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Category: Drug Addiction

Drug Addiction

  • The Recovery Support that is Available Following Overdose

    What subsequently happens to people who experience a drug overdose and are successfully rescued through emergency medical intervention?

    What is their fate after they leave the hospital or other emergency care setting?

    Missing in the media coverage of the unrelenting legions of drug overdose deaths in the United States is an equally important but less heralded story. What happens to people who experience a drug overdose and are successfully revived through emergency medical intervention? What is their fate after they leave the hospital or other emergency care setting? The Connecticut Community for Addiction Recovery (CCAR)  and other  grassroots recovery community organizations (RCOs) nationwide are influencing positive outcomes to overdose by placing recovery coaches with first responders and doctors in the emergency departments in hospitals to advance recovery options for the revived overdose patients.

    The Connecticut Community for Addiction Recovery (CCAR) is one of several hundred recovery advocacy and recovery support organizations (RCOs) rising on the American landscape in the last two decades.  CCAR began piloting an Emergency Department Recovery Coach (EDRC) Program in March of 2017. Through this program, CCAR-trained recovery coaches are on-call for hospital emergency rooms to offer assistance to patients and their families during an emergency room visit resulting from an adverse drug reaction or other alcohol- or another drug-related medical crisis. An evaluation of EDRC services provided between March and November 2017 within four collaborating hospitals revealed the following. CCAR-trained recovery coaches provided recovery support services to 534 patients/families during the 8-month evaluation period with a relatively even distribution of services provided across the four hospitals. Of those served by the EDRC, the majority were in the ER due to an alcohol- or opioid-related condition; 70% were male; and 5% were seen more than once during the evaluation period. Most importantly, of the 534-people interviewed, 528 were assertively linked to a detoxification program, inpatient or outpatient treatment, or community-based recovery support resources.

    A more formal and sustained evaluation of the EDRC program is underway in collaboration with Yale University, and the program is now being expanded to an additional four hospitals. Funding support for the EDRC comes from the Connecticut Department of Mental Health and Addiction Services through support of the federal block grant and a Targeted Response to the Opioid Crisis Grant from the Substance Abuse and Mental Health Services Administration.

    CCAR’s EDRC program has many distinct features worthy of replication and local refinement. Among the more striking of such features are the following-

    • The EDRC program is governed by a formal agreement between CCAR and each participating hospital that delineates the roles and responsibilities of each party.
    • The EDRC program is currently staffed by one Recovery Coach Manager and 9 full-time Recovery Coaches (RCs).
    • Emergency Department Recovery Coaches (EDRCs) are recruited and screened (2 interviews with background and reference checks) based on desired experience, skills, and a good work history, but also for what our EDRC manager, Jennifer Chadukiewicz, calls “a servant’s heart.”
    • All EDRCs go through more than 60 hours of training and spend the first weeks shadowing tenured EDRCs. The training includes the CCAR Recovery Coach Academy© (30 hours) as well as topical trainings, e.g., Narcan (naloxone administration), medication-assisted recovery, ethical decision-making, crisis intervention, and conflict resolution. Hospital specific training includes such areas as fire/general safety, OSHA, blood borne pathogens, infection control, hazardous materials, and HIPPA regulations.
    • EDRC Recovery Coaches are employed by CCAR rather than the hospitals and enter the hospitals as service vendors and “guests” who defer to leadership of ER staff.
    • The RCs are paid a livable wage ($20-$25/hr. to start plus benefits, health insurance, etc.) that allows them to work full time and support themselves and their families while affording time away for rest and self-care.
    • EDRC coverage is provided from 8 am to 12 midnight, seven days a week, 365 days a year.
    • Patients have the option of enrollment in enhanced Telephone Recovery Support (TRS) program (i.e., patients receive daily support calls for the next 10 days and then weekly if desired).
    • EDRC’s provide assertive linkage and transportation (when needed) to treatment and recovery support resources.
    • The EDRCs spend considerable time with community providers and other stakeholders building collaborative relationships that facilitate this patient referral and service linkage process.
    • CCAR provides each hospital emergency department with “prescription pad” style resource handouts that can be attached to discharge paperwork and given to patient friend/family member.

    There are critical windows of vulnerability and opportunity within addiction and recovery careers that serve to plunge one deeper into addiction or mark the catalytic beginning of a recovery process. The reversal of a drug overdose or treatment of other drug-related medical crises can constitute a recovery tipping point.

    The emergency room is not the only critical point of potential intervention to reduce the risk of drug-related deaths and to promote addiction recovery. For persons with a history of addiction, the days and weeks immediately following release from a correctional facility, release from an inpatient or residential detoxification/treatment program without medication support, or cessation of medication-assisted treatment, and even transfer from one medication-assisted treatment provider to another all constitute a zone of heightened risk for re-initiation of risky drug use and death. Altering such risks and tipping the scales toward recovery stabilization, recovery maintenance, and enhanced quality of personal/family life in long-term recovery should be the goals of every community. Recovery community organizations like CCAR are showing us how this can be done.

