RecoveryCoachNewYorkCity.com

Author: Melissa Killeen

  • 7 questions wives of porn addicts ask

    manhattan_bridge_post_versionPornography addiction is a form of sex addiction. Wives of porn addicts are baffled by this addiction and feel like they are partially responsible for her husband’s behavior. The reasons for this are numerous and include the shame associated with this addiction for both the addict and the spouse, the sense of betrayal, and stereotypes linked to the addiction. Ella Hutchinson, a counselor from Katy, Texas who specializes in counseling wives of sex addicts. She sees women who haven’t told anyone about their husband’s addiction, sometimes for months, years and often they never disclose. The lack of support available to spouses, and often inaccurate information being put out about partners of sexual addicts, can cause a wife to suffer additional trauma. Ella has formulated 7 questions wives of porn addicts ask.

    #1: How can my husband love me and look at porn when he knows it hurts me?

     It is possible for your husband to love you, even though he is looking at pornography. In fact, the two are completely unrelated. Men are better than women at compartmentalization. A man’s brain can be compared to a waffle. There are many different compartments so that he can divide his life up into separate components that don’t touch each other. His marriage and family can be in one compartment, his job in another…you get the point. This is a benefit when a man is fighting in a war and able to focus on the task at hand without worrying about his family back home. But it also makes a man able to look at pornography without thinking about how it may hurt you or his marriage. Women’s brains are more like spaghetti where everything is connected. Women are more likely to be worrying about our kids when we are at work and thinking about work when we are at home.

    When a man becomes addicted to pornography, it can become a perceived need rather than a choice for him until he becomes willing to reach out for help. His use of porn causes a release of the same chemicals involved when a drug is ingested. At the height of his addiction, nothing, not even the risk of losing his job or his marriage, is enough to stop him. This explains how a politician or celebrity can make such risky, career-destroying moves without stopping to consider the consequences.

    Later Ella will discuss the kinds of consequences that can catapult an addict into reality.

    #2: Why does my husband prefer porn and masturbation to sex with me?

     Norman Doidge, psychiatrist and author of the acclaimed book, The Brain That Changes Itself, studied porn addicts. He stated,

    They reported increasing difficulty in being turned on by their actual sexual partners, spouses, or girlfriends, though they still considered them objectively attractive. When I asked if this phenomenon had any relationship to viewing pornography, they answered that it initially helped them get more excited during sex but over time had the opposite effect.

    Your husband had this addiction, or the proclivity toward it, before he ever met you, regardless of what he says. In spite of what you think or even what he might have said, nothing you could do could be enough to sexually satisfy your porn addicted spouse. Pornography presents an unrealistic reality that damages a person’s brain. They become engrossed in this fantasy world where they don’t have to worry about pleasing anyone but themselves and no emotional connection is required.

    While a porn addict desperately craves love and intimacy (something he is probably unaware of), he seeks it out in the exact place that will cause him to become less and less able to experience it. As a counselor, Ella hears sexual addicts talk about their past, it becomes apparent why they are so uncomfortable with the idea of intimacy. This topic is beyond our scope here, but it is important for a wife to be aware that there is a reason her husband became addicted to porn, and that reason is not her.

    #3: Why am I not enough if I am sexually available to him?

    Beyond the intimacy issue, pornography offers the thrill of what is forbidden. The more taboo, the more exciting. This is why a porn addict may progress to looking at more hardcore porn and even pornography involving aspects that a healthy person would consider offensive and grotesque.

    Gary Wilson, human sciences instructor, and Marnia Robinson, author of Cupid’s Poisoned Arrow: From Habit to Harmony in Sexual Relationships, state:

     The uniqueness of Internet porn can goad a user relentlessly, as it possesses all the elements that keep dopamine surging. The excitement of the hunt for the perfect image releases dopamine. Moreover, there’s always something new, always something kinkier. Dopamine is released when something is more arousing than anticipated, causing nerve cells to fire like crazy. In contrast, sex with your spouse is not always better than expected. Nor does it offer endless variety. This can cause problems because a primitive part of your brain assumes quantity of dopamine equals value of activity, even when it doesn’t. Indeed, porn’s dopamine fireworks can produce a drug-like high that is more compelling than sex with a familiar mate.

    #4: He says he looks at porn because I don’t have sex with him enough, am I not pretty enough, am I  too fat, etc. What can I do?

    Ella hears this a lot and it is called justification. Your husband doesn’t want to believe he is sick. If he is not ready to admit he is an addict and take responsibility for his own behavior, he will say anything to convince you, and even himself, that he does not have a problem. Blaming you is an easy way to save face.

    There is nothing you could do to be appealing enough to make your husband stop looking at porn. We see very beautiful women whose husbands no longer desire them, couples where the wife looks like she belongs on the cover of Cosmopolitan magazine or on a model runway, and the husband has admitted to her that he is physically repulsed by her. Ella speaks of another couple who has sex every day, yet she still catches him looking at porn and frequenting adult bookstores. There is simply no credibility to the argument that a wife causes or contributes to her husband’s use of pornography.

    #5: My husband says all men do it. Am I making too big a deal out of this?

    It is unfortunate, but true, that pornography use is overwhelmingly common. This does not make it okay or mean you should turn a blind eye. Ella often hears women say that their husband’s porn use makes them feel cheated on. This makes sense. When a man uses porn he is finding sexual satisfaction from someone other than his wife. So the betrayal a woman feels is natural. God created sex to be between a man and his wife. The Ten Commandments interpret looking at a woman with lust is the same as committing adultery with her in his heart. Looking at porn is purposely choosing to lust.

    #6: My husband refuses to get help or admit this is a problem. How can I make him stop? What are the risks if he doesn’t stop?

    In short, you cannot make him stop. It usually takes something significant to get a man to the point where he is ready to admit his porn addiction. This is what they call “hitting rock bottom”. Sometimes, for a man who has hidden his porn use for years, just getting caught is enough. But more often, it takes losing his job, his wife leaving him, or another monumental event to shake him to the core and wake him up to reality. It may be his porn use progressing to acting out with another person or other people and facing the multiple possible consequences of this, to cause him to recognize his need for help.

    You can insist your husband stop his porn use and you have every right to do so. The compulsive use of porn will, without exception, do damage to your marriage and your family. It affects a person’s sense of right and wrong. It can cause your husband to lose respect for you. You will likely feel him pulling further away from you and your family as he gets more entrenched in this sinful lifestyle. If he refuses help, it will only get worse. Your pleading that he stop will fall on deaf ears if he isn’t ready to hear it. This is a harsh reality, but one too many women just do not get. Some women beg and plead for decades until they grow cold and bitter. Then they tell me that they wish they had left years ago and feel they have wasted most of their life.

    When porn is an issue, it is likely that extramarital affairs are or will become an issue. This means you are at risk of more than the heartache of discovering your husband has been sexual with another person. You are also at risk of STDs or your husband fathering another woman’s child. Additionally, your children are almost guaranteed early exposure to porn, something that was likely a contributing factor in your husband’s addiction.

    #7: Is there hope? Can a man like this change?

    Recovery from sexual addiction is very much possible. Men who get out feel a sense of freedom, as if a huge boulder has been lifted off their chest. It is such a liberating feeling that many men forget that their wives are still grieving from his actions and likely will be for some time.

    For some men, simply the threat of their wife leaving is enough to cause them to get help. But for many others, they need something more. This can cause you, as the wife, to feel helpless. You are not helpless. You can’t control your husband’s recovery, but as the injured spouse, you can control your own. The fact that you need recovery does not mean you are sick or that something is wrong with you, but that you have likely been traumatized by your husband’s behavior. Your recovery includes building up a support system for yourself. Don’t keep silent. Reach out to a trusted friend, your pastor, or a therapist. Keeping this secret will cause feelings of shame, loneliness and isolation. Finding a support group for wives of sex/porn addicts can be very helpful. If there is not one in your area, there are phone support groups available, led by trained life coaches and therapists who have been in your shoes. Finally, learn to recognize your unmet needs and what it will take to meet them. A skilled therapist can help you with this. The absolute best book written for wives is Your Sexually Addicted Spouse by Barbara Steffens and Marsha Means. Ella strongly encourages you to find a therapist (individual and marriage) who is familiar with this book and subscribes to the treatment model described in it. If your therapist isn’t familiar, ask if they’d be willing to read it.

    Beyond self-care, Ella recommends that you take some time to come up with some clear, firm boundaries for your marriage. While this may not result in the desired outcome, it is worth it to put in the effort. At the very least, this is a first step toward helping you get to a place where you can make an informed decision about the direction for your relationship. This means bottom line behaviors that you will not tolerate and actions you need to see happening in order for you to feel safe in your marriage. Your list of unacceptable behaviors may include viewing pornography in the home, inappropriate conversations or relationships with other people, and other possible abusive behaviors toward you that are often present in a sexual addict. The actions you need to see your husband take might be installing a filter on computers and phones, open discussions about where all the money is going with you having access to all accounts, attending sexual purity or sexual addiction support groups, counseling, and talking to a pastor.

    Before you present this to your husband, make sure you are prepared to follow through with consequences if he refuses or does not stick to what he agreed to do. Consequences can be anything from insisting one of you move to a separate bedroom (an in-house separation) to one of you moving out of the home. Your husband will likely be resistant to you setting these boundaries and may accuse you of being demanding and giving him an ultimatum. Do not engage in any kind of manipulative or accusatory conversations with your husband. Learn to recognize this behavior and refuse to participate. It is important that you wait to address your new boundaries until you are able to do so in a calm manner. A therapist’s presence (and guidance beforehand) is a good idea. A good book on this topic is The Gaslight Effect by Dr. Robin Stern.

    If your husband does not follow the boundaries you set, you now have a choice to make. You can choose to accept that your husband is simply not ready to stop his porn use. This means letting go of the nagging, criticism, and efforts to control (which should have stopped already by this point since you have learned they don’t work). If you choose to to not follow through with the consequences, even though he has made it clear through his words or actions that he is not willing to stop, you are choosing to accept his behavior. This will probably require a good deal of emotional detachment on your part. It may be a marriage that looks more like you are roommates. Ella says she has not yet met a woman who has chosen this arrangement and found any kind of long-term life satisfaction in it, but it is an option.

    Your choices may need to include making the necessary preparations in case you need to leave. This may mean getting a job if you don’t work and starting to put money aside. Separation does not mean divorce, but it can be a prelude to it. Ideally, that should not be the goal for separation. The purpose is to show your husband that you are unwilling to share him with pornography. Once he sees you are serious and can no longer be placated with words and half-hearted attempts that don’t last, he is also more likely to take his addiction seriously. Also, getting physical space between you and him can make it easier for you to clear your mind, spend more time in prayer and God’s Word, and make objective decisions about your future. A good Christian counselor can guide you through a therapeutic separation where rules are put in place for you both to follow during this time.

    Many men have escaped the chains of sexual addiction. Here is an important truth to be aware of. Your husband has probably tried to stop more times than he can count. He is not deriving pleasure from his lifestyle. He keeps going back, trying to fill a void that porn will never fill. Willpower is not enough. Recovery from sexual addiction is multifaceted, but includes reaching out to other men who have been there, and often requires professional help as well.

    God must be the central focus in recovery. However, many men have learned the hard way, in the words of author, speaker, therapist and recovering addict, Dr. Mark Laaser, “You can’t pray it away.” If prayer was all we needed then we wouldn’t have to have jobs or pay bills. We could just pray about it and our bank account would never run out and the bills would get paid. If prayer was enough we could eat and drink whatever we want and every check-up would reveal a clean bill of health. But God wants us to do the work, and keep doing it.

