Blog Posts

Living with Addiction: A Developmental, Progressive and Holistic Condition

In the field of substance use disorder care counselors like myself work diligently in support of those nearest to the patients we treat. Whether it is a traditional family member, an elected family member or anyone that shares an emotional bond with the patient, their health and the health of the system they inhabit can be an asset in all measures of patient care. It is vital to have a sound understanding of how the disease of addiction impacts those around the chemically dependent individual. I would like to add a bit to this conversation.

Pre-contemplative

First, it’s important to understand that the evolving methods of compensation that family members and friends create in their efforts to live with someone with substance abuse disorder are mechanisms for survival. Secondly, it is vital to recognize these evolving methods as pre-contemplative; that is to say the individual is not completely aware that they are living in a manner that is all that different. Once the progression begins, previously unthinkable actions or activities come slowly into conception, ultimately working to become acceptable and even commonplace. Without understanding this process it is easy to blame a family member or loved one for “enabling” the behaviors of those with a substance use disorder.

Developmental/Holistic/Progressive

The impact of the disease of addiction is progressive. So, just as an individual with a substance use disorder will become increasingly ill, so too will family members or other loved ones if they remain in proximity of the substance user without intervention. In addition, as clinicians have noted for some time, since the social structures in which family members reside and the physiological responses they have are so similar this progression can be qualified and even quantified to substantiate the level of impact endured. Let’s explore this reality.

Spirituality/Values: At the outset you will see the genesis of this progressive influence on value systems; the impacted family member or other loved ones spiritual nature begins to erode. He or she begins to doubt their own judgment, abilities and senses. They begin to accept violations as to how they might wish to live, or how they are treated. Similarly, a parent, spouse or other loved one begins to feel lost, confused or uncertain and subsequently begins to acquiesce to the previously unacceptable.

Mentally/Rationality: These low-grade violations spark the use of defense systemCapture 1s, or active methods of compensation. The affected family member begins to intellectualize, justify, or minimize what he or she sees and/or how they are now living. Rationalizations become commonplace: “All kids experiment right?” . . . it is just a phase . . . she is just stressed with work . . . it is only weed . . . everything will be better after the holidays . . . and the list goes on. Although these defenses can be quite productive in decreasing discomfort or stress short-term (try saying the word “only” aloud… comforting right?), long-term they add to the mounting violations of self.

Emotionally: Emotions begin to be more high-risk as family members live constantly in fear for the safety and wellbeing of someone they care so much for. They look for control and begin demanding change, and attempt to orchestrate stability. As their confusion and disbelief grows they become angry or dreadfully sad. “How did we get here?”, “why are they doing this?” Members may become defensive and jealous of those not struggling as they are. They begin to feel unsafe in their own home, often consumed with resentment. They can find little hope in most of what is around them and find themselves wishing desperately that things would just change.

Physically/Behaviorally: The substance user and family members have begun to live much differently now; isolating themselves, declining social engagements. As family members grasp for order they become an unwitting detective in their own home, searching for evidence, attempting to fill up the hole that has been created in their heart. They begin to hide valuables, lock rooms; perhaps purchase a safe, or take doors off of hinges. They might sleep on the couch waiting, or drive to a location to see if their loved one got there as they didn’t believe they would, yet could not say “no” to their request. As this progression begins to run full steam family members move into physical distress. They have become hypersensitive to their environment, jumping at sudden noises like when the phones rings or a door slams. Stress responses have led to sleep disturbances in which they might wake hourly, or wake early before the alarm goes off, staring at it each morning as getting out of bed is now a laborious chore. They may even note they have stopped dreaming vividly as they now tend not to enter into REM sleep. Their appetite is diminished, accompanied by other stomach alignments. Finally they might find they are experiencing muscle twitches in their legs or the corner of their eyes, or hair loss, and dry skin. They may notice they are clenching or grinding teeth at night, or biting nails. Breathing is consistently shallow and it feels like a weight is constantly on the chest. Overall they feel sad and unmotivated, have racing, anxious thoughts and forget things easily. Relaxation is a long lost friend as is self-worth and esteem. And yet in spite of the profound impact, in the back of their mind, the thought still remains— “if I could just get them to stop all would be well… “

Moving forward

Those of us who traverse this terrain know well that affected family members and loved ones require and deserve the healing and comfort that accompanies personal recovery. And though not yet its own substantiated diagnosis I believe practitioners should continue to critically evaluate the reality of addiction as a Family Disease and work to classify symptom progression to better support the care we provide clinically.