    This blog was written by William White, Rebecca Allen & Phil Valentine. It was originally posted on the William White web site: www.williamwhitepapers.com on January 18, 2018

    Connecticut Community of Addiction Recovery (CCAR) is one of the nation’s first RCOs, CCAR pioneered what have since become standard RCO service fare: recovery-focused professional and public education, legislative advocacy, recovery community centers, recovery celebration walks and conferences, recovery support groups, training for recovery home operators, face-to-face and telephone-based recovery support services, family-focused recovery education and support services, and collaboration with research scientists on the evaluation of the effects of peer support on long-term recovery outcomes. As an example of its reach, CCAR’s Recovery Coach Academy curriculum has been used in the training of more than 20,000 recovery coaches in more than 33 states and in such countries as Sweden, Vietnam, Canada, and Spain.

  • Recovery Rising – A memoir of William L White

    Recovery Rising is the memoir of foremost recovery researcher and advocate, William L White. It has just been released on Amazon. White, for over five decades has had different roles in the addiction treatment field, beginning in Chicago’s inner city as a street worker working with addicts and the homeless, an addiction counselor, clinical supervisor, treatment administrator, educator, clinical and organizational consultant, and research scientist to being honored as the addiction field’s preeminent historian, one of the fields most visionary voices and a most prolific author.

    In Recovery Rising, William White’s ideas, methods, and organizational studies emerge to give the reader an idea on how dynamic a leader White is in the modern addictions field. These stories, sometimes poignant, sometime humorous always are revealing and informative. Williams White’s life work has been affirmed by this memoir and (hopefully) a younger generation of addiction advocates and professionals will be inspired by his story  to continue his good work.

    This link to his book on Amazon is:

    https://www.amazon.com/Recovery-Rising-Retrospective-Addiction-Treatment-ebook/dp/B07526ZDVD/ref=sr_1_1?s=books&ie=UTF8&qid=1506351061&sr=1-1&keywords=recovery+rising

  • What is a recovery coach?

    In 2013, I published Recovery Coaching – A Guide to Coaching People in Recovery from Addictions, since then the duties and responsibilities of recovery coaches, peer recovery support specialists and professional recovery coaches have expanded significantly.

    In this article, I hope to define some different recovery coaching titles for those interested in becoming a recovery coach, what certifications they should seek, the places they could work and what they can anticipate as compensation for their work.

    What kind of certification should a future recovery coach receive?

    Recovery coach training and certification is a requirement in this field. Coaching certification and training is one of the fastest growing aspects of the healthcare field. The number of recovery coaching training and certification courses has expanded to over 300 institutions nationwide. Many employers require recovery coach and peer recovery support specialist certifications. In the links section of this web site is a state by state listing of all the organizations that offer certifications for addiction recovery coaches. If you are reading this to receive basic recovery coaching information, first decide if you enjoy working with people in recovery from substance misuse or want to work with people in recovery from a mental health or behavioral health disorder.

    Are you interested in working with people in recovery from addictions or in recovery from a mental health or behavioral health diagnosis?

    A nearly universal definition of a peer recovery support specialist or a recovery coach is “an individual with the lived experience of their own recovery journey and wants to assist others who are in the early stages of the healing process from psychic, traumatic and/or substance misuse challenges, thus, this peer can aid and support another peer’s personal recovery journey”. Some certifications for a peer recovery support specialist give an individual the training necessary to work with individuals with a behavioral health disorder or a mental health diagnosis. These certifications include more training on the nature of behavioral health disorders, the medications used to treat these disorders, crisis interventions, life/occupational skills, and trauma informed care. A recovery coach working with people in addiction recovery does not necessarily need these types of training. In this article, I will focus on the recovery coach working with people in recovery from substance misuse.

    The individuals that work with people in recovery from substance misuse are called recovery coaches, as well as peer recovery support specialists (PRSS), peer recovery support practitioners (PRSP), recovery support specialists (RSS), sober companions, recovery associates or quit coaches. In all cases, they support individuals in recovery from addiction(s), which can include alcohol, drugs, gambling, eating disorders as well as other addictive behaviors.

    The basic recovery coaching credential is required. If you want recovery coaching certification, google this term with the region you live in. For addition recovery coaching education, I suggest: adding certification for treating co-occurring disorders, training on the application of Narcan which includes the certification for coaching persons detoxing from an opioid overdose, also certification for counseling individuals in Suboxone or Methadone treatment also called Medication Assisted Treatment (MAT) and Medication Supported Recovery (MSR), certification for spiritual recovery coaches and credentials for coaches working with individuals with behavioral addictions such as sexual compulsivity, internet gaming and gambling disorders. If you would like to work in an inpatient treatment center, drug and alcohol counseling certification maybe required.