    Once a man has decided to become serious about recovery from sexual addiction, there are more steps to take to help the marriage heal. After all, just because the behavior has stopped, it doesn’t mean the damage that has been done will go away. Marriage counseling with a skilled sex addiction therapist is important. Couple’s Intensives are a great way to get a jump start on recovery for the couple. Ella recommends the book Hope and Freedom by Milton Magness to learn more about recovery for you, your husband, and your marriage. You can also read more of Ella’s blogs, learn about her weekend retreats and other issues surrounding marriage and sexual addiction on Ella’s website, Comfort Christian Counseling.

    . . . .

    ella hutchinson photoElla Hutchinson, is a Licensed Professional Counselor with a Bachelor of Science degree in Psychology and a Master’s degree in Counseling from St. Edward’s University in Austin, TX. She is also a member of the American Association of Christian Counselors. In addition, Ella is certified in treating sex addiction and specializes in counseling partners of sexual addicts. She practices at

           Comfort Christian Counseling

    2900 Commercial Center Blvd #101, Katy, TX 77494

    You can contact Ella at:

    http://comfortchristiancounseling.com/

     

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  • Ten ways of Improving Your Chances of Keeping that New Year’s Resolution

    calvin-hobbes-new-year-resolution1Make a list and think it through

    It’s that time and everyone is thinking of New Year’s Resolutions. You’re itching to get rid of that bad habit right now, but consider this: think it through. I know you have heard that AA saying “Baby Steps” before…but sticking to a habit change is not trying to be perfect right out of the gate. So before you start trying to change a habit, consider thinking about it thoroughly for a month or two. First, list every reason you want to stop, figuring out what triggers or cues you react to, what routine you fall into as a result of that trigger and experiment with the types of rewards you are looking for from that habit. Write down and record every time you catch yourself doing the habit, and soon a pattern will appear. Maybe checking out a few twelve step programs or a therapy group can give you an idea of outside support options. You will be better prepared to conquer the habit after processing it during the next few weeks.

    2.  Identify your triggers

    By doing this review you will see you do the same behaviors, in the same place, at the same time. If at 3:00, you go on a smoke break in your car, the time and the car itself can become a trigger (or cues as Charles Duhigg author of The Power of Habit calls them). These actions can become a cue to start a habit —sometimes these cues are very subtle to notice. As AA says “Avoid People, Places and Things.” Identify and understand your triggers. These triggers fall into one of the following five categories:

    1. Location, a bar, your ex-girlfriend’s neighborhood, a bakery
    2. Time, 3:00, happy hour, visiting family
    3. Emotional State, Hungry, angry, lonely or tired
    4. Other People, the ex, your Mom, Dad or that annoying co-worker
    5. An immediately preceding action, or what happened just before you picked up that joint? An argument with your spouse? Anticipating that your boss will ream your butt at work this morning for being late? Packing the car to see the folks for the holidays?

    3.  Delayed Gratification and Contingency Management

    There are some other simple psychological tricks you can employ as well, such as delayed gratification and contingency management. The 20-Second Rule is an example of delayed gratification: Make bad habits take 20 seconds longer to start. For example, move junk food to the back of the pantry, or leave the credit cards at home so you don’t over spend on lunch. A program sister suggests a Rule of Five, delaying the behavior until you have 5 glasses of water, or walk for 5 minutes or call five 12 step program people. Consider rewarding yourself for not relapsing, it’s called contingency management. Suggest this to yourself: if I don’t act out for 60 days, I can lead the Sunday night 12 step meeting or if I don’t drink now, later tonight, my wife and I can be intimate, or if I don’t use this week my IOP counselor will give me a free lunch coupon for the Olive Garden.

    4. Reframe that habit thought

    Even if we hate the habit we’re doing, like smoking or over eating, we tend to continue doing it because it provides us with some sort of satisfaction or psychological reward. Catch yourself thinking any positive thoughts or feelings about your bad habits (like: if I have a drink, I will not feel so nervous around my in-laws) and reframe these thoughts to remind you of the negative aspects of your habits. Maybe think this thought instead, “One drink is too many and a thousand drinks is not enough.” That is reframing the habit thought.

    5.  Willpower is in limited supply

    Research has shown that we don’t have unlimited willpower (it didn’t take scholarly research to confirm this for you!) The truth is we’re constantly exercising willpower and self-control. The problem is that willpower is like a muscle, capable of fatigue and a muscle can’t be flexed forever. Researchers placed some study participants in situations in which they had to practice self-control—like not eating chocolate-chip cookies in front of them. While another group could eat as many cookies as they wanted. Then both groups were given a second test that required self-control.

    The results? The group that had to resist the cookies did not perform as well on the second task. The group that was allowed to eat as many cookies they wanted, excelled at this second self-control test. The conclusion was that those who had to exert more willpower in the first task exhausted their willpower strength, and were unable to exert the self-control needed for the second task.

    Just place yourself in a similar situation, think of you controlling yourself from strangling your self-absorbed-narcissistic colleague during a staff meeting, then around to 3:00, a typical smoke break time for you, you are triggered. You want to not smoke, but low and behold, a cigarette seems like just the reward you need.

    6.  Make a plan for relapses

    Chances are you’re going to have bad days. Setbacks are normal and we should expect them. Have a plan to get back on track. Recovery coaches call this a relapse prevention plan (click here to link to Mary Ellen Copeland’s WRAP Plan). Coaches have the client write a relapse prevention plan directly after a slip as a way to understand what happened and how to avoid it next time.

    7.  Harm Reduction Option

    Every recovery coach anticipates a relapse, they acknowledge it will happen and attach no shame or guilt to a slip. Often, choosing an action based on Harm Reduction, (which is most often recognized as distributing clean needles to intravenous drug users to reduce HIV infection) is a good alternative. Some Harm Reduction ideas are: smoke a cigarette instead of a blasting a whole stick, limit yourself to buying a lottery ticket instead of logging on to a gambling web site or eat a cup of fruit yogurt instead of a chocolate chip cookie.

    8.  Change takes a village

    With making a resolution to change, don’t attach it to the ever failing New Year’s Resolution. Attach it to a positive change within you. Let people know about it. Ask for help, even if it is a nagging wife or over- bearing parent. Better yet, join a 12 step group. Research shows change happens when you have support from others.

    9.  Make a Plan

    Once you have figured out your ‘habit loop’, your cues/triggers, the routine you use, and the reward you expect, you can begin to shift your behavior. All you need is a plan. Open your-self up for improved, healthier routines; such as meditation, an afternoon walk, a talk with a co-worker or new way to drive home. These will become very good sources of generating your rewards and within 30, 60 or 90 days it will become a habit. Just give it time and

    10. Don’t give up! Keep trying!! It’s progress not perfection!

     

    Happy New Year!

    Special thanks to Charles Duhigg author of The Power of Habit for supplying all of this excellent information on changing a habit and to Calvin and Hobbes for making fun of it!

     

  • Believe Change is Possible

    manhattan_bridge_post_versionAs a recovery coach, I work with people trying to change a habit. We work on finding different ways of responding to a trigger. For some seeking recovery, they want to find an easier, softer way. Others think willpower is all they need to get sober. But that doesn’t always work. As Charles Duhigg describes in his book, the Power of Habit, for a habit to be changed, people must believe change is possible..

    Where does this belief come from? Habit change can emerge from a tragedy or from some kind of adversity. Many addictions have been successfully abandoned when an individual hits bottom and finally seeks treatment. Many people give up smoking after a diagnosis of heart disease or when a family member is being treated for lung cancer.

    A Harvard study in 1994 examined people that had radically changed their lives. Some had experienced the death of a loved one, divorce or life-threatening illness. Others radically changed their life from observing a friend experience a disaster. Tragedy plays an important part of having an impact on one’s life. But equal to tragedy facilitating change, the same amount of people made change happen in their life because they were surrounded by supportive friends that encouraged change. The Harvard study sites a woman that changed the direction her life when she took one psychology course at a local college and found a group of like-minded individuals. Another man came out of his introverted shell when he joined an acting group. So for change to happen for many, it didn’t take a life shattering event, it simply took a community of believers.

    “Change occurs among people”

    –Todd Heatherton, Dartmouth College Lincoln Filene Professor

    A community of non-smokers talk about how great it feels like to be a non-smoker. How nice it is not to have your hair smell like an ashtray. Your spouse commented on how fresh his clothes smell, now that you have stopped smoking. And co-workers admire you for having the strength to stop smoking. These like-minded people can also resolve some negative feelings, as well. Such as what to do after a meal, when the habit of lighting up a Marlboro is the most strong. Or how to refrain from smoking in your car. These friends are there for you to call, text or email whenever the urge to smoke becomes unbearable. Support from a community and their confidence in you, bolsters the strength you need to believe you will not pick up a cigarette.

    For habits to change permanently, people must believe change is possible. This same process makes any mutual support group very effective – the power of a group to teach individuals that they can believe it is possible to change. This belief happens when people come together to help one another to change. Whether the group is Nicotine Anonymous, a grief support group or massive amounts of volunteers descending on New Orleans, post Katrina, to re-build the city to it’s former glory.

    Change is easier when it occurs within a community.

     

     

  • Changing a Habit

    Changing a Habit

    manhattan_bridge

    Quitting drinking or drugging is the same as developing an exercise program or winning a football game. Simply by changing a habit, you can succeed in staying sober.

    Charles Duhigg investigates this theory in his 2012 book, The Power of Habit. Duhigg uses the classic example of how Bill W., founder of Alcoholics Anonymous, stopped drinking. He expands on this tale, by adding current research verifying the power of believing that the 12-step concept gives an individual the strength to quit a habit.

    In his book, Duhigg outlines the addictive process for the reader and asks them to answer these questions:

    Identify the Craving

    Identify the Cue or Trigger

    What Routine does that kick in?

    What Reward do you receive from completing that routine?

    Yes, many recovering alcoholics will say the answer to #1 is “I am craving alcohol,” but that isn’t necessarily the correct answer. Perhaps the alcoholic is lonely and craves camaraderie, old friends, or being social. Perhaps the alcoholic doesn’t want to spend the evening in his apartment all alone, eating another microwave dinner. So for this recovering alcoholic, his answers to Duhigg’s questions may look like this:

    1. Identify the craving — Not being alone.
    2. Identify the Cue or Trigger — On my way home from work, I drive by my favorite bar, thinking about stopping in to see some friends.
    3. What routine does that kick in? — Stop into the bar, see my friends, and order dinner and a beer.
    4.  What reward do you receive from completing that routine? — Happy spending time with old friends, and having a better meal than a microwave dinner.

    So, we all know how that evening ends.

    Duhigg’s suggestions on changing a habit is as simple as substituting a new routine. Yes, the cravings and cues remain the same, and the reward remains the same, as well. The reward, for our alcoholic friend, is spending time with friends. Here is a suggestion for our friend:

    1. Identify the craving — Not being alone.
    2. Identify the Cue or Trigger — Thinking about seeing some friends.
    3. What routine does that kick in? — Go to an AA meeting which is on my way home, that starts at 6:00pm, and see some friends.
    4. What reward do you receive from completing that routine? — Happy spending time with friends.

    Let’s try this concept on another addiction, such as smoking. I personally have struggled to stop smoking since 2014. I found that I didn’t really crave the act of smoking, I hate the smell and the taste it leaves in my mouth. My craving was to be social. So this is my outline using Duhigg’s Theory of Habit Change.

    It is 3:00pm, and I am sitting at my desk. I would like to take a break, and see what my smoking buddy Chiquita is doing. Here is the scenario:

    1. Identify the craving — Time for a break from work to socialize.
    2. Identify the Cue or Trigger — Its 3:00pm, usually I have a smoke with Chiquita.
    3. What routine does that kick in? — Go to Chiquita’s office to ask her to come out to the smoking area, for a smoke.
    4. What reward do you receive from completing that routine? — Happy spending time socializing.

    What do I do to turn around that routine in order not to smoke?