Be well,

Jerry Blackburn M.Ed., CDP

www.jerryblackburn.weebly.com

If you or a loved one is struggling with a substance use disorder or its impact please seek help.

http://jerryblackburn.weebly.com/resources.html

Mindfulness – An Approach to

by Barbara de Michele

“Mindfulness” should have been the 2014 Word of the Year, because I’m seeing it everywhere.  There’s even a new magazine called Mindful, available on newsstands for $5.95.

Seemingly daily, researchers confirm that mindfulness – which is closely aligned but not quite the same thing as meditation – reduces anxiety, aids in physical healing, sets criminals toward rehabilitation, and helps recovery from addiction.

It also makes you faster than a flying bullet, more powerful than a locomotive and able to leap tall buildings!  Well, not quite.  But, as someone who has practiced meditation and mindfulness for about twenty years, I can say that it’s changed my mind and life in some pretty amazing ways.

I came to meditation following a profound personal loss.  Searching for ways to cope with deep grief, I spotted a small notice in my church’s bulletin offering a four-week introduction to meditation.  I showed up ready to walk out at the slightest hint of weirdness.

The instructor, as it turned out, reminded me of my grandmother – softly plump and welcoming to the 12 people who attended.  She briefly described the history of meditation, showed us how to place our hands and feet, illustrated breathing and how to use a mantra if desired.  And then – boom – she signaled five minutes of meditation and rang a small bell. The room fell into complete silence.

It was excruciating.  Five minutes loomed in front of me like a prison sentence.  My mind darted around like a  . . . well, like a monkey.  What was I supposed to be thinking?  What was I supposed to be feeling?  Breathe in, breathe out, and off my mind raced again.  A thought did occur to me — had I EVER had to sit quietly with myself, doing nothing mentally or physically, in my entire life? As instructed, I let go of the thought as though it were a cloud sailing on the horizon.  Breathe in, breathe out.

The instructor rang the bell and talked briefly about “monkey mind” (oh . . . that’s what that was!) and answered questions.  One man in his twenties expressed great disappointment because “nothing happened.”  After that evening he never returned.  I understood his frustration but was ready to give it another try.  After four weeks I was hooked.

I relished sitting in silence, removed from the busy-ness of the world, safely able to deal with the torrent of thoughts running through my head.  I began sitting every day at home, and tried many different forms of meditation and mindfulness.  By now, I can say that just about everything I needed to know about meditation, I learned in that first class.

Meditation is an incredibly simple, direct method of calming the mind and body, exploring your own mental constructs, and yes . . . eventually . . . arriving at insights that change the way you see yourself, see the world and interact with life.

A few tips:

  • Meditation does not require adherence to a particular set of religious beliefs, or any belief at all. Find an approach that fits with your religious or non-religious orientation.
  • In my exploration of different types of meditation, I came across “mindfulness” which I would define as using meditation techniques – such as deep breathing, focus and non-judgment – while going about your daily business. For example, try eating your breakfast as mindfully as possible, slowing down to experience the taste and texture of the food, thinking about how the food got onto your table, experiencing your own body’s reactions to the food, and so forth. Wake up, focus and objectively observe exactly what is in front of you at any given time and you’ve entered the realm of mindfulness.
  • If joining a class or group is not your thing, there are nearly infinite numbers of books and magazines that explain everything you ever need to know about the subject. “Meditation for Dummies” is a good one.  For a deeper look, try “Sitting Quietly, Doing Nothing,” a chapter in “The Way of Zen” by Alan Watts.
  • Lots of people who practice meditation feel that “nothing happens” for quite some time. Relax. Keep at it.  Breathe in.  Breathe out.  One day you’ll go:  “Aha!”