    Recovery coaching credentialing has expanded to include coach supervision certification, which is training for individuals who want to manage other recovery coaches. Also there is an elevated level of certification called professional recovery coaching. A professional recovery coach is an individual that has been coaching for several years, has hundreds of coaching hours under their belt, manages other coaches and/or has received other coaching credentials. A professional recovery coach is sometimes referred to as a life recovery coach. A professional recovery coach can receive training from any of the organizations that train peers or recovery coaches, and in addition, they can receive training from the International Coach Federation’s accredited life coach training program or a professional recovery coach certification from Recovery Coaches International. Recently, Connecticut Community of Addiction Recovery (CCAR) has started developing a Professional Coaching Certification.

    Where do you want to work?

    Some recovery coaches seek to work at a recovery community organization (RCOs) or a recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. The recovery coaches at these recovery community organizations work with people of all financial means, addicts that are homeless, offenders, even professionals like nurses, teachers, lawyers and highly educated individuals, who have hit bottom. Sometimes, the recovery coaches at these centers receive a salary from the RCO. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

    Recovery coaches can be employed by treatment centers coaches, developing a coaching relationship with a client outside of the clinical treatment. They can escort a client home from a treatment center and stay with the client for a period of time, insuring they do not relapse after discharge. More half way houses or sober living environments are employing recovery coaches. In fact, many recovery coaches have opened a transitional living home or a supportive sober living environments. They act as a recovery coach and a house manager at the same time, their presence adds to the quality of the recovery experience for the residents. Recovery coaches can work in emergency departments in hospitals, detoxification centers or sobering centers; working with individuals in crisis, either detoxing from an alcohol or opioid overdose.

    Lastly, some recovery coaches run their own coaching business. They will visit clients or talk with them over the phone or on SKYPE. These recovery coaches market themselves by contacting a treatment center’s aftercare coordinator or will seek referrals from therapists. The client is billed directly for the coaching services, there is no insurance coverage for a recovery coach.

    How much do you want to be paid for your services?

    Recovery coaches are paid a variety of rates. A recovery community organization, a treatment center, sober living environment or social services agency recovery coaching rates are from $12-$18 per hour. If a recovery coach receives their salary from a social services agency, or a recovery community organization that agency may have received a grant to run a peer program from the State or Federal government.

    A professional life recovery coach can bill from $35 up to $100 an hour for their coaching services. These professional recovery coaches bill their clients directly and incur expenses for running their coaching practice such as insurance, travel and overhead. This ‘pie in the sky’ $100 per hour fee of a professional recovery coach is not for the inexperienced or newbie coach. There are significant responsibilities a recovery coach has for their client, primarily keeping them free from relapse or overdose, or in other words- keeping them alive.

    Soon, there will be reimbursement from health insurance companies for recovery coaching for individuals who are diagnosed as dependent on a substance. New York 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, Pennsylvania, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place. However, currently, private independent health insurance companies do not cover the services of a recovery coach working with an individual in recovery from an addiction.

    In less than five years the field of recovery coaching has grown significantly. With the advent of the Affordable Care Act and the legislation to fight addiction, the 21st Century CURES and the CARA Acts, recovery coaching is now recognized as one of the most important tools to initiate and maintain long term recovery. This recognition will continue as the benefits from recovery coaching continue to be realized.

     

  • Lions, Tigers, Bears and the Yellow Brick Road to Recovery

    This is a guest post by Steve Devlin, a recovery coach from Philadelphia PA, and a long time friend. I chose to post this over the Holiday weekend, because it brings me such joy, and brings back wonderful memories of watching the Wizard of Oz on TV during the 60’s. Thank-you Steve, and Happy Holidays to all of my readers.

    Over the past week, I have been thinking about the Serenity Prayer and its connection to the Wizard of Oz.  Some of you might be looking at your computer and wonder if I have lost my mind.  I beg for your patience and to hear me out.  First a caveat or two.  I represent only myself in this message.  The second caveat is this message was inspired by a share I heard at a 12-step meeting.  The person who said it gave me permission to use it.  So here we go!

    We all know the Serenity Prayer.  “May God grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference.”  And almost everyone knows the story of the Wizard of Oz or at least the movie version of the story. Dorothy is not happy with life on the farm, runs away, is swept up in a tornado, lands in a strange place, and gathers three companions on her journey to the Emerald City to meet the Wizard.  On the way, she must deal with witches – good and bad – flying monkeys, and castle guards before she finds she always had the power to grant her wish of returning home.

    So what does this story have to do with the Serenity Prayer, let alone recovery?  We cannot find fulfillment, happiness, or peace in our lives. We run away and just when we realize that we have run too far, we are swept up in the tornado (or drug of our choice).  Its path of destruction destroys the landscape of our lives and carries us far away. Thankfully, when the storm passes we land in a new brightly-colored world filled with sober people singing about the blessings of recovery.  Yet our own work is just beginning.  There is a road we must follow with steps leading to the Emerald City of sobriety.  We also learn that we cannot walk the path alone.  There are still temptations, flying monkeys, people, places, and things calling us back to the darkness.  However, as we follow the path we first find the companion of serenity – the heart to love ourselves and others.  A new heart also gives us the gift of forgiveness and acceptance.