    1. Identify the craving — Time for a break from work to socialize.
    2. Identify the Cue or Trigger — Its 3pm, usually I have a smoke with Chiquita.
    3. What routine does that kick in? — Option #1 Go to the cafeteria and get a cup of tea, or bottle of water and socialize with the people there. Option #2 — Pop a mint into my mouth, and go down the hall to say hello to a friend that I also have to ask a work question.
    4. What reward do you receive from completing that routine? — Happy spending time socializing.

    In all of these scenarios, the craving, cue and reward remain the same. The only thing that changes is the routine. As a recovery coach, this is one of the first lessons we teach our clients. Change your routine.

    Don’t drive by the bar

    Don’t dial the old girlfriend.

    Don’t hang out with a drugging buddy

    Don’t visit your smoking friend’s desk.

    Change your routine.

    I know, you are thinking about how difficult changing a routine is. Well, Duhigg knows a few more “tips” to ensure this routine sticks. I will be discussing these tips in my next post.

  • Stop calling it behavioral health!

    Stop calling it behavioral health! Does the term cause stigma and discrimination?

    By Robert Kent JD and Charles Morgan MD

    Reprinted from thefix.com, originally published on 11/12/15

    When somebody is treated for smoking cessation, the care will probably be provided within the behavioral health system. If that person is later diagnosed with lung cancer that will be treated over in physical health. If she becomes depressed, that’ll be managed back over in behavioral health. But if the depression causes digestive problems, that aspect of the patient’s health and health care will be treated…you get the picture. Many “behavioral” issues are driven by biological or hereditary conditions, and yet physical and behavioral health are frequently organized, paid for and managed in two entirely different systems. Two key figures at OASAS, which oversees one of the largest addiction treatment systems in the country, argue that the divide between physical and behavioral health, and the term itself, can lead to stigmatization and discrimination against people with “behavioral disorders.” Robert Kent, J.D., the general counsel at the NYS Office of Alcoholism and Substance Abuse Services (OASAS), leads OASAS’s work to implement health care and insurance reform for the Substance Use Disorders system in New York. Charles Morgan, MD, is the medical director of OASAS and a physician who has devoted over three decades to working with people and families affected by addiction. They both want you to “STOP CALLING IT BEHAVIORAL HEALTH!”… Richard Juman, PsyD.

    We believe that it is time to stop calling substance use disorder and mental health “behavioral health.” We are unabashed advocates and supporters of the substance use disorder (SUD) treatment, prevention and recovery system. We are regularly amazed by the stories of people who are now able to live their lives in recovery because of the work done by the people in our system. We need to talk about these disorders in a language that reflects their true nature; they are medical conditions, the origins of which lie in the person’s brain, and the effects of which extend into every part of that person’s life, and as with other illnesses, virtually always into the lives of the people who are touched by the patient.

    The term “behavioral health” is imprecise, since it doesn’t indicate whether one is talking about a mental health condition or a substance use disorder. More importantly, the concept of “behavioral health” as separate from the rest of health care has allowed insurance and managed care companies to create rules for managing services which have denied people access to needed services. If you follow the logic of using the term “behavioral health,” then people with type 2 diabetes, heart disease and asthma could very accurately be identified as having a “behavioral health” issue, as their chronic medical condition is aggravated by their behaviors. But we would never do that with those disorders.

    Constellations of behavior manifest from many chronic medical conditions, some of which are construed as “medical” and others as “behavioral.” The bifurcation is as illogical as it is stigmatizing. People aren’t expected to be able to shrink their own tumors or cure their own infections, but they are expected to control their own behavior. Consequently, calling psychiatric and substance use conditions “behavioral” puts the onus on the patient, often to his tragic detriment in the form of discrimination in housing and employment or the realm of criminal prosecution.

    An individual with a substance use disorder has a natural, predictable disease course, one that is responsive to treatment, allowing for recovery. While we obviously do not want these symptoms to continue, blaming a person for their “behavioral health” issues, rather than treating them, is as counterproductive as blaming a person with epilepsy for falling down when they have a seizure, or blaming the person who is allergic to bees for disrupting the annual family reunion picnic because s/he needs emergency care when s/he is stung. Since we do not want such problems to continue or to be ignored, being judgmental or pejorative about them is harmful because it impedes treatment. In the case of the person with a bee allergy, we would instead encourage him to carry an EpiPen, and we would work to remove any barriers that might prevent him from doing so. We would also remove the bees’ nest!

    With regard to the methods and rules used by the insurers and managed care companies that operate in “behavioral health,” some of our recent initiatives provide ample proof of the impact of using the term. Thanks to the leadership of New York Governor Andrew Cuomo, we now have a state law that requires insurance and managed care companies to have the decision-making criteria they use to manage substance use disorders reviewed and approved by OASAS. Our review of the criteria being used revealed that SUD level of care decisions were being significantly influenced by a person’s past failures or relapses, by whether they had “failed first” at a lower level of care before they sought a higher level of care, and by their “motivation” to seek help.

    Some insurers, and even some providers of care, use the term “motivation” to exclude people from treatment. This is in contrast to the concept of motivation as described by the stages of change model, or in motivational interviewing technique, where a patient’s level of motivation is understood in order to allow for effective treatment. These types of rules would never be allowed for other chronic medical conditions like diabetes, heart disease, and asthma. Would we deny a diabetic their insulin because they ate chocolate cake the night before? Would we deny the person with heart disease medications because they ate chicken wings and french fries? Of course not, because we do not think of those other chronic medical conditions as behavioral in nature. Unfortunately, there is a bias towards thinking of SUDs as behavioral, and then allowing the punishment of the behaviors that are symptomatic of the condition.

    Finally, and most importantly, we believe use of the term “behavioral health” plays a major role in the continued stigmatization of those with an SUD. Such terminology reflects a misunderstanding of SUD, and allows us to perpetuate the myth that the illness is volitional rather than based in biology. Critics of our stance tell us we are absolving people of responsibility for their actions, when in fact we are doing quite the opposite. By delineating the true nature of the illness, we can allow patients to get proper treatment for their illness. Blaming people for addiction would be like blaming people with irritable bowel syndrome for the symptoms of their disease. Acknowledging the disease of IBS allows for proper treatment, which then allows people to be more functional and self-actualized in a way that allows them to take responsibility for their recoveries and to get relief of debilitating symptoms. Similarly, when we treat SUD rationally in this way, rather than as a series of “volitional behaviors” that those afflicted should be able to stop if they were properly motivated, people affected by SUD can then take responsibility for their illness and get effective treatment.

    With regard to the stigmatization of people with SUD, researchers estimate that only one in 10 people who have an SUD actually seek help. While we know there are many reasons people do not seek help, we know that the stigma associated with SUD has a significant inhibitory impact.

    We should listen to the experts. The American Society of Addiction Medicine (ASAM) defines addiction as follows:

    Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

    Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

    Michael Botticelli, the director of the White House Office of National Drug Control Policy, has talked recently about the language we use impacting whether people seek help for an SUD and he has encouraged us to use different language. We know that some will disagree with our viewpoint and some will dispute the basis used for making it. We also know that we can only change what we do, and we can hope others will do the same.

    It is essential that we start thinking of substance use disorders and describing them by using the same language that we use when we describe other chronic medical conditions. The language is critical here: Let’s change the world by changing the way we think about, and talk about, the medical conditions formerly known as “behavioral health.”

    This article written by Robert Kent and Dr. Charles Morgan was reprinted with permission from the 11/12/2015 issue of theFix.com https://www.thefix.com/stop-calling-it-behavioral-health

    Robert A. Kent serves as the General Counsel for the New York State Office of Alcoholism and Substance Abuse Services. In this role, Mr. Kent provides overall legal support, policy guidance and direction to OASAS Commissioner Arlene González-Sánchez, the Executive Office and all divisions of the agency. Robert is leading the OASAS efforts to implement Governor Cuomo’s Combat Heroin and Medicaid Redesign Team initiatives.

    Charles W. Morgan, MD, FASAM, FAAFP, DABAM is the Medical Director of OASAS. He has worked in the field of Addiction Medicine for over three decades and is a Fellow of both the American Society of Addiction Medicine and the American Academy of Family Medicine. Dr. Morgan has expertise in all modalities of patient and family healthcare.

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  • Internet Addiction Disorder- What is it? What treatment is available?

    Internet Addiction Disorder- What is it?

    Internet addiction disorder or IAD is also referred to as Problematic Internet Use (PIU),[i] Compulsive Internet Use, (CIU),[ii] Internet overuse, problematic computer use, pathological computer use, or I-Disorder,[iii]. IAD is excessive computer use which interferes with daily life.[iv]

    manhattan_bridge_post_versionHabits such as reading email, playing computer games, or binge viewing every Twilight movie or entire seasons of Breaking Bad are troubling only to the extent that these activities interfere with normal life. Internet Addiction Disorder (IAD) is often separated by the activity involved in the compulsive actions, such as video or online gaming; online social networking;[i] blogging; online stock trading, online gambling, inappropriate Internet pornography use, reading email;[ii] or Internet shopping.[iii]

    A Cyber-Relationship Addiction has been described as the addiction to accessing and using social networking platforms such as Facebook, Linked In, or online dating services such as Match.com and creating fictitious relationships with others through the internet. Along with many other meet-up platforms, such as Tinder or Siren, (mobile phone apps using a GPS that create a way to meet new people), finding online friends has been made very easy, yet very dangerous because there is no way to check the backgrounds of these fictitious friends. These virtual online friends start to gain more importance to the addict, eventually becoming more important than family and real-life friends.

    Most, if not all “Internet addicts”, already fall under existing diagnostic labels.[iv] For many individuals, overuse or inappropriate use of the Internet is a manifestation of their depression, anxiety, impulse control disorders, or pathological gambling. According to the Center for Internet Addiction Recovery’s director Kimberly S. Young,[v] “Internet addicts suffer from emotional problems such as depression and anxiety-related disorders and often use the fantasy world of the Internet to psychologically escape unpleasant feelings or stressful situations.”[vi] More than half are also addicted to alcohol, drugs, tobacco, pornography or sex.[vii]

    What kind of treatment is available?

    Corrective strategies include using software that will control or block the unwanted content, such as porn or gaming sites from an individual’s computer, addiction counselling, and cognitive behavioral therapy.[viii] One might consider placing time limits on smart phone or computer use, such as no smart phone use during homework time or no computer use after 9pm. The major reasons that the Internet is so addicting is the lack of limits and the absence of accountability by parents, teachers, and health professionals.[ix] Professionals generally agree that, for Internet addiction, controlled use is a more practical goal than total abstinence.[x]

    Families in the People’s Republic of China and South Korea have turned to unlicensed training camps that offer to “wean” their children, often in their teens, from overuse of the Internet. An internet addiction treatment center was started in Delhi, the capital city of India by a nonprofit organization, the Uday Foundation. In 2009, ReSTART, a residential treatment center for “pathological computer use”, opened near Seattle, Washington. The Ranch, a treatment center in Nunnelly, TN, that focuses on behavioral addictions has an internet addiction program. Dr Kimberly Young directs a treatment program called the Internet Addiction Program as part of the Behavioral Health Services Dual Diagnosis Unit at Bradford Regional Medical Center in Bradford, PA. Dr. Maressa Orzack, has treated addictive behaviors at the Computer Addiction Services unit at the McLean Hospital, in Belmont and Newton Center, Massachusetts. The Illinois Institute for Addiction Recovery has an Internet Addictions treatment track with locations in Peoria, Normal, Harvey and Springfield Illinois. New Beginnings offers treatment for Internet Addiction with facilities in many states.

    For those that are not exactly sure they need treatment for an Internet addiction, there is Online Gamers Anonymous, (OLGA, and OLG-Anon). Founded in 2002, by Elizabeth (Liz) Woolley after her son, Shawn Woolley, committed suicide while logged into EverQuest.  OLGA is a twelve-step, self-help, support and recovery organization for gamers (OLGA) and their loved ones (OLG-Anon) who are suffering from the adverse effects of addictive computer gaming. It offers resources such as discussion forums, online chat meetings, Skype meetings and links to other resources.[xv]

    References used in this blog

    [i] Masters K. (2015). “Social Networking Addiction among Health Sciences Students in Oman“. Sultan Qaboos University Medical Journal 15 (3): 357–363. doi:10.18295/squmj.2015.15.03.009.