Eating Disorder Myths and Reality

Eating Disorder Myths and Reality

When I think back to high school and my first years of college, I regret the time I lost to a common obsession: Not an hour went by without thoughts of food—what I ate, what I would eat, what I wouldn’t eat—and my body—how big it was, how much it weighed, how it looked, how I wanted it to look. I didn’t talk with anyone about these thoughts because I thought they were inevitable. I didn’t think I had a serious problem because every girl seemed to share my obsession. That’s how it was, I thought, and there was nothing anyone could do about it. Sure I binged sometimes, but that was just a lack of self-control. Sure I went on extreme diets, but that was just to make up for the binges.

Because my behavior didn’t fit my understanding of an eating disorder, I didn’t ask for help until my third year of college when my eating had become so erratic my body started to shut down. To my surprise, I discovered through treatment that I didn’t have to live with self-loathing thoughts and self-punishing behavior. I found respect for my body and freedom from obsession. I might have found freedom years earlier if I hadn’t waited for the situation to become life-threatening before asking for help—if I’d understood how food and body obsession were already robbing me of a full life.

What you think you know about eating disorders might not be true. At best, misconceptions may be hurtful to individuals struggling with disordered eating. At worst, they may keep you or someone you know from getting needed help. Consider these six common eating disorder myths, and how a better understanding can bring hope and healing.

Myth #1: Eating disorders are primarily about food.

Just eat. This may be your intuitive response to someone who refuses food—or to someone who’s bingeing, just stop eating. These are among the least helpful comments you can make to someone with an eating disorder. Eating disorders have complex causes and cannot be willed away. If you are struggling with disordered eating, don’t deceive yourself into thinking you just need more willpower. Don’t beat yourself up when willpower fails. Find someone who can help.

Check out the National Eating Disorders Association (NEDA) website for more information about the causes and treatment of eating disorders.

Myth #2: Eating disorders are a “white girl’s disease.”

Eating disorders affect individuals of all ethnic backgrounds and ages, and males have eating disorders too. The national Eating Disorders Coalition reports an increase in the prevalence of eating disorders among all ethnic and cultural groups. Disordered eating can begin in elementary school and is becoming more common among older women. And according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), males account for 10 to 15 percent of those diagnosed with eating disorders. Don’t dismiss your own or someone else’s struggle because it doesn’t match the picture you expect to see. Eating disorders are real and their consequences are serious no matter who experiences them.

For further reading, see NEDA’s collection of articles about eating disorders among diverse populations.

Myth #3: Body size is the best indicator of an eating disorder.

People of all shapes and sizes have eating disorders. While a low body weight is among the diagnostic criteria for anorexia, individuals with binge eating disorder are often obese, and those with bulimia can be underweight, overweight, or in between. What’s more, it’s difficult to judge weight by appearance. An emaciated look is cause for concern, but distress over food is a more consistent indicator that help is needed.

Read more about the signs and symptoms of eating disorders at the Eating Disorder Hope website.

Myth #4: People with eating disorders don’t want help.

While resistance to treatment is not uncommon, studies have found that as many as 80 percent of referred patients agree to receive help and remain in treatment through its completion. Other studies have found that individuals who received life-saving eating disorder treatment without their initial consent later expressed goodwill toward care providers. Don’t assume someone with an eating disorder will refuse your help. If they do initially refuse, don’t assume that nothing can be done.

Helpguide.org offers tips on helping someone with an eating disorder.

Myth #5: Eating disorders aren’t dangerous.