    The second companion is the courage to move forwards even when encountering lions, tigers, and bears.  It is courage which lets us turn over our lives, let go of character defects, and make amends.  It is also courage that lets us pick up the phone or go to a meeting.

    Finally, there is wisdom, which gives us the ability to see choices in our lives and to know what we can and cannot change.  After long periods of feeling tied up like a scarecrow on a post, we are set free to walk a brick road of new life.  Of course, finding these three companions to fight back addiction is only part of the story and the Emerald City is not the ultimate destination.  Our companions bring us to the shining light of recovery, but we must take the gifts back home and use them in our daily lives outside of the rooms.

    I wish recovery was as easy as clicking our heals together.  Finding our way home takes work but with heart, courage, and wisdom we can overcome all the flying monkeys and stay out of the way of tornadoes.  We also learn that the greatest companion of recovery is gratitude which was always just in our own backyard.

    Question: Who are your companions on the brick road?

  • What is a recovery coach?

    What is a recovery coach, a peer recovery support specialist or a professional recovery coach?

    In 2013, I published Recovery Coaching – A Guide to Coaching People in Recovery from Addictions, since then the duties and responsibilities of recovery coaches, peer recovery support specialists and professional recovery coaches have expanded significantly.

    In this post, I hope to help define for those interested in becoming a recovery coach what certifications they should seek, the places they could work and what they can anticipate as compensation for their work.

    What kind of certification should a future recovery coach receive?

    Recovery coach training and certification is a requirement in this field. Coaching certification and training is one of the fastest growing aspects of the healthcare field. The number of recovery coaching training and certification courses has expanded to over 300 institutions nationwide. Many employers require recovery coach and peer recovery support specialist certifications. In the links section of this web site is a state by state listing of all the organizations that offer certifications for addiction recovery coaches.

    If you are reading this post to receive basic recovery coaching information, first decide if you enjoy working with people in recovery from substance misuse or want to work with people in recovery from a mental health or behavioral health disorder.

    Are you interested in working with people in recovery from addictions or in recovery from a mental health or behavioral health diagnosis?

    A nearly universal definition of a peer recovery support specialist or a recovery coach is an individual with the lived experience of their own recovery journey and wants to assist others who are in the early stages of the healing process from psychic, traumatic and/or substance misuse challenges, thus, this peer can aid and support another peer’s personal recovery journey.

    Some certifications for a peer recovery support specialist give an individual the training necessary to work with individuals with a behavioral health disorder or a mental health diagnosis. These certifications include more training on the nature of behavioral health disorders, the medications used to treat these disorders, crisis interventions, life/occupational skills, and trauma informed care. A recovery coach working with people in addiction recovery does not necessarily need these types of training. In this blog, I will focus on the recovery coach working with people in recovery from substance misuse.

    The individuals that work with people in recovery from substance misuse are called recovery coaches, as well as peer recovery support specialists (PRSS), peer recovery support practitioners (PRSP), recovery support specialists (RSS), sober companions, recovery associates or quit coaches. In all cases, they support individuals in recovery from addiction(s), which can include alcohol, drugs, gambling, eating disorders as well as other addictive behaviors.

    The basic recovery coaching credential is very broad. If you want more specific training, one can add certification for treating co-occurring disorders, the application of Narcan which includes the certification for coaching persons detoxing from an opioid overdose, certification coaching individuals in Suboxone or Methadone treatment also called Medication Assisted Treatment (MAT) and Medication Supported Recovery (MSR), certification for spiritual recovery coaches and credentials for coaches working with individuals with behavioral addictions such as sexual compulsivity, internet gaming and gambling disorders.

    Recovery coaching credentialing has expanded to include training for individuals that want to supervise other recovery coaches, or an elevated level of certification called professional recovery coaching.

    A professional recovery coach is an individual that has been coaching for several years, has hundreds of coaching hours under their belt, manages other coaches and/or has received other coaching credentials. A professional recovery coach is sometimes referred to as a life recovery coach. A professional recovery coach can receive training from any of the organizations that train peers or recovery coaches, and in addition, they can receive training from the International Coach Federation’s accredited life coach training program. Recently, Connecticut Community of Addiction Recovery has started developing a Professional Coaching Certification.

    Where do you want to work?

    Some recovery coaches seek to work at a recovery community organization (RCOs) or a recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. The recovery coaches at these recovery community organizations work with people of all financial means, addicts that are homeless, offenders, even professionals like nurses, teachers, lawyers and highly educated individuals, who have hit bottom. Sometimes, the recovery coaches at these centers receive a salary from the RCO. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

    Recovery coaches can be employed by treatment centers coaches often escort a client home from a treatment center insuring they do not relapse in the first 30 days after discharge. More half way houses or sober living environments are employing recovery coaches. In fact, many recovery coaches have opened a transitional living home or a supportive sober living environments. They act as a recovery coach and a house manager at the same time, their presence adds to the quality of the recovery experience for the residents.