    [ii] Turel, O. & Serenko, A. (2010). “Is mobile email addiction overlooked?” (PDF). Communications of the ACM 53 (5): 41–43. doi:10.1145/1735223.1735237.

    [iii] eBay Addiction”. Center for Internet Addiction, web site: Net Addiction http://netaddiction.com/ebay-addiction/Retrieved 2015-11-16

    [iv] Hooked on the Web: Help Is on the Way. New York Times, Dec. 1, 2005.

    [v] Young, K. (2009). Issues for Internet Addiction as a New Diagnosis in the DSM-V. Washington, District of Columbia, US: American Psychological Association. Retrieved from PsycEXTRA database.

    [vi] “Frequently Asked Questions”. Netaddiction.com. Retrieved 2014-01-30.

    [vii] “Frequently Asked Questions”. Netaddiction.com. Retrieved 2014-01-30.

    [viii] “University of Notre Dame Counseling Center, “Self help – Lost in Cyberspace”. Retrieved 2009-11-11.

    [ix] “Internet addiction and lack of accountability”. internet-addiction-guide.com. 2010-12-07. Retrieved 2011-07-06.

    [x] Young, Kimberly S. (2007). “Treatment Outcomes with Internet Addicts” (PDF). CyberPsychology & Behavior 10 (5): 671–679. doi:10.1089/cpb.2007.9971. Retrieved 2014-03-13.

    [xi] Wikipedia, OLGA accessed on Nov 16, 2015- https://en.wikipedia.org/wiki/On-Line_Gamers_Anonymous

  • Service keeps you sober — Research is proving this age-old slogan

    manhattan_bridgeEver since I walked into the rooms, I heard the phrase “Service keeps you sober.” I already knew I was a helping type of person, in fact in my addiction it was called being a rescuer. So I stayed away from service for the first few years. When I was ready to do service, I remember desperately waiting the required three months of sobriety to chair my first meeting. Then praying to receive special dispensation to be a meeting list coordinator at the Intergroup/Regional level, because I only had six months, not the required one year of sobriety. I learned why service kept me sober. It occupies the time I would be spending acting out with doing good things. Well, that’s what I thought.

    Service might be the key to staying sober

    Maria Pagano, an addiction researcher at Case Western University, thinks service to others might be the key to staying sober. In recent years, a growing body of research has found that helping others brings measurable physical and psychological benefits to the helper. Building on this work, Pagano is exploring the surprising benefits of altruism for people battling addiction. Her studies have shown that addicts who help others, even in small ways—such as calling other AA members to remind them about meetings or setting up chairs before a meeting—can significantly improve their chances of staying sober and avoiding relapse.

    Surveys and studies say that abuse of alcohol and narcotics is rising among young people  and drug-related deaths have doubled among middle-class whites. Many addicts who exit treatment programs relapse within the first 90 days of being discharged, leaving treatment professionals yearning for more effective treatment strategies. If getting addicts to do service is key to their recovery, as Pagano believes, it could revolutionize the addictions treatment field.

    Pagano was familiar with the research on helping when she joined Brown University’s Center for Alcohol and Addiction Studies Center in 2002. As she learned more about the different treatments for addiction, she was surprised that there seemed to be no one looking at the role of doing service.

    “It was all about what services to give these suffering patients,” she says, “and nothing about getting them active or about how their own experiences about getting sober and being sober can be useful to others.”

    Addicts help their recovery by helping other people

    She decided to explore the impact that helping others could have on people in recovery. Looking at data from one of the largest studies of addiction to date, with 1,726 participants, conducted by the University of Connecticut, Pagano was able to measure it by looking at how many study participants became AA sponsors or completed the 12th step of AA, which involves helping others in recovery.

    When she compared helpers to non-helpers in AA, she found that 40 percent of the addicts that did service or the “helpers” avoided taking a drink in the 12 months following their stay at treatment facility, while only 22 percent of “non-helpers” stayed sober. These results have rarely been seen in addiction treatment studies before.

    In fact, age, gender, income, work status, addiction severity level, or level of antisocial personality disorder of the participants in the study didn’t matter. None of these characteristics predicted helping behavior. “Someone from Yale to jail had an equal chance of being a helper,” Pagano says.

    Only one factor seemed related to helping; those who were more depressed starting out in their recovery were more likely to help. This seemed counter-intuitive, given that depressed people often suffer from lethargy and a sense of helplessness. But according to Pagano, this is exactly the kind of thinking about depression that gets recovery therapists in trouble.

    “In the treatment field, we have this notion that says, ‘Oh, don’t ask too much of the client, especially if they’re depressed. They just need to rest,’” she says. But when she studied the effect of helping on clinical depression, she found that, after six months of doing service, people who had been depressed had their depression levels drop significantly—below the level of what’s clinically considered “depressed.”

    Pagano and her colleagues devised a more precise measure of helping behavior called the SOS (Service to Others in Sobriety) scale for use in future studies. This scale lists 12 helping behaviors that are built into AA and Narcotics Anonymous (NA) meetings—like picking up the phone and calling a fellow AA or NA member, contacting someone to encourage meeting attendance, setting up chairs before the meetings, or becoming a sponsor.

    Maria Pagano’s research suggests addicts help their recovery by helping other people. “This is a no-brainer,” she says. “It’s as essential as medication-assisted therapy.”

    You can’t be ruminating or feeling bitter if you’re feeling moved by helping someone else.

    With a grant from the John Templeton Foundation and funding from the National Institute on Alcohol Abuse and Alcoholism, Pagano used the SOS scale to look at 200 adolescents undergoing treatment for alcoholism or drug addiction in Northern Ohio. Her results showed that kids with higher helping scores on the SOS had significantly lower cravings for alcohol and narcotics, reduced feelings of entitlement, and higher “global functioning”—a measure used by clinicians to reflect participation in groups, getting along with others, and academic performance, among other behaviors.

    In fact, Pagano found that even risk factors like having alcoholic or drug-addicted parents, learning problems, physical disabilities, or additional psychiatric diagnoses didn’t change the effect of helping others; helping still had a positive impact.

    Pagano’s analysis makes a significant contribution to the research that shows adolescents benefit from helping others. Pagano’s research is unique and cutting edge, because no one has really studied helping in the context of recovering from addictions.

    AA folks recognized the benefits of service in AA, but there was no research to back it up. Maria Pagano is bringing good science to this age old-slogan “Service keeps you sober”.

    Resources used in this blog

    Learn more about Maria Pagano’s work on her website, Helping Others Live Sober.

    Pagano, M. E., Kelly, J. F., Scur, M. D., Ionescu, R. A., Stout, R. L., Post, S. G. (2013). Assessing Youth Participation in AA-Related Helping: Validity of the Service to Others in Sobriety (SOS) Questionnaire in an Adolescent Sample. American Journal on Addictions 22(1), 60-66.

    Pagano, M.E., Post, S.G., & Johnson, S.M. (2011). Alcoholics Anonymous-Related Helping and the Helper Therapy Principle. Alcoholism Treatment Quarterly 29(1), 23-34.

    Pagano, M.E., Krentzman, A.R., Onder, C.C., Baryak, J.L., Murphy, J.L., Zywiak, W.H., & Stout, R.L. (2010). Service to Others in Sobriety (SOS). Alcoholism Treatment Quarterly 28(2), 111-127. PMC3050518.

    Pagano, M.E., Zemore, S.E., Onder, C.C., & Stout, R.L. (2009). Predictors of initial AA-related helping: Findings from Project MATCH. Journal of Studies on Alcohol and Drugs 70(1), 117-125. PMC2629624.

  • On the Nature of Addiction and the Loss of Hope

    On the Nature of Addiction and the Loss of Hope

    Guest post by David Chapman

    The normal state of a productive and happy human existence includes a sense of hope. Dave Chapman block golf shirtThe  nature of addiction exhausts all sense of hope.

    The sense of hope is based on the understanding that the process of productive effort usually results in some observable, measurable improvement in the quality of one’s life and the lives of those important to the individual. The nature of having an addiction means the loss of this hope.

    “I will restore my own sense of hope. I know if I exert control over my environment and my actions I will regain control of my life and I will have reason to be hopeful once more.”

    If I chop some large amount of dry wood and keep it dry, my family and I will be warmed throughout the winter, our ability to survive the winter and the possibility of our thriving in the spring will be augmented. The hope of minimizing suffering, increasing comfort and sustaining enhancements in the quality of our lives is significantly based on the belief that the productive effort is worthwhile and that similar efforts in the future will also be worthwhile.

     

    The act of putting rational expectation – hope – into productive effort is based initially on trial and error. As demonstrated by observation and experience, it is then continued in the manner found to be most efficient.

    I contend that addiction is more than chemical dependence. It is significantly, I believe, fueled by a sense of hopelessness resulting from the brutalization of our rational, reasonable expectations.

    Children who are raised in emotionally irrational or physically violent households have their natural sense of hope altered and sometimes, sadly, destroyed altogether. Hope is similarly damaged in an adult body politic where effort goes unrewarded beyond a level of primitive sustenance and/or when participation in the political process is deemed to be futile and ineffective.

    When we attempt to adjust our behavior to what we think are the demands or desires of those exerting control of our physical and intellectual environment, but those irrational behaviors continue, the ensuing sense of hopelessness – hopelessness based on rational observation – will continue and can threaten to become permanent.

    The addicted personality may be able to overcome a physical addiction. However, until a sense of rational hopefulness is restored and we can believe that our thoughts and actions will have a beneficial impact on our lives, the spiritual addiction will probably not be overcome.

     

    Dave Chapman is our guest blogger this week. Dave was born in Newark, New Jersey and grew up in the suburban town of Glen Ridge, New Jersey. He has been a shoe shine boy, a moving man, a golf caddy, a limousine driver, a truck driver, worked retail at The Home Depot, a life insurance agent, a stock broker and financial advisor. He studied the humanities and comparative literature at Ohio Wesleyan University. In addition to his motivational speaking and John Maxwell coaching affiliation, Dave is a freelance writer and teaches several classes in the Humanities as an Adjunct Professor at the Osher Lifelong Learning Institute at Rutgers University. He can be contacted by email at: davechapman@wellsaiddave.com

     

  • How can you heal the trauma within?

    manhattan_bridgeTrauma changes you. You might not necessarily like that change. How can you heal the trauma within? You have the ability to transform yourself into a healthier person. You have enormous healing potential; the goal is learning to access it—and then to use that potential to heal the trauma, release the addiction(s), and obtain a glorious new life.

    Without your consent, trauma can change you, often into a person you’d rather not be.                                                -Michele Rosenthal

    Working through trauma can be scary, painful, and sometimes retraumatizing. Because of the risk of retraumatization, this healing work is best done with the help of an experienced trauma specialist. The clinical term for a therapist that has experience in treating trauma  is a trauma informed therapist. The therapist will be able to answer questions as to his/her experience in trauma informed care over the phone. You want to ask if they are experienced in EMDR, Light Entrainment or Somatic Experiencing.