Don’t write off troublesome eating behavior as “no big deal.” Despite what you might read on pro-ana or pro-mia websites, there is no healthy way to embrace an eating disorder. Eating disorders are always damaging to your physical and mental health, and they can become fatal. For example, ANAD reports that young women with anorexia are 12 times more likely to die before age 24 than young women without anorexia. Take disordered eating seriously and ask for help. The earlier a person seeks treatment, the higher the likelihood of success.

Myth #6: You can never recover from an eating disorder.

According to statistics reported on the website Mirror-Mirror.org, 60 percent of those who receive eating disorder treatment experience full recovery, and another 20 percent experience partial recovery. Recovery can be a slow process, lasting several years and involving relapses and restarts. If you or someone you love is recovering from an eating disorder, have patience and hope. Find a provider and type of treatment that works for you. Recovery is possible and, with appropriate treatment, likely.

Read more about recovering from an eating disorder.

Sources:

Eating Disorders Coalition: http://eatingdisorderscoalition.org/

Eating Disorder Hope: http://www.eatingdisorderhope.com/

Helpguide.org: http://helpguide.org/

Mirror-Mirror.org: http://www.mirror-mirror.org/

National Association of Anorexia Nervosa and Associated Disorders: http://www.anad.org/

National Eating Disorders Association: http://www.nationaleatingdisorders.org/

Becoming Part of the Solution

As with communities all over the country, Issaquah and Sammamish are in the midst of a healthcare crisis. In the last month or so we have witnessed several fatal overdoses involving young adults, and even as a healthcare provider I cannot begin to estimate how many overdoses have gone without response.

What we have begun to acknowledge in our community however is that substance use, abuse and dependence are an ever present reality that require our compassionate attention.   Drug use trends tend to change slowly as is the nature of populations. That being said, at times we can have bursts of change, usually resulting from some atypical event. Take for example what is commonly referred to as our current “opiate epidemic”— in hindsight a clear product of the massive over-prescription of powerful opiate medication. Another example is our state’s rapid comfort with medicinal and recreational use of marijuana impacting youth access and use.

There are fortunately some community investments we can make to support our young folks with regard to risk and protective factors.

Some of the basics are:

  • Be informed- Reality and perception are often distant. For example according to Issaquah High School’s 2012 Healthy Youth Survey, 40% of our seniors report having used marijuana. What percentage of parents might consider it to be their child? http://www.issaquah.wednet.edu/family/health/HYS.aspx
  • Share a consistent message- Often students hear mixed messages. Perhaps one substance is acceptable, and another is not, etc. Law enforcement, parents, schools and the community can work to share a common theme. Bottom line, healthy youth do not use any substances, and alcohol and other drug use always degrades their physiological wellness, health and development.
  • Share your expectations- This is a significant predictor of young people declining to use drugs. They really do hear us!
  • Positively populate- Be a vocal, invested community member. Venture out and provide a community norm that regards health and safety and discourages drug use and other illegal activity.

Our young people look to us for boundaries and a safe place to learn and grow. They thrive in the security and consistency we create. Let us give them the best that we have. The most advantageous of opportunities.

Please join us for substance use specific content and support in our community.

https://www.facebook.com/IssaquahCommunityDrugFreeCoalition

Let’s Learn About Mental Health Parity

All right students, take out your textbooks and turn to page 42, “learning about mental health parity.”

Enough already with the moaning and groaning.  This is an important topic.

Did you know, for example, that “the vast majority of Americans” know nothing about mental health parity?  According to Dr. Gregory Fritz of Brown University, “They are neither ‘for’ nor ‘against’ it – they just don’t think about it.”

Dr. Fritz also says that mental health advocates have a “huge educational task” before them and that the first step is to “educate ourselves.”

So let’s get on with it!  Let’s learn about mental health parity.

The word “parity” means “the state or condition of being equal, especially in status or pay.”  When we talk about “mental health parity” we are highlighting efforts to treat mental health with the same dignity and importance as physical health.

