between the space and sleep.

A bedtime routine including relaxation helps make the transition from a state of wakefulness to sleep more natural. Recommended activities include yoga and meditation, as well as simple comforts such as taking a hot bath or reading a story.

It’s important to discuss your sleep issues with your doctor and others in your recovery support system to ensure your needs are being properly addressed. Better sleep leads to healthier living, and better empowers you to take the steps towards sobriety.

 

 

Alisa is the editor in chief at Nestmaven.com where she writes about all things sleep related – from how to improve your sleep hygiene, how to find the best mattress or tips on sleep meditation techniques. She has a Bachelor of Honors in Information Science, loves yoga, healthy food and chocolate (and is totally fine with that contradiction).


 

We invite SMART-related blog entries from all interested readers. Entries should have strong pertinence to SMART. Queries are welcome. Send manuscripts or queries to blog@smartrecovery.org

 

 

 



from
http://blog.smartrecovery.org/2017/11/14/how-to-improve-your-sleep-while-in-addiction-recovery/

Tuesday 7 November 2017

Book Review: Alex Korb’s The Upward Spiral

Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time. Oakland, CA: New Harbinger Publications, 2015, 225 pp.

Review by Ted Alston, facilitator

Bad feelings and bad habits fly together, and evasive maneuvers for one may serve for both. Accordingly, students of SMART Recovery may enjoy this book that addresses depression. Alex Korb, PhD, is an expert on neurotransmission, but he presents a model permitting self-management and and self-empowerment to have roles in mental health. In this model. a prescriber might help someone with a medication molecule that modulates neurotransmission, but readers have the power to choose other reasonable tactics that are non-pharmacological but have neurotransmission aspects.

Korb puts forth the important and attractive concept that neuroscience does not doom anyone to depression or addiction, nor to various other conditions with labels. He emphasizes that we all have pretty much the same instrument of thought and behavior. Whatever genetic or experiential differences may be, the troubled brain is usually out of tune rather than defective. Korb has a gift for analogy, and I do not want to spoil the encounters of his readers with those gems, but I will mention one. I liked when he said, “There’s nothing wrong with your brain, just like there’s nothing wrong with the air in Oklahoma–despite the devastating tornados.” This excerpted quote might seem inscrutable, but Korb’s full argument is easy to follow.

Korb offers much advice that is in line with the philosophies of SMART tools. For instance, a section of Chapter 2 is subtitled “The ABCs of Anxiety.” The Korb ABC is different from that of Albert Ellis, but it rhymes. One could delete all of the neuroscience from the Korb book and be left with a practical and reasonable pamphlet collating many SMART concepts. However, Korb offers a lot more than that. His every point includes a rationale based on what is known about neuroanatomy and neurophysiology. The book is intended for a broad audience, so the science depth is limited. However, the work is a superb introduction to neuroscience. Even a professional neuroscientist might appreciate the book for Korb’s power of explication.

Pharmacological and procedural therapies are beyond the scope of SMART Recovery, but the subjects are of wide interest. This book is a great introduction but does not attempt to handle issues such as the potential for adverse effects. However, too much information would have detracted from the superb readability. Consequently, there are a few glib statements. For instance, electroconvulsive therapy “increases BDNF, which helps grow new neurons.” (BDNF is a protein called Brain-Derived Neurotrophic Factor.) Anyway, ECT is not a focus of the book. Korb has much more to say about other antidepressant strategies, such as cultivating social interactions. According to Chapter 10, boosting gratitude is just the thing for your serotonin. Be that as it may, from a SMART standpoint, grateful beliefs tend to be more rational, helpful, and realistic than ones of ingratitude. And considering your gratitude is a way to examine your beliefs.

Albert Ellis spoke of bibliotherapy for depression and other disturbances. David Burns cited a study showing that the act of reading his book Feeling Good has a measurable antidepressant effect. Korb suggests that a read of Upward Spiral is one small but appreciable change away from depression. The suggestion is plausible.

We invite SMART-related blog entries from all interested readers. Entries should have strong pertinence to SMART. Queries are welcome. Send manuscripts or queries to blog@smartrecovery.org



from
http://blog.smartrecovery.org/2017/11/07/book-review-alex-korbs-the-upward-spiral/