    Recovery coaches can work in emergency departments in hospitals, detoxification centers or sobering centers; working with individuals in crisis, either detoxing from an alcohol or opioid overdose.

    Lastly, some recovery coaches run their own business. They will visit clients or call them over the phone or use SKYPE. These recovery coaches market themselves by contacting a treatment center’s aftercare coordinator, maintaining a web site or will seek referrals from therapists. These coaches meet face to face with the client weekly and will work with them over the phone or face to face on a regular basis. The client is billed directly for the coaching services.

    How much do you want to be paid for your services?

    Recovery coaches are paid a variety of rates. A recovery community organization, a treatment center, sober living environment or social services agency recovery coaching rates are from $12-$20 per hour. If a recovery coach receives their salary from a social services agency, or a recovery community organization that agency may have received a grant to run a peer program from the State or Federal government.

    A professional life recovery coach can bill from $35 up to $100 an hour for their coaching services. These professional recovery coaches bill their clients directly and incur expenses for running their coaching practice such as insurance, travel and overhead. This ‘pie in the sky’ $100 per hour fee of a professional recovery coach is not for the inexperienced or newbie coach. There are significant responsibilities a recovery coach has for their client, primarily keeping them free from relapse or overdose, or in other words- keeping them alive.

    Soon, there will be reimbursement from health insurance companies for recovery coaching for individuals who are diagnosed as dependent on a substance. New York 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, Pennsylvania, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place. However, currently, private independent health insurance companies do not cover the services of a recovery coach working with an individual in recovery from an addiction.

    In less than four years the field of recovery coaching has grown significantly. With the advent of the Affordable Healthcare Act and the newest legislation to fight addiction, the 21st Century CURES and the CARA Acts , recovery coaching is now recognized as one of the most important tools to initiate and maintain long term recovery. This recognition will continue as the benefits from recovery coaching continue to be realized.

  • Getting through the tough times

    As a recovery coach, I often see my clients need help getting through the tough times, without using, picking up or acting out. Recently, I personally encountered some rough patches in my life, so, I went to my library of recovery books. Several years ago, when I was experiencing trouble living life on life’s terms, I became an avid reader of Pema Chodron.

    Pema Chodron Celebrates her 80th Year

    Pema Chodron, is a Buddhist nun, she was born in 1936, in New York City, and is celebrating her 80th year. After a divorce, in her mid-thirties, Pema traveled to the French Alps and encountered Buddhist teacher Lama Chime Rinpoche, and she studied with him for several years. She became a novice Buddhist nun in 1974. Pema moved to rural Cape Breton, Nova Scotia in 1984, ­­­to be the director of Gampo Abbey and worked to establish a place to teach the Buddhist monastic traditions (waking before sunrise, chanting scriptures, daily chores, communal meals and providing blessings for the laity). In Nova Scotia and through the Chodron Foundation, she works with others, sharing her ideas and teachings. She has written several books, and in my time of deep spiritual need, I went to her book “When Things Fall Apart”.

    A Compassionate Tool

    Drawn from traditional Buddhist wisdom, Pema’s radical and compassionate advice for what to do when things fall apart in our lives helped me. There is not only one approach to suffering that is of lasting benefit, Pema teaches several approaches that involve moving toward the painful situation and relaxing us to realize the essential groundlessness of our situation. It is in this book, I discovered a simple breathing exercise, I can use during these chaotic times so I can move into a better space. Pema advocates this tool as a breathing exercise, although this exercise could also be considered a mindful meditation.

    I use Chodron’s tool whenever and wherever life hits me below the belt. I share this tool with my clients. It is all about breathing and consciously repeating words to yourself to accompany the breathing. Since we breathe every day, it is indiscernible whether you are using this tool as you travel on the bus commuting home from work, in a conference room with your boss, or when you are feeling low and want to curl up in a ball and die.

    Breathe

    Breathe. Pema explains in her book, when things get way too complicated; step back and breathe. When the force of the world, the politics of the U.S., Great Britain or Italy start weighing heavily on your mind, breathe. When you look at all the pain around you and feel powerless to do anything, breathe.

    Pema explains, inhale and say silently to yourself breathe in the pain, then exhale and say breathe out relief. Then, inhale, and say silently to yourself breathe in the relief, and exhale and say breathe out the pain. I find I need about 15 minutes of conscious breathing, breathing in the pain and breathing out relief, works for me. After doing this, I find I have new energy or something else crosses my path to move me into a more uplifting space.

    Chodron’s exercise places me in a space I need to be. If I continue to be in that “negative space” of worry or feeling powerless, then absolutely nothing will be accomplished that day. I know we all have something to accomplish every day, whether it is just getting out of bed, taking a shower and brushing our teeth or running a Fortune 500 company, this exercise gets us from zero to ten in fifteen minutes. It is the boost we need.