Sounds simple, right?  Unfortunately, for centuries people didn’t think mental health was equal to physical health.  Even in the 20th Century, “It’s all in your head” and “get a grip” were responses given to men and women seeking help for mental illness.  The stigma was so painful that most people feared to seek help.

It’s been a long, hard struggle to bring mental illness out of the shadows.

Less than twenty years ago the first Mental Health Parity Act was passed by the United States Congress.  The MHPA required insurers to provide mental health benefits no lower than the annual and lifetime benefits they accorded to physical health.

It was a good first step, but essentially toothless.  Like today, most patients didn’t know about the law.  Doctors, hospitals and insurers found ways to get around it.  The law itself didn’t actually mandate mental health coverage.  Insurers could simply by-pass the Act by not offering it.  The Act didn’t cover substance abuse treatment, because – even in 1996 – most Americans viewed substance abuse as a moral, not a physical, failure.

Then, in 2008, Congress passed the Mental Health Parity and Addiction Equity Act.  Once again, the MHPAEA did not mandate mental health coverage.  And, once again, the MHPAEA was stymied, this time by regulatory agencies that delayed interpretive rulings until late 2013.  However, for the first time, substance abuse disorders were included.

By 2013 the MHPAEA had already been superseded by passage of the Affordable Care Act (aka Obamacare).  Under the ACA, mental health is one of ten “Essential Health Benefits” (EHBs).  The ACA mandates equal coverage for mental health, substance abuse disorders and eating disorders.

Yes, that’s right Jonah.  Mental health parity is now the law of the land.

Is the fight over?  Doctors report there are not enough psychologists, counselors and therapists to meet the increased need for mental health services.  Along with the law, we need a greatly expanded mental health infrastructure.  In addition, the stigma of mental illness and substance abuse disorders continues to keep patients from seeking treatment.

Even with these challenges, we’re at an historic crossroads in the history of mental health.  Dr. Fritz says, “We are seeing the greatest increase in mental health treatment in a generation,” affecting some 62 million people.

Students, that’s all the time we have for this session on Mental Health Parity.

But before you go, remember this:  you can help.  Tell your friends, family, classmates, and the community that it is okay to seek medical help for mental illness, substance abuse disorders and eating disorders.  Not only are these diseases curable in many cases, the law says they should be treated the same way doctors treat a broken arm, a skin rash or the flu.

Thanks for your attention.  Class dismissed!!

Coping with Anxiety

I had my first panic attack in seventh grade, while taking a science test. One minute, I was scribbling an answer to an essay question. The next minute, my heart was pounding, my skin was clammy, and I felt dizzy and numb. My teacher sent me to the nurse’s office, and I made up the test the next day. It wasn’t until several years and a dozen panic attacks later that I understood my symptoms as a physical experience of anxiety.

Anxiety – an uncomfortable feeling of fear or concern – is a common and normal human experience. In fact, anxiety is beneficial when it keeps us from taking unnecessary risks or motivates us to prepare for a challenge. But anxiety becomes a problem when it interferes with daily life. Chronic worry, avoidance behaviors, and frequent panic attacks can all be symptoms of problematic anxiety.

Fortunately, people of all ages can learn to manage anxiety. The remainder of this post will offer tips on coping with anxiety, followed by a discussion of when and how to ask for help.

Managing Anxiety

The following suggestions for managing anxiety are adapted from the Anxiety and Depression Association of America website:

  • Take a break. Practice deep breathing, learn a relaxation technique, pray or meditate, listen to music, enjoy nature, read a book, write in a journal. Try something that calms you and gives you time away from your problem.
  • Take care of your physical self. Get enough sleep and exercise. Fuel your body with healthy foods. Avoid caffeine and sugar.
  • Adjust your outlook. Have realistic expectations. Aim for good, not perfect. Accept that you can’t control everything. Try replacing negative thoughts with positive. Embrace humor.
  • Learn what triggers your anxiety. Prepare for challenges instead of avoiding them. Facing your fears takes away their power.
  • Building healthy relationships. Find a group activity you enjoy. Help others and let them help you. Share your feelings with someone you trust.