    Treatment for Trauma

    When you are triggered by a trauma memory, your nervous system gets stuck in overdrive. Successful trauma treatment revisits these traumatic memories, and allows you observe the trauma and your “fight-flight-freeze” response. The therapist will establish a sense of safety and help you resolve the past traumas. The following therapies are commonly used in the treatment of PTSD, emotional and psychological trauma:

      • Somatic Experiencing:  Somatic processing of trauma takes advantage of the body’s unique ability to heal itself. The focus of therapy is on bodily sensations or movements (like excessive leg movement, wringing of your hands or profuse perspiration) rather than thoughts and memories about the traumatic event. By concentrating on what’s happening in your body, you gradually get in touch with trauma-related energy and tension. The therapist will encourage you to safely release this pent-up energy through shaking, crying, and other forms of physical release.
      • EMDR (Eye Movement Desensitization and Reprocessing): This practice incorporates two paddles that when held in your hands vibrate, and a headset that sends a low tone alternating from one ear and then to the other ear. The tones and the vibration of the paddles distract the conscience mind, allowing for the unconscious or sub-conscience memories to arise. The therapist and you explore these memories and discuss them to attempt to resolve the feelings around the trauma.
      • CLEAR Therapy (Colored Light Entrainment and Re-patterning) Clear Therapy is a method of releasing unresolved core emotional issues using colored light. When a flashing light is emitted into the eyes, the brain adopts the rhythm of the strobe. In the initial intake session, you will look at 11 different colors of flashing light and the therapist is able to pinpoint issues based on what you see in each color. In the following sessions, the feedback from your perception of the colors enables the therapist to uncover core beliefs that drive your thinking, feelings or behavior. CLEAR is coordinated with eye movement (see EMDR), breath work and meridian-based therapies (see EFT) to facilitate rapid resolution of the problem.
      • LST (Light Stimulation Therapy) LST enhances learning abilities and performance by stimulating the eye and brain with light. A LST session has you sitting comfortably in a darkened room, looking at a waveband of colored light which is focused directly on your eyes. It is advised to have 3 to 5 sessions per week until a total of 20 sessions is completed. At the end of the 20-sessions, there is a reevaluation to determine the necessity of further treatment.
      • The Brain and Brainwave Entrainment-The DAVID Device: The senses of sight and hearing, by their very nature, provide a favorable environment for affecting brainwaves. By presenting pulsed audio and visual stimulation to the brain, the brain begins to vibrate at the same frequency as the pulsed audio from the DAVID Device. The device sends flashes of lights into a pair of glasses, and pulsed tones through a pair of headphones to gently guide the brain into altered states of consciousness.
      • The Green Wave Therapy: The Green Wave Therapy is a technique that combines green laser light, micro current energy, and some of the principles of EMDR [Eye Movement Desensitization and Re-patterning], and EFT [The Emotional Freedom Acupressure Technique]. You will rest on a massage table, and a micro current device focuses on the region between your eyebrows. You hold the EMDR paddles in your hands as they pulse rhythmically. You also wear a headset that delivers audio tones in unison with the paddle’s vibrations. The practitioner stands back about 4-5 feet and circles the entire body with green laser light. With every 1-2 minute pass, the clinician checks the level of distress you are experiencing while thinking about the trauma.
      • Emotional Freedom Technique (EFT): Based on impressive new discoveries involving the body’s energies, EFT has been reported to be 80% clinically effective in relieving Trauma. The EFT procedure involves tapping with the fingers on points on the body that are associated with acupuncture pressure points. While doing the tapping sequence, distressful thoughts and/or events are targeted and healing statements are repeated out loud. EFT often works where nothing else will. It is rapid, long lasting and gentle. No drugs or equipment are involved. It is easily learned by anyone in less than an hour. EFT techniques can be taught and be self-administered.

    Trauma Recovery Tips

    Recovering from emotional and psychological trauma takes time. Give yourself time to heal and to mourn the losses you’ve experienced. During your trauma therapy here are some self-help strategies to keep you healthy and continue the healing between your therapeutic sessions:

               1: Don’t isolate

               2: Stay grounded

               3: Take care of your health

    Don’t try to force the healing process. Be patient with your pace of recovery. Finally, be prepared for difficult and volatile emotions. Allow yourself to feel whatever you’re feeling without judgment or guilt.

     

  • Is there a trauma-addiction connection?

    manhattan_bridgeIs there a trauma-addiction connection? Adverse childhood experiences (trauma) are well known to significantly increase the risk of psychiatric disorders in adulthood. Ample evidence has shown that childhood trauma endangers the brain’s development, structure and function. Several traumatic experiences could make a person susceptible, later in life, to problems related to memory, judgment, reasoning, and could affect emotional and decision-making skills. Psychiatric illnesses, including schizophrenia, major depression, bipolar disorder, Post-Traumatic Stress Disorder (PTSD), and addiction, are also linked to adverse childhood traumatic experiences.

    Traumatic life experiences, such as physical and sexual abuse as well as neglect, occur at alarmingly high rates in the United States and is considered a major public health problem. Other examples of traumatic life experiences could be witnessing family violence, parental separation and divorce, experiencing a catastrophic weather event such as Hurricane Katrina, losing your home as a result of a wild fire, moving several times in childhood or going hungry.

    The link between traumatic experiences and substance abuse has been well-established. For example, in the National Survey of Adolescents, teens who had experienced physical, or sexual abuse or assault were three times more likely to report they had abused a substance than those without a history of trauma.

    In surveys of adolescents receiving treatment for substance abuse, more than 70% of the adolescents reported a history of some sort of trauma.

    While experiencing a trauma doesn’t guarantee that a person will develop an addiction, research clearly suggests that trauma is a major underlying source of addiction behavior. Founder of HealMyPTSD.com and author Michele Rosenthal culled statistics from a report issued by the National Center for Post-Traumatic Stress Disorder and the Department of Veterans Affairs to show the strong correlation between trauma and alcohol addiction:

    • Sources estimate that 25 and 75 percent of people who survive abuse and/or violent experiences develop issues related to alcohol abuse.
    • Accidents, illness or natural disasters translate to between 10 to 33 percent of survivors reporting alcohol abuse.
    • A diagnosis of PTSD (post-traumatic stress disorder) increases the risk of developing alcohol abuse.
    • Female trauma survivors face increased risk for an alcohol-use disorder.
    • Male and female sexual abuse survivors experience a higher rate of alcohol- and drug-use disorders compared to those who have not survived such abuse.
    • 27 percent of veterans in Veterans Administration care diagnosed with PTSD also have Substance Use Disorder (SUD)

    Similar research linking trauma and addiction exists for other habitual behaviors, including sexually compulsive behavior and eating disorders. Delving deeper into the trauma-addiction connection tells us that addiction is a coping mechanism. Addictions often help reduce the sensation of the overwhelming anxiety, stress and fear that trauma triggers create. Individuals participating in the research confirm that addictions are implemented as an attempt to self-manage (or self-medicate) what comes up for them when unmanageable trauma memories appear. These forms of self-management or self-medication are used as a positive survival instinct, but have very negative consequences. The key is to recognize the use of substances to manage trauma responses and to choose another tool for self-management.

    Next week’s post will go further exploring the link of addiction and trauma.

    References used in this post:

    Department of Veterans Affairs Teesson M, Ross J, Peters L (2006) Trauma, PTSD, and substance use disorders: findings from the Australian National Survey of Mental Health and Well-Being. American Journal of Psychiatry. 2006 Apr;163(4):652-8., http://www.ncbi.nlm.nih.gov/pubmed/16585440

    Public Interest Directorate- Children, Youth, and Families, An American Psychological Association Directorate-Advancing the creation, communication and application of psychological knowledge to benefit society and improve people’s lives. Activity Summary- August 2012 – August 2013Website: http://www.apa.org/pi/families/index.aspx

    Kilpatrick DG, Saunders BE, Smith DW.(2003). Youth Victimization: Prevalence and Implications [Electronic]. U.S. Department of Justice, Office of Justice Program, National Institute of Justice. Available at: http://www.ncjrs.gov/pdffiles1/nij/194972.pdf

    Michele Rosenthal (2015) Trauma and Addiction: 7 Reasons Your Habit Makes Perfect Sense, Published on March 30, 2015 in Behavioral Health, Living in Recovery, Living with Addiction and at Recovery.org website: http://www.recovery.org/pro/articles/trauma-and-addiction-7-reasons-your-habit-makes-perfect-sense/

    and  http://healmyptsd.com/

    Please feel free to leave a comment:

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  • Addiction is a Symptom of Untreated Trauma

    manhattan_bridgeI am a recovery coach. A recovery coach or sober companion is often called in to work with the most difficult addict, the chronic relapser. A chronic relapser is an individual that has been to several rehabs, often 7, 8 or 9 visits in less than five years. Who has not been able to put together 90 sober days, except in treatment. Whose family, spouse or children have given up on them. In reality, a chronic relapser is an addict that is acting out compulsively in their addiction. The chronic relapsing in their addiction is a sign or a symptom of an unresolved traumatic occurrence in their youth. Their addiction is a symptom of untreated trauma.

    Often, calling a recovery coach is the last resort.

    My first job, of course, is to make sure this person doesn’t drink, use or act out. And to find some redeeming qualities of this addicted person so I can approach healing the behaviors driving the addiction. This is the key point that brought me to the understanding that many of my clients have experienced some form of trauma, early in their childhood or adolescent lives.

    “What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.”    — Alice Miller, author of Breaking down the Wall of Silence

    I always ask the client for their story. I provide all of my clients the ACE study questions. ACE means Adverse Childhood Experiences. The ACE study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. It started in 1976 with the purpose of finding more about childhood trauma, and the later-life health and well-being of participants. (For more information on ACE, see my blog post dated August 20, 2015). The ACE study poses such questions as: Did you move a lot? Did you ever go hungry? Did you experience a childhood that was less than nurturing? Did you ever have a moment that overwhelmed you? Did you live through an ordeal that changed how you think about people, places or things? The results of the ACE questions, and the addict’s story that comes after it, always profoundly moves me. I get a much more honest story than most clinicians, mainly because of these questions.

    The reason it’s significant for me to identify and acknowledge trauma, is because research proves that trauma can activate behaviors that lead to addiction. My clients are using a drug or alcohol as a way of self-protection, of calming down, as life preservation. Everyone in the rooms (AA, NA meetings) knows addicts “use” in order to “numb out.” Well, let’s rethink that, turning it a bit to say: victims of trauma are really using a drug or drink to:

    • Stay safe: After trauma the addict’s own mind can feel like a danger zone, which makes being “out of it” feel safer than being in it.
    • Escape memories: Unwanted and unresolved memories have a way of popping up incessantly after trauma; addictions offer the mind a different area of, or reduced capacity for focus that helps suppress reminiscing.
    • Soothe pain: Substances or the adrenalin rush of self-destructive behaviors change the addict’s body chemistry, releasing endorphins and other mood enhancers that reduce discomfort.
    • Be in control: Sometimes, engaging in addictive behaviors can lead an addict to feel strong, resilient and courageous, an experience that is tremendously alluring when trauma from the past intrudes on the present.
    • Create a world the addict can tolerate: The intense feelings brought on by fear, memories and anxiety can make any moment seem overwhelming. The release of tension brought on by addiction-oriented behavior helps facilitate a manageable experience.
    • Treat yourself the way you feel you deserve: Trauma can leave an addict feeling less-than, worthless, hopeless, and damaged. The more self-destructive the addict behaves, the more it can feel like he or she is living in alignment with who they truly are. While this is false, it can help reduce feelings of otherness and disconnection.
    • Redefine who the addict really is: Trauma changes an addict’s identity all the way down to the core of their beliefs and self-definition. It can seem as if no one understands them. Engaging in addictions can help create a sense of community by connecting the addict to others who feel, see, think and behave as they do. Addictions can help the addict revise their self-perception by allowing them to engage in and act out behaviors that allow them to feel stronger, more courageous, capable, etc., than trauma has left them feeling.[1]

    This puts the addiction-trauma link into perfect perspective for me, and I hope it opens some eyes for other addicts, alcoholics, and clinicians that are reading this post. Next week’s post will go on to explain the scientific research that backs up this discovery that addiction is just a symptom of untreated trauma.