     So, I invite you to try this simple exercise…and remember…keep breathing

     

  • A new ER resource – recovery coaches

    manhattan_bridgeIn Rhode Island, more than 1,000 addicts have been brought from the edge of death due to an opioid overdose, thanks to first-responders and emergency room workers using the new lifesaving drugs Narcan and Naloxone. When patients are overdosing, first-responders or ER nurses administer these new drugs, which reverse an opioid overdose. The ER staff members use it so often it’s become a verb, as in: “we Narcaned him.”

    In 2015, a pilot program to train law enforcement officers to use Narcan and Naloxone prefilled syringes or nasal spray was started in the New Jersey counties of Monmouth and Ocean. It has been successful in reversing over 400 potentially fatal overdoses. Narcan kits are now available in police cars, ambulances, public transportation centers and even at your local CVS. But the growing number of overdoses has stretched the emergency room doctors and nurses to a breaking point.

    When Narcan patients come to the ER, they can be angry and disorientated, when upon waking they find their high is gone. Emergency rooms are handling a lot of overdose patients, and the work can be frustrating. These patients are combative, upset, demeaning, often yelling or physically acting out. ER personnel, not trained in detox reactions, are perplexed. They are being pulled away from the people who have more medically-critical needs.

    In a relatively short period of time, Naloxone and Narcan are emerging as very one-dimensional treatments. They are lifesavers, but don’t treat the real problem that brings the patient into the emergency room. Another similar one-dimensional treatment is using a defibrillator for a heart attack, it saves the life but it doesn’t treat the heart disease. Using Narcan does not treat the disease of addiction.

    As a result, emergency room physicians, first-responders and treatment experts across the country say the same thing, without a mechanism to connect the overdose patients to addiction services, Narcan and Naloxone only create a revolving door in emergency rooms. Some addicts have returned from the edge of death four and five times, thanks to Narcan injections or nasal sprays.

    In Rhode Island’s hospitals, and in hospitals throughout New Hampshire and New Jersey, ER doctors have called on a relatively new resource to help: the recovery coach. These coaches are not ER employees but are part of a new plan to assist ER personnel in dealing with the detoxing victims of an opioid overdose. These recovery coaches work with the detoxing patients, allowing the ER staff to continue with their tasks of treating others that come into an emergency room. These recovery coaches are peers, many of them former addicts trained to work with an overdose patient coming down from the opioid. These coaches are trained to move the patients into long-term treatment programs for their drug addiction.

    “The goal of the LifelineED program is to get individuals who were Narcaned into detox and treatment,” says Sharon Chapman, program supervisor of the LifelineED program at Center for Family Services in Voorhees, NJ. “Our Recovery Coaches and Patient Navigators work with each individual to help get them into a treatment facility. It’s important for these patients to know they’re not alone, we offer support to help the patients and their families as they go through the recovery journey.”

    These recovery coaches offer peer-to-peer support. There’s nothing like being approached by another recovering drug addict who can help you in your time of need, who knows exactly what you’re going through at that moment. Often, they use information and resources that the hospital staff might not have, such as a list of treatment programs, how to go through the intake process, as well as spending time to educate addicts’ families about the treatment process and how to recognize early signs of the addiction. Of course, the patient decides whether they will take part in treatment, but willingness is the strongest when the patient realizes they just have been given a new “lease on life.” Emergency staff acknowledge it’s helpful to have recovery coaches who can spend time with a patient, and can begin moving them into treatment. These coaches know the recovery terrain better than the ER nurses and physicians. Patients have the option to go to a treatment center, or if they choose to go home, they take the recovery coach’s number with them. The recovery coach or the patient navigator will follow up with them, and assists in helping the patient take the next steps towards recovery. Overdose victims are willing to let recovery coaches into their homes to talk about the program immediately after their overdose. Some need time to come to the realization that if they don’t accept the offer of treatment, there may not be another opportunity. Finding the time for a home visit is something that the ER staff could never do.

    Funding for these ER Recovery Coaching programs is popping up all over the United States, since President Obama and Michael Botticelli, the Director of National Drug Control policy, have requested over $1 billion dollars to be placed into the 2017 budget to fight this growing opioid epidemic. This funding request surpasses the $400 million amount Obama signed for in the 2016 budget, which was a jump of $100 million over the 2014 budget, all in hopes of addressing this harrowing epidemic, which has ravaged communities in all corners of the U.S.

    If you are interested in learning more about working in an ER room as a recovery coach, here are some resources:

    Providence Center-AnchorED–

    Holly Fitting

    Phone: (401) 528-0123 / Email: hfitting@provcntr.org

    528 North Main Street,

    Providence, RI 02904

    https://providencecenter.org/services/crisis-emergency-care/anchored

    Attn: Melissa Silvey

    311 Route 108,

    Somersworth, NH 03878

    Phone: (603) 516-2562 / Email: info@onevoicenh.org

    Sharon Chapman, Program Supervisor

    108 Somerdale Rd,

    Voorhees NJ 08043

    http://www.centerffs.org/programs/lifelineed

    Phone: (856) 428-5699 x116 / Email: lifelineED@centerffs.org

    Attn.: Michael Santillo

    16 Spring Street

    Paterson, NJ 07501

    Phone: (973) 754-6784

    http://evasvillage.org/recovery-center.shtml

    • Barnabas Health Opioid Overdose Recovery Program

    Phone: (732) 914-3815

    1691 U.S. 9, Toms River, NJ 08754

  • Is Recovery Coaching Effective?