When and How to Ask for Professional Help

Sometimes individual coping strategies are not enough. The National Institute of Mental Health estimates that about 8 percent of teens have diagnosable anxiety disorders and could benefit from treatment. Individuals with untreated anxiety disorders are at increased risk for depression, substance abuse, disordered eating, and other issues. (For example, I learned to cope with my panic attacks while in treatment for depression.) Anxiety treatment has a high rate of success and can include therapy, medication, or both. According to the American Psychological Association, the following are signs that it’s time to ask for help:

  • You experience extreme fear or worry that does not let up.
  • Anxiety is interfering with your daily life.
  • You have trouble concentrating because of your worries.
  • You have frequent panic attacks.
  • You often avoid situations due to unrealistic fears.
  • You repeatedly perform routines or rituals to try to rid yourself of anxiety.

A parent, school counselor, or other trusted adult can support you in seeking professional help for anxiety. You can also find support and links to resources through NAMI Washington, Psychology Today’s therapist directory, or King County’s Teen Link help line (1-866-833-6546).

To meet some real teens who have received successful treatment for anxiety, watch “Worried Sick: Living with Anxiety,” a 22-minute video produced for Nick News.

Sources:

American Psychological Association

Anxiety and Depression Association of America

National Institute of Mental Health

Addiction: A disease or bad behaviors

When chatting with the kids I work with in treatment about the healthy results recovery affords us, I often joke with them that I have 21 years clean and sober and have not been arrested in, let’s see, 21 years. Must be just an odd coincidence.

All jokes aside I can easily appreciate why folks still have such difficulty understanding Substance Use Disorders as a disease rather than a function of poor choices or even character or morality. Let’s look at a few of the factors that may contribute to this difficulty.

I think one that is glaringly apparent regards our culture’s connection to the idea of personal choice. It makes sense that this American ideal would contradict the loss of control a chemically dependent individual experiences as we do not “drink responsibly” as the ad suggests. So powerful is this notion in fact that many of us with this healthcare condition blame ourselves and struggle with significant guilt over our actions while in active addiction.

Another factor is simply statistical. The majority of folks never develop any difficulty with substance use and cannot imagine how someone would not have the ability to control their own behaviors.

Finally, and let’s be honest, quite early on in the progression of this disease an individual begins violating their own system of values and acts in a manner contradictory to commonly held social and legal standards the majority adhere to. Sadly I am the one ruining a good friend’s wedding, picking the kids up after a few too many, or passing out at the birthday party. I am the one who is “super nice” as long as I am not drinking. The list just goes on and folks whisper “why would he keep doing that?”, yet no one waits for the answer.

Well here it is.

To transcend the common misconceptions related to Substance Use Disorders we have to understand their nature. Some individuals simply have a response to substances that is anomalous or exceptional. Think about a bell curve. No healthcare condition effects everyone. This unique response is usually a function of a genetic predisposition and it subsequently begins the ever increasing compulsion and obsession to use substances in spite of sometimes catastrophic consequences in order to maintain the pleasurable reward response. As time goes on my central nervous system is just unable to keep me in balance neurologically and so continued drug use becomes the only option for general comfort or even survival.

Imagine being hungry, having not eaten for days. What lengths might you go to in order to satisfy this need? Now multiply that by hundreds! This is the “why” if you will. Executive [brain] functions (Prefrontal Cortex) simply do not have the ability to override the primal necessity created in the reward pleasure center (Nucleus Accumbens). Human beings are designed like this. Primitive systems such as pain, or flight/fright are designed to take precedence. As such, I do not “want” to use a substance, I “need” to use. This combined with tissue dependence leaves a biological system that only functions normally in the presence of a drug.

This does not mean I am not accountable for my actions as I am solely responsible for my health in recovery and the amends I need to make. It simply means I am not a bad person needing to get good, but rather an individual with a healthcare condition that needs to be managed into remission.