    Research used in this blog:

    Centers for Disease Control and Prevention, http://www.cdc.gov/violenceprevention/acestudy/about.html

    Adverse Childhood Experiences Study, Posted on August 20, 2015 by Melissa Killeen, http://www.mkrecoverycoaching.com

    [1] Trauma and Addiction: 7 Reasons Your Habit Makes Perfect Sense, by Michele Rosenthal. Published on March 30, 2015 in Behavioral Health, Living in Recovery, Living with Addiction and at http://www.recovery.org

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  • What kind of credential do I need to be a Professional Recovery Coach?

    What kind of credential do I need to be a Professional Recovery Coach?

    manhattan_bridge_post_versionWhen I published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013, the term professional recovery coach or professional recovery life coach was not in frequent use.

    A professional recovery coach is trained in professional coaching techniques, which means he or she has been educated in group dynamics (how people act in a group), how to develop high performing individuals (leadership) or how to facilitate change. Additionally, they have training in the addiction recovery models, motivational interviewing and Harm Reduction. They may use their experiential knowledge of their own recovery to augment their professional recovery coaching faculties. Professional coaches work in many fields: executive coaching, business coaching, finance coaching, wellness coaching or life coaching. Recovery coaching fits nicely into the life coaching model.

    International Coaching Federation (ICF)

    There is one worldwide organization that is recognized as issuing professional coaching credentials, the International Coaching Federation (ICF), http://coachfederation.org. There are three levels of ICF coaching credentials. The Associate Certified Coach (ACC) Credential is for the coach who is just beginning in the field, and is the first credential that can be completed with ICF. The Professional Certified Coach Credential (PCC) is for the more experienced coach and the Master Certified Coach (MCC) Credential is for the expert coach.

    When seeking to be credentialed as an Associate Certified Coach (ACC), the coach has to have completed an entire ICF Accredited Coach Training Program (ACTP). On the ICF website is a list of all of the accepted training programs from which the ICF will accept training credentials. The ICF does not offer a unique recovery coaching credential, nor a peer recovery-support credential.

    There is one organization, Family Recovery Resources, listed in the ICF Accredited Coach Training Program that offers a family-in-recovery coaching course for a family recovery coach certificate. There are no other recommended organizations that offer any recovery coach orientated courses. If a recovery coach has received training from any organization specializing in recovery coaching training, it is likely that the training would not be credited toward an ICF certificate. There is a very interesting selection of courses in the ICF Accredited Coach Training Program, such as executive coaching, end-of-life coaching, divorce coaching, Neuro-Linguistic Programming, wellness coaching, conflict coaching and several other excellent learning opportunities, on the ICF web site.

    The ACC applicants must work while they learn, and complete 100 hours of client-to-coach experience during their coach-specific training program. In addition the applicants are required to receive 10 hours of Mentor Coaching, and 100 hours (75 hours to be paid) of coaching experience with at least 8 clients, post training. There is a performance evaluation (audio recording and written transcript of coaching session) and a Coaching Knowledge Assessment (CKA) to complete the ACC credentialing application. The ACC credentialing process costs are dependent on the types of training courses a coach must take to complete the requirements for the certificate. The ACC credentialing process can take from 18 months to two years complete.

    It is my hope that the information transmitted in the past few posts will help a person interested in recovery coaching see the path to certification a bit more clearly. Please feel free to contact me with any questions you have about the path you should take in seeking your recovery coaching training and credentialing.

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  • What training and certificate do you need to be a peer recovery support specialist ?

    What training and certificate do you need to be a peer recovery support specialist ?

    manhattan_bridge_post_versionI published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. Since then, recovery coach or peer recovery support specialist training has become one of the fastest growing aspects of the coaching field. So, what kind of training and certificate do you need to be a peer recovery support specialist ?

    In 2013, the organizations that offered recovery coach or peer recovery specialist training numbered around 50. Today, the number has grown to 250. Many state certification boards have established recovery coach and peer recovery support specialist certifications.

    The definition of a recovery coach, and a peer recovery support specialist has changed significantly, as well. Now, the term peer-to-peer recovery support specialist defines a coach that works with people in mental health recovery and/or people that are in co-occurring recovery (co-occurring describes when a person has an addiction and a mental health diagnosis). Commonly the coach in this job is called a “peer.”

    Even though most of the state certification boards issue a certificate with the same “title,” (such as certified peer recovery support-specialist) the agencies that are looking for coaches to work with addicts advertise for recovery coaches and the agencies that are looking for coaches to work with people with behavioral or mental health disorders advertise for peers.

    In the treatment field it is common to have states use different terminology and acronyms for a certificate of the same job description. For example, the terminology for a certified recovery coach or peer in New Jersey is Certified Peer Support Practitioner (CRSP).The Alcohol and Drug Abuse Certification Board of Georgia calls this credential a Certified Peer Recovery Coach (CPRC). The Minnesota Certification Board offers a Certified Peer Recovery Specialist (CPRS) credential. There are several different terms for certificates for the same job description throughout the United States.

    As of March 2014, 38 states and the District of Columbia have established programs to train and certify peer-to-peer recovery support specialist working with people in mental health recovery. Eight states are in the process of developing and/or implementing a peer program. For information on locating these agencies go to the International Association of Peer Specialists at: http://inaops.org/training-and-certification/.

    The International Association of Peer Specialists web site features a PDF document that is downloadable, with a list of all of the peer training organizations. This document is entitled: Peer Specialist Training and Certification Programs: A National Overview, and was compiled by the Texas Institute for Excellence in Mental Health, in the School of Social Work at the University of Texas at Austin. This PDF breaks down the peer certifications for every state, gives a web site and email contact for the training organizations as well as the required domains to master, in order to receive the certification. As an adjunct to this PDF, an additional list of recognized peer support training providers is available. The link is: http://inaops.org/training-providers/. If your area is not served by training organizations featured in these two documents, email: training@naops.org to find training in your area.

    What are the peer recovery support specialist guidelines for receiving certification?

    The peer recovery support-specialist application for certification will vary from state to state but essentially the guidelines are similar. Individuals can qualify to become certified peer-to-peer recovery support specialist by meeting the following guidelines:

    • Have a minimum of one year demonstrated recovery time from a significant mental health and/or substance use disorder at the date of application.
    • Be at least 18 years of age.
    • Must have a minimum of at least a high school diploma or GED.
    • Have attended and successfully completed a recognized training curriculum (face to face in a classroom setting or on-line) that totals 40 hours at a minimum and have a valid certificate of completion from that training.
    • Have completed an additional 20 hours of training and have valid certificates verifying attendance and participation in the following training categories: Wellness Recovery Action Planning (WRAP), Person Centered Thinking, Personal Assistance in Community Existence (PACE), Crisis Prevention, Veteran supports and interventions. Applicants can also use other college coursework, if related to the work of a Certified Peer Support-Specialist, if it will enhance the ability to provide services to people with mental health and/or substance use disorders. The applicant must submit an official transcript for review with the application.
    • Acknowledge the peer will follow the ethical guidelines of a peer recovery support-specialist by signing a form stating they have read and comprehend the guidelines
    • Submit two (2) personal reference letters

    What are the costs of Certified Peer Recovery Support-Specialist Training?

    Costs for Certified Peer Specialist training range from $400-$1,000. There are several ways to pay for Certified Peer Specialist (CPS) training. There are a number of programs and organizations that sponsor free Peer Recovery Support-Specialists certification training, continuing education classes, and supervisor training classes. As follows, are some suggestions:

    Offices of Vocational Rehabilitation (OVR) help people with disabilities prepare for and achieve an employment goal. OVR has many offices located throughout United States. If you qualify for OVR services, OVR may pay up to $900 for you to receive certification training.

    County Mental Health and Developmental Services is another source of possible funding. Some county MH/DS offices contract with training vendors to provide a Certified Peer Specialist class in that county. When this happens, a county purchases an entire class (20 seats) from a training vendor. The county then accepts applications from people who want to attend the training. In these cases, the training is usually only open to people who reside in that county.

    The Mental Health Associations of your state may provide low cost Certified Peer Specialist training.

    Review the document, Peer Specialist Training and Certification Programs—A National Overview (http://www.dbsalliance.org/pdfs/training/Peer-Specialist-Training-and-Certification-Programs-A-National-Overview%20UT%202013.pdf ). There are many states, Alabama, Ohio, New Jersey and North Carolina, to name a few that offer free training and are listed in this document.

    Next week’s blog post will review what certification is required to be a professional recovery coach working as a coach that has a variety of coaching credentials.

  • What kind of training do I need to be a recovery coach?

    What kind of training do I need to be a recovery coach?

    manhattan_bridgeI published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. Since then, recovery coach or peer recovery specialist training has become one of the fastest growing aspects of the coaching field. So what kind of training do I need to be a recovery coach?

    In 2013, the organizations that offer recovery coach or peer recovery-specialist training numbered around 50. Today, the number has grown to 250. Many state certification boards have established recovery coach and peer recovery support specialist certifications.

    Many of the organizations that offer addictions recovery coach training or peer recovery support specialist training are listed on my web site: http://www.mkrecoverycoaching.com/recovery-coach-training-organizations/. For many people interested in being a recovery coach, the training costs, deciding on the best training organization and the training necessary to fulfill the certification requirements can be confusing. So I would like to attempt to clear up this confusion and will answer these questions in this post:

    • What are the guidelines I must meet to apply for recovery coaching training?
    • What kind of training do I need to be a recovery coach?

    What are the guidelines to apply for recovery coaching training?

    Applicants must meet the following guidelines to apply for a training course in order to be a recovery coach or a peer recovery support-specialist. These guidelines are shared by many training organizations and certification boards across the nation as a standard for what a potential recovery coach must have before applying for recovery coaching training:

    • High school diploma, GED or higher
    • Minimum of one year of direct knowledge of sponsorship and 12-step programs
    • Minimum one year of sobriety from substance use or one year sobriety in co-occurring mental health and substance use disorders (self-attestation)

    What kind of training should I look for?

    Certification boards require the coach to receive outside training that fulfills the requirements mandated by the state board. These requirements are often a certain amount of hours training in topics such as addiction recovery theory and models, coaching ethics, motivational interviewing, relapse prevention, nicotine cessation, suicide prevention and HIV-AIDS education. Each state and organization has different requirements. So first check with your state to ensure the course you take will be accepted by the state credentialing board.

    There are trainings offered that can give a coach more information that may not be on the state certification board list, but are very helpful. The kinds of training I found helpful as a new recovery coach were: conflict management, anger management, intervention training, co-occurring disorders, behavioral addictions, the pharmacology of addiction, and psycho-pharmacology as well as knowledge about coaching families in relationships with addicted persons. There are also training organizations that offer three different levels of recovery coaching training: novice, intermediate and master-level coaching certificates.

    The places in which you receive this training are quite diverse. In the links section of this web site, I list over 250 organizations offering recovery coach training. The courses can be online, or in a classroom. The costs for this training is diverse as well, from free (in Ohio) up to $4,000 per course. The length of the course could be three days or four months.

    At no time does taking a recovery coaching course give you an immediate state certification board recovery-coaching credential. It gives you a document (called a certificate) that says you completed the training. There are many coaches who do not seek state board certification, and use this document or certificate from a training organization as adequate proof they are knowledgeable in performing the duties of a recovery coach.

    There is one international credentialing organization, the International Certification and Reciprocity Consortium, commonly known as the IC & RC(http://internationalcredentialing.org/) that runs many state credentialing boards and has developed an exam for a Peer Recovery (PR) Certification. The IC & RC suggests applicants check with their state credentialing board for specific test taking guidelines.

    Are there any additional requirements for recovery coaching certification?

    NAADAC, the Association for Addiction Professionals, and the National Certification Commission for Addiction Professionals (NCC AP) http://www.naadac.org/NCPRSS offer the Peer Recovery Support-Specialist Certification. Similar to the requirements of the IC & RC, the NCC AP recommends, in order to receive certification, a coach read and sign a statement on the application affirming adherence to the Peer Recovery Support-Specialist Code of Ethics. Credentialing boards require supervisors of the coaches-in-training to sign a document verifying they have supervised the coach during the period of the coach’s training. Letters of recommendation are also items required by some credentialing boards. Other state boards require a recent photograph. As always, check with the state credentialing board for specific requirements for credentialing.