    Is Recovery Coaching Effective?

    manhattan_bridgeTreatment professionals and researchers are calling for a change in the treatment model for substance use disorders (SUD). This change calls for shedding the acute care model (28 days of SUD treatment will fix you) to a continuum of care models, similar to how chronic diseases like diabetes or arthritis are treated. (Humphreys & Tucker, 2002; Institute of Medicine, 2005; McLellan et al., 2000; White, Boyle, Loveland, & Corrington, 2005).

    At the same time, the mental health and the substance abuse treatment fields have merged, creating the behavioral health field. With this merger, the recovery-oriented systems of care model (ROSC) has become the accepted approach to treatment for those with mental and substance use disorders. This holistic approach, rather than focusing on the addiction, considers the whole person and how they interact in real life. ROSC emphasizes that recovery depends on the connection of mind, body, and spirit, motivating addicts to choose to improve their mental health, their physical health, and to embrace a spiritual component of their recovery (SAMHSA, 2011). This multi-system approach has ROSC counselors encouraging visits to the general practitioner, the OBGyn and the dentist. They assess for co-occurring disorders and embrace one-on-one therapeutic treatment and group therapy. And ROSC practitioners embrace mutual support programs, such as AA, NA or even nontraditional mutual support groups like SOS, or Women for Sobriety. A spiritual program is also encouraged. Lastly, the newest introduction to the treatment field is the recovery coach.

    As mental health and addiction treatment services are adopting this recovery-oriented approach, the emphasis on incorporating various forms of recovery coaching or peer-based recovery support into treatment services is growing rapidly. Peer-based recovery support services are defined as

    “the process of giving and receiving nonprofessional, nonclinical assistance to achieve long-term recovery from mental health and substance use disorders” (Borkman, 1999)

    This support is provided by “peers,” “peer-recovery support specialists,” “recovery coaches,” “peer mentors,” or “peer support specialists” who have lived and experienced personal recovery (Borkman, 1999). The peers assist others in initiating, maintaining and embracing recovery from their mental health or substance use disorders.

    As recovery coaches and peers begin to infiltrate treatment centers and recovery support, community organizations, there is a needling question that arises: are recovery coaches effective in the recovery process?

    Studies have been completed on the effectiveness of recovery coaches aiding in individuals achieving long-term recovery since 2005. Many were small studies, some were not exactly scientific, nor could other studies stand up to researcher’s scrutiny. None of the studies had the critical mass to come to a clear conclusion. Ellen L. Bassuk, M.D., Justine Hanson, Ph.D., R. Neil Greene, M.A., Molly Richard, B.A., and Alexandre Laudet, PhD began examining the 1,221 studies that analyze the effectiveness of peer-delivered, recovery support services for individuals in recovery. They wrote a systematic review called Peer Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.

    This compilation of all the current studies is to create an appraisal, and summarization of the success of peer-delivered, recovery support services, using strict scientific criteria. As part of their review process, the 1,221 studies were screened, but only nine studies were deemed to meet the strict review requirements.

    The nine studies examined the effectiveness of recovery support services that were delivered by a peer using a wide range of interventions and models. These studies also examined the variety of locations that offered peer support, including peer-run, drop-in centers (Ja et al., 2009), peer-run, recovery community organizations (Kamon & Turner, 2013), and Veteran’s Administration medical outpatient clinics (Bernstein et al., 2005).

    This review showed peer-delivered recovery support services accomplished the following successful outcomes:

    1. Decreased alcohol use
    2. Decreased drinking to intoxication by reducing the odds of drinking to intoxication by 2.9 percent (Smelson et al. 2013)
    3. Peer participation lowered re-hospitalization rates, meaning only 62 percent of participants from the peer based support group were re-hospitalized compared to 73 percent of those not receiving peer based support (Min et al. (2007)
    4. Increased post-discharge sobriety time was achieved by the individuals receiving the peer intervention (O’Connell et al. 2014)
    5. If peers led groups in life-skills training, those participants had 14.8 fewer days drinking
    6. Peer recovery support affected those discharged from inpatient treatment by maintaining a post-discharge sobriety rate of 43 percent to 48 percent as compared to 33 percent sobriety for those not receiving peer based support (Tracy et al. 2011)

    Overall, the review of these studies indicate that peers involved in recovery support interventions have beneficial effects on participants. While the reviewers can conclude that there is evidence supporting the effectiveness of peer-delivered, recovery support services, they acknowledge that additional research is necessary to determine the usefulness of peer support services. While this knowledge is encouraging, research in this area is just emerging, and there is a strong need to improve outcomes by completing future studies.