    Next week’s post will review what certification is required to be a peer-to-peer support-specialist working with people in mental health recovery.

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

  • What kind of certification do I need to be a recovery coach?

    What kind of certification do I need to be a recovery coach?

    manhattan_bridge_post_versionI published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. Since then, recovery coach or peer-recovery specialist certification training has become one of the fastest growing aspects of the coaching field. So what kind of certification do I need to be a recovery coach?

    In 2013, the organizations that offer recovery coach or peer-recovery specialist training numbered around 50. Today, the number has grown to 250. Many state certification boards have established recovery coach and peer-recovery support specialist certifications. Yet, for many people that seek to be a recovery coach the qualifications, the training, the requirements for certification, or credentialing seem baffling. So I would like to attempt to clear up this confusion and will answer these questions in this post:

    • What is the process for certification as a recovery coach or peer recovery specialist?
    • What kind of certification should I be focusing on?

    What is the process of being qualified, getting training and then credentialed as a recovery coach or peer-recovery support specialist?

    If you are investigating becoming a recovery coach, I suggest you follow these steps:

    1. Research the training organizations that offer recovery coach training you can afford. Go to http://www.mkrecoverycoaching.com/recovery-coach-training-organizations/ for a list of addiction recovery coach training organizations
    2. Verify that you meet the qualifications to apply for the course (e.g. be 18-years-old, have a GED or high school diploma, one year sobriety from any addiction)
    3. Take and pass the course, retain the coaching certificate for future purposes
    4. Research places like Recovery Community Organizations or treatment centers to work or volunteer as a recovery-coach-in-training
    5. Apply to your state certification board for recovery coach certification (a fee may apply)
    6. Complete the recovery-coach-in-training supervised practice hours that are required by the state board
    7. Send in your application with paperwork verifying the completion of practice hours to the state credentialing board with a certification fee (fee varies for every state, from $100-$250)
    8. Receive your recovery coaching or peer-recovery support specialist certificate
    9. In the next 2 – 5 years take the required courses for renewing this certificate. Refer to your state board for more information on courses and renewal time frames. A renewal fee will be required.

    What kind of certification do I need to be a recovery coach?

    For an addiction recovery coach, the certification and training is prefaced with the terms: peer-support specialist, certified peer-recovery practitioner, recovery coach or peer-recovery specialist. Every state is different and every state uses different names for these certifications. Look for courses that offer the training needed for an addictions coach and a peer working with people in mental health recovery certification. It is the exact same training, in the same exact classroom, for two different jobs descriptions! It may be confusing now, and quite possibly the content and descriptions of  these courses may change going forward. But I would have to have a crystal ball to predict that for certain.

    I suggest you first take a certification training course. You can make the decision after the training is completed to apply for state board certification. As a coach if you are interested in being your own business person, certification by a training organization should be adequate. If you want to work in a treatment center, with a recovery community organization, social services agency or hospital, certification issued by the state’s certification board or the International Certification and Reciprocity Consortium (IC&RC) is required by the institution hiring you. If you want to carry professional liability insurance, or be reimbursed by Medicaid for your services, certification by a state certification board is mandatory.

    What is a state certification board?

    The process for receiving a certificate as a recovery coach is overseen by a state’s certification or licensing board. A state certification board tests and renews practitioner’s (coaches, therapists, nurses, etc.) certificates to ensure their knowledge is up to par. Also, that they have the ethical knowledge to practice in their profession. These processes for certification, such as training, educational requirements, exams and renewal guidelines, varies from state to state. These certification standards are recognized by health care companies, insurance companies, Medicaid, Medicare as well as companies that hire these practitioners.

    These state certification boards are the same boards that issue licenses or certifications for drug and alcohol counselors, and therapists. Some states have combined licenses and certifications boards all in one office, so it could be the same office in which nurses or hairdressers receive their licenses. I suggest you search the Internet for drug and alcohol certification for your state. Then search for the state board website for recovery coach or peer-recovery support specialist certification. As of May 2008, thirty state credentialing boards had developed criteria for the training and deployment of recovery coaches and peer-recovery specialists, so you should have no trouble finding these boards on the Internet.

    What is Reciprocity?

    Reciprocity is a term you will see used often on these board sites. When you are certified through your home state’s certification board, you may have the ability to transfer that credential to another state. This is called reciprocity. State certification boards may offer reciprocity to certified coaches in other states. The state boards have the authority to set reciprocity requirements for coaches to practice in their state. Not all certifications are eligible for reciprocity. It is vitally important that you investigate reciprocity guidelines prior to relocating to another state, because it can be a very complicated process.

    There are national and international recovery coach certifications available. In 2013, the International Certification and Reciprocity Consortium (IC&RC) developed a peer recovery credential. The application for the peer-recovery certification appears on the IC & RC web site. An IC & RC credential is accepted by many agencies and treatment centers when they are hiring recovery coaches.

    In next week’s post I will review what kind of training you need to have in order to apply for recovery coach certification.

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  • What is the difference between a recovery coach, a peer recovery support specialist and a professional recovery coach?

     

    melissa-new-post

    I published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. A recovery coach, a peer recovery support specialist and a professional recovery coach’s job descriptions have expanded significantly since then. The organizations that offer recovery coach training numbered around 50 in 2013. Today, the number has grown to 250. Recovery coach certification training is one of the fastest growing aspects of the coaching field, with many states establishing recovery coaching and peer recovery support-specialist certifications. Yet, for many people who seek to achieve basic recovery coaching information, the process of training, certification, credentialing or licensing are baffling. With all of this growth and change, anyone who is interested in being a recovery coach is very confused about the necessary training, what to call this training and even what to call themselves! I want to make an attempt to clear up this confusion and answer these questions:

    • What is the difference between a recovery coach, a peer recovery support-specialist and a professional recovery coach?
    • On what kind of certification should a future recovery coach focus?
    • What are the guidelines for certification of a recovery coach?

    (Some of the answers to these questions will appear in upcoming posts.)

    What is a Recovery Coach?

    A recovery coach is a person that works with and supports individuals immersed in an addiction(s), and coaches people in recovery from the abuse of alcohol and drugs, gambling, eating disorders or other addictive behaviors. Sometimes recovery coaches who work with people with addictions have been referred to as a peer recovery support specialist, a recovery support specialist, a sober companion, recovery associate or quit coach. In all cases these terminologies describe the same job description; a person who meets with clients in order to aid in their recovery from addiction(s). Even though many certifications for recovery coaches are classified as peer recovery support practitioner certifications. I prefer to use the term recovery coach in describing a person coaching an individual in recovery from addiction, instead of using the term “peer,” mainly because there is no requirement that a recovery coach be a peer (meaning they are an addict in recovery). Although it may be believed having experiential knowledge is a best practice for a recovery coach, it could be a recovery coach has knowledge of addiction and recovery perhaps by knowing an addict, having a family member with an addiction or taking courses in the treatment field.

    I have kept the term “non-clinical” out of this definition of a recovery coach because over the course of several years, I have seen drug and alcohol counselors, family and marriage therapists (MFTs), licensed clinical social workers, interventionists (LCSWs), psychotherapists and psychiatrists, train to be recovery coaches and then add coaching to their resume. I hear from these individuals that they embrace the coaching approach, and merge the knowledge they have as a clinician or interventionist with recovery coaching methods.

    Some individuals seek recovery and sobriety from addictions by frequenting a recovery community organization (RCOs) or recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. There are recovery coaches at these recovery community organizations. These coaches have very diverse backgrounds. I have met coaches that were addicts, homeless, offenders, teachers, lawyers and highly educated individuals, who choose to help another person in recovery. I have seen these coaches espouse 12-step ideologies as well as non-12-step recovery models such as Buddhist Recovery, Moderation Management, Kundalini Yoga or Harm Reduction. Sometimes, the recovery coaches at these centers receive a salary from the RCO, however, the client is not charged for the recovery coaching services. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

    Lastly, recovery coaches can be employed by treatment centers or sober living homes and receive compensation from them. In cases such as this, the client is billed for the coaching services from the centers or homes. I know many a recovery coach who has opened a transitional living home or a supportive sober living environment. They coach the people who reside at these locations and their presence adds to the quality of the recovery experience.

    Is recovery coaching covered by insurance?

    Unfortunately, the answer to that question is no. No independent health insurance company covers the services of a recovery coach working with an individual in recovery from an addiction. There is currently only one state, New York, that has an arrangement with the state’s Medicaid offices to reimburse for recovery coaching for individuals who are diagnosed as dependent on a substance. Other states, Tennessee, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place.

    What is a peer to peer recovery support specialist?

    A nearly universal definition of a peer to peer recovery support specialist is an individual with lived experience who has initiated his/her own recovery journey and assists others who are in earlier stages of the healing process of recovery from psychic, traumatic and/or substance-use challenges and, as a result, can offer assistance and support to promote another peer’s own personal recovery journey. A peer to peer recovery support specialist is also called a peer, peer support-practitioner, peer mentor, or a certified peer. All of these terms basically describe the same job description. More and more, this job description is focused on the peer to peer recovery support specialist working with a person in mental health recovery.

    The certified peer to peer recovery support specialist workforce is relatively new in the behavioral health field, with state-recognized certification programs first emerging in 2001. Within this short time frame, states have recognized the potential of peer specialists to improve consumer outcomes by promoting recovery. Many social service agencies pay the peer’s salary, and the client does not pay for the coaching. In the mental health/behavioral health field, when referred by a social services agency or mental health treatment organization, reimbursement for a peer to peer recovery support specialist is covered by a health plan or Medicaid.

    Peer to peer recovery support specialists can also work independently from an agency and be reimbursed by the client or a family. Peer to peer recovery support specialists can also choose to provide these services as a volunteer and receive no financial reward.

    What is a professional recovery coach?

    A professional recovery coach, is sometimes referred to as a recovery life coach. A professional recovery coach has experience and training in the recovery models, and training as a professional coach. These professional and credentialed coaching programs are sometimes referred to as life coaching training. A professional recovery coach can receive training from any of the 250 organizations that train recovery coaches, and select not to receive the certificate from a state certification board or the IC & RC (see the certification information in next week’s post). A professional coach can receive training from the ICF – International Coach Federation’s accredited coach training programs, and apply for a credential issued by the ICF.

    A professional recovery coach can assist a client with a variety of coaching interventions including, but not limited to recovery from addictions, dealing with mental health diagnoses, divorce, financial downturns, grieving, career change and even family relationship issues. The client is billed for the coaching services from the professional recovery coach. Again, healthcare plans do not reimburse for these coaching services.

    Stay tuned for next week’s post on certification for recovery coaches.

  • The Family Relationship Consultant

    by Ronald B Cohen, MD

    According to Ronald B. Cohen, MD, an experienced Bowen Family Relationship Consultant, and this week’s guest blogger, we all struggle with balancing emotional closeness and distance in our families or origin.

    Learning and Doing

    “How long can we go on being angry?”

    — Elie Wiesel

    Consequently we can all benefit from relationship coaching and consultation. This guest blog, originally published on the FamilyFocusedSolutions.com web site in May 2015, can be found in its entirety along with social media comments and links to related blogs, at http://www.familyfocusedsolutions.com/the-family-relationship-consultant/. You may also share your thoughts and experiences concerning the primacy of relationships in your life in the “Post Comments” box on the original blog.

    Relationships matter. We all belong to families whose emotional connections greatly impact our lives. The behavior of any member of a family affects every other member in some way. We exist in our relationships and our inescapable connection to our family of origin.

    Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation. The family system resides in the self as much as the self-resides in the family system. Bowen Family Systems Theory (BFST) understands family functioning and behavior as arising from an emotional system that is a universal feature of all living things.

    All families have a set of rules, roles and relationship requirements. None of us can ever completely emotionally leave the family we grew up in, nor do we have a choice as to whether or not we deal with them. Even choosing not to deal with them is a way of choosing to deal with them. It just means we leave an awful lot of what’s going on unspoken and have no control over the outcome.

    The goal is to change your relationships with other members of your family of origin to improve your life and your family’s life regardless of what anybody else does. If you change yourself, you fundamentally change the nature of your relationships. Taking responsibility for what you can take responsibility for and attending to your needs in the context of intimate relationships, opens the door to facilitating healing of the entire family.

    Coaching and Relationship Consulting based on Bowen Family Systems Theory (BFST) involves joint observation, investigation and research about present day and historical family functioning. The process of self-differentiation is built upon ownership of one’s emotional reactivity. A primary prerequisite for engaging in the process is to develop realistic expectations when moving toward changing your part in your family’s dance.

    You are learning how to deal with differences without losing connections.

    Bowen preferred the “Coaching” nomenclature because his theoretical underpinnings, process of interaction, and desired outcomes were so different from conventional psychotherapy that the term therapy did not capture all of its essential aspects. The journey of self-differentiation may be described as “Growing in the ability to be fully responsible for my own life while being committed to growing closer to those I love.”

    Autonomy and emotional connection become congruent and not adversarial.

    The “work” itself is an individual and somewhat solitary undertaking that emphasizes self-directed effort. Learn to observe non-reactively the relationship patterns in your original family and explore your role in these patterns. Strive to bring your behavior more in line with your deepest beliefs, even if this means upsetting family members by disobeying family “rules.”

    You can make change in your family relationships even without the participation of other family members. If you want your life to be better you have to do the work.

    Remember, you are completely in control of your process and end up in a better place whether or not anybody else in the family signs on.

    The lives of our children and our children’s children are deeply affected by how we live our lives. Healing current relationships avoids leaving a damaging legacy for our descendants.

    Consultation with a well-trained Bowen Family Systems Theory “Coach” can help develop a solid self in the wider historical context of our most important relationships.

    Best of luck on your unfolding journey of a lifetime.

    Ron Cohen MDRonald B Cohen, MD is a Board Certified Psychiatrist and Bowen Family Systems Theory Coach and Relationship Consultant in Great Neck, New York. He can help develop a solid image of your ‘self’ in the wider historical context of your most important relationships. To request more information or contact Ron Cohen directly for any reason, please email him at: RBCohenMD@FamilyFocusedSolutions.com or call him at: (516) 466-7530

  • Addicted to Dimes, Confessions of a Liar and a Cheat – Part 4

    manhattan_bridge_post_versionThis week’s guest blogger is  Catherine Townsend-Lyon, an author, blogger and  marketing guru. Catherine lives in Arizona and is a recovering gambling addict.  In this blog Catherine features a segment of her book “Addicted to Dimes”.

    Belts, Handles and Spoons

    My family background was like any other family – or so I thought. My mom was a homemaker, and she’d baby sit other children to make a little money on the side. My dad was career Air Force. I was born in New Jersey and lived there until I was 7 ½. I had an older sister, Rose, and an older brother, Rob, and a younger sister, Angela, who was born a few years after we moved to Southern California.

    My dad finished his tour in Vietnam in January 1970, and got his last transfer orders before retiring in 1975 from Norton Air Force Base in Highland, Calif. My parents bought a home in Highland and that’s where I grew up until I moved away, out-of-state, to Grants Pass, Ore., in May 1987. I had a fairly normal childhood up until I was about 11 or 12. That’s when I was sexually abused by a close family friend. It was the most awful, shameful thing for a young girl to have to go through. I watched the value and respect I had for myself be stripped away each time it happened.

    I wanted so desperately to tell someone, but the fear and anguish put upon me by my abuser held me back. He said no one would believe me, or they would say I was a liar. My parents were the kind of parents who were a little “unconventional” when it came to punishment. I’m not saying my parents were bad parents, just which by today’s standards, some of the physical discipline we received could be considered abuse. I’m also saying that, for me, it was traumatic events that bothered me later in my life.

    For example, one of the events that occurred which really bothered me was when my mom sent us kids to the store to get her a couple things. She gave my brother extra money to get us an ice cream cone at the store. We got outside, my sister’s ice cream fell on the ground and she started crying, so Rob went back to ask for another and the clerk told him, “No.” Rob wanted Rose to stop crying, so he went over to the Brach’s candy bins and took a couple of pieces. He got caught by the owner, who knew my mom. So, my mom had to come pick us up from the store.

    We got home and Rob told her what happened. She said, “You don’t steal, no matter what.” Making this a “teachable” moment, she made them hold out their hands and she took a large sewing needle and pricked the tops of their hands until they bled! That was too much for me to watch, but she made me, and it still disturbs me to this day . . . .

    I hope you enjoyed reading the first few sections of Catherine’s book, Addicted to Dimes. We know in recovery that we turn to addiction for many reasons, and that we can recover without knowing the reasons why we walked down a dark path. And sometimes, we discover some of the underlying issues of the addiction sucked us in.

    Author, Catherine Townsend-Lyon lives in Arizona writes a blog on her web site: https://catherinelyonaddictedtodimes.wordpress.com/author/kitcat4459/

    And works with other authors on marketing their books at:

    https://anAuthorandWriterinProgress.wordpress.com You can Email her at: LyonMedia@aol.com

  • Addicted to Dimes, Confessions of a Liar and a Cheat – Part 3

    manhattan_bridge_post_versionThis week’s guest blogger is  Catherine Townsend-Lyon, an author, blogger and  marketing guru. Catherine lives in Arizona and is a recovering gambling addict. For the next two weeks, Catherine will feature segments of her book “Addicted to Dimes” in this blog.

    The Woman in the Mirror

    I used gambling to get reactions from people who didn’t communicate feelings or get reactions from people who had hurt me.

    I know I’ve always had a compulsive type of personality and high anxiety most of my life. I had to always be moving or engaged in something. While in treatment, and during my first time in the crisis center, I found out I suffer from severe depression, severe anxiety and PTSD from my childhood trauma. I started on medications for them, in November 2002. I also remember, while in the crisis center after being there only a few days, I was getting ready to take a shower and I looked at myself in the mirror. I didn’t recognize the woman looking back at me. I’d always been a fun, bubbly, caring person, but this woman looking back at me, I didn’t know or recognize. I also was suffering with mood swings sleep problems and felt as though the medications I was taking weren’t helping these symptoms. I sure wished they could come up with a cure or a pill for gambling addiction.

    Needing My Parents Love I Never Got

    I found that there were other people going through some of the same things with their addiction as I was. The amount of money lost to our gambling may have been different, but I didn’t feel as though I was alone in this insane disease. There is a lot more to the addiction than just placing a bet or being in action. I learned to use my addiction as a way to cope with feelings and disappointments that I had pushed deep down rather than dealing with them. I would gamble to escape reality, which was very immature in retrospect. I was selfish and only cared about myself. Just as the addiction makes you selfish, so does recovery. Recovery requires hard work and the desire to want to stop gambling.

    You have to put those first, before everything else, to get well again. For me, I know the problem started a long time ago. As I was growing up, I had this nagging feeling of always having to prove myself to others, especially my parents, and I wasted many years doing just that. The only thing I ever wanted was my parents’ unconditional love. I became emotionally drained after years of waiting to hear they were proud of me. My parents were not the type of people to share their feelings or emotions, so it led me on a long journey of trying to win their approval of me.

    Bah, Bah Black Sheep

    It seemed I was destined to be the black sheep of the family, and seemed to be treated as such as I got into adulthood. I think that’s where I got my feelings of a sense of entitlement, later on in my life. Because of the way my family had hurt me so much through the years, I used my addiction to hurt them. But the only one I really hurt was myself. Growing up, I just wanted to be heard, or acknowledged. That’s all. We didn’t have any family history of gambling problems. When my parents had friends or family over, they would play cards, or my mom would play bingo now and then. My dad was in the Air Force, so she’d go to the air base at Norton to play bingo. My sister and I would tag along sometimes and we’d win things like irons and toasters.

    I hope you enjoyed reading the first few sections of Catherine’s book, Addicted to Dimes. The series will continue for another week. We know in recovery that we turn to addiction for many reasons, and that we can recover without knowing the reasons why we walked down such a dark path. And sometimes, we discover some of the underlying issues of why the addiction sucked us in.

    Author, Catherine Townsend-Lyon lives in Arizona writes a blog on her web site: https://catherinelyonaddictedtodimes.wordpress.com/author/kitcat4459/

    And works with other authors on marketing their books at:

    https://anAuthorandWriterinProgress.wordpress.com

    You can Email her at: LyonMedia@aol.com

     

     

     

     

  • Addicted to Dimes, Confessions of a Liar and a Cheat – Part 2

    manhattan_bridge_post_versionThis week’s guest blogger is  Catherine Townsend-Lyon, an author, blogger and  marketing guru. Catherine lives in Arizona and is a recovering gambling addict. For the next three weeks, Catherine will feature segments of her book “Addicted to Dimes” in this blog.

     Baffling Exposure

    Another part of this addiction that baffled me was the medical side of the disease. When you see people with drug or alcohol addictions, by most outward appearances, you can usually tell when someone is under the influence.

    With a gambling addiction, the chemicals in your body have the same effect as substances do for other addicts. I just could not wrap my head around that. Gambling addicts have the same types of physical symptoms such as the shakes from withdrawals, feeling sick to one’s stomach, sweats and chills. The feelings of fear, hopelessness, emotional and mental blackouts and suicidal thoughts after a gambling binge or relapse, and after the reality of the devastation you’ve just caused financially … feeling the loss of control, and powerlessness over being able to stop gambling. You’re on edge and stressed all the time, and often thinking about how, when and where you will gamble again, and how to get the money. There is a never-ending gambling cycle. It runs in many phases. This was the most important thing I learned later on, in intense therapy, with a guy who came to my aid in 2006. I will share more about that later in this book.

    I learned with the cycle of my addiction, it goes in an insane cycle when you cross the line into uncontrollable gambling. I also learned there are many reasons why we turn to compulsive gambling in the first place. It can be from childhood or adult traumas, or events like child abuse, sexual abuse, or mental and emotional abuses. It could be from some underlying behaviors, a death, or that you may have grown up with addicted gamblers. You use it as a coping skill or as an escape from everyday life.

    The cycle of my addiction starts with the winning phase. At first, you seem to win often, which makes you want to gamble more often. I remember how the feelings of excitement build, and how I thought I could win enough to make all my dreams come true, and pay off my bills. That’s when you start increasing the amount you bet, and how much money you bring to play with. I’d tell everyone how I won all the time. (Red flag of denial.) Then you’ll go through the losing phase. That is, when I noticed I was gambling more by myself. That’s when I started to lie and cover up the money I lost, and when I started to obsess about gambling all the time. I started to borrow money from family and pawned some jewelry. Bills started being late and I noticed a change in my attitude and personality.

    Finally, after several years, I got into a desperate phase. I started feeling hopeless. I fought with my husband a lot, and I blamed our financial problems on things other than my gambling. I lost time from work, family and friends. I was gambling every chance I got, then more credit cards and more debt. I stole, lied and cheated. My reputation and good character was damaged. All that and more happened before I got help.

    I hope you enjoyed reading the first few sections of Catherine’s book, Addicted to Dimes. The series will continue for the next two weeks. We know in recovery that we turn to addiction for many reasons, and that we can recover without knowing the reasons why we walked down such a dark path. And sometimes, we discover some of the underlying issues of why the addiction sucked us in.

    Author, Catherine Townsend-Lyon lives in Arizona writes a blog on her web site: https://catherinelyonaddictedtodimes.wordpress.com/author/kitcat4459/

    And works with other authors on marketing their books at:

    https://anAuthorandWriterinProgress.wordpress.com

    You can Email her at: LyonMedia@aol.com