    References

    1. Humphreys, K., & Tucker, J. (2002). Toward more responsive and effective intervention systems for alcohol-related problems. Addiction, 97(2), 126–132.
    2. Institute of Medicine (2005). Improving the quality of health care for mental and substance use conditions. Washington, DC: National Academy Press.
    3. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695.
    4. White, W., Boyle, M., Loveland, D., & Corrington, P. (2005). What is behavioral health recovery management? A brief primer. (Retrieved from www.addictionmanagement.org/recovery%20management.pdf).
    5. Substance Abuse and Mental Health Services Administration (SAMHSA) (2011). SAMHSA’s Working Definition of Recovery. (Retrieved from http://www.samhsa.gov/recovery/).
    6. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
    7. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
    8. Ja, D. Y., Gee, M., Savolainen, J.,Wu, S., & Forghani, S. (2009). Peers Reaching Out Supporting Peers to Embrace Recovery (PROPSPER): A final evaluation report. San Francisco, CA: DYJ, Inc. for Walden House, Inc. and the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (Retrieved from http://www.dyja./com/sites/default/files/u24/PROSPER%20Final%20Evaluation%20Report.pdf).
    9. Kamon, J., & Turner,W. (2013). Recovery coaching in recovery centers: What the initial data suggest: A brief report from the Vermont Recovery Network. Montpelier, Vermont Evidence-Based Solutions (Retrieved form https://vtrecoverynetwork.org/PDF/VRN_RC_eval_report.pdf).
    10. Bernstein, E., Bernstein, J., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77, 49–59
    11. Smelson, D. A., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W. Kane, V. (2013). A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychological Services, 10(2), 161–167.
    12. Min, S. Y., Whitecraft, E., Rothbard, A. B., & Salzer, M. S. (2007). Peer support for persons with co-occurring disorders and community tenure: A survival analysis. Psychiatric Rehabilitation Journal, 30(3), 207–213. http://dx.doi.org/10.2975/30.3.2007.207.213.
    13. O’Connell, M. J., Flanagan, E., Delphin, M., & Davidson, L. (2014). Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery supports. Unpublished manuscript.
    14. Tracy, K., Burton, M., Nich, C., & Rounsaville, B. (2011). Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment. The American Journal of Drug and Alcohol Abuse, 37(6), 525–531

  • The Top Ten Warning Signs You Are Talking to an Online Catfisher-Part 4

     innocence-en-dangerHow can you protect yourself from a Catfisher or an online predator?

    Why do they do what they do? Catfishers want something from you. These are people that are not motivated by love, but are driven by money, perverse sexual desires and criminal intent.

    • Money is usually the first thing predators want from adult contacts
    • They want to win you over and manipulate you, so you begin to desire them in a sexual way and that means you will begin to trust them
    • They will use your photographs and distribute them to other online predators, they will re-post the pictures online in sexual forums or just enjoy your photographs themselves, privately
    • They want to have conversations with you, texting or otherwise, in order to get sexually aroused during the conversation
    • Any of the above contacts will enable these predators to black-mail, extort or rape you

    Scary Stats

    There are some scary statistics on Catfishers or online predators.

    • An estimated 725,000 people are aggressively pursued online for sex or extortion annually in the US
    • In 2005 alone, 25% percent of rapists used online dating sites to find their victims
    • In 2011, the FBI Internet Crime Complaint Center lodged 5,600 complaints from victims of “romance scams” or “catfishers”
    • Reports say victims of these romance scams have lost over fifty million dollars—however authorities know this figure is much higher because many victims are too embarrassed to report the incidents
    • Every 2 minutes a person in America is sexually assaulted
    • 1 out of 4 children in the U.S. have been sent pictures of people who were naked or having sex by an online predator
    • Each year Internet predators commit over 16,000 abductions, over 100 murders, and thousands of rapes
    • Over 39,000 verified Registered Sex Offenders have profiles on social media sites
    • 1 out of 5 kids have been solicited for sex on the Internet
    • 1 out of 4 kids have been contacted online by a person not representing themselves in a true or accurate way
    • Only 25% of kids tell parents or adults about any online encounters
    • 77% of the time, the targets for online predators are usually in the 11-14 year-old-age range
    • 25% of children that were surveyed were exposed to unwanted pornographic material

    Dating Safety Tips

    Online dating often leads to offline dates, which may end up as a successful relationship. However, before you meet someone in person, take all the time you need to get well-acquainted with this person, so there is hopefully nothing to worry about when you meet face-to-face. Sexual assault on a date is definitely not an everyday occurrence, nonetheless, you need to ensure your personal safety when planning to meet someone for a first date. Take the time to really get to know a person and dangerous incidents are less likely to occur.

    The predators need to be exposed, if you or anyone you know has been contacted by an online predator or has received unwanted solicitation from someone online, call the police and notify the social networking site on which the contact was made.

    • NEVER give out your personal information or home address online, even giving out the town you live in can reveal too much information to a predator
    • Don’t reply to social media messages from people you don’t know
    • NEVER meet face-to-face with someone you have just met online, give yourself and the contact at least 3 weeks to get to know each other before a face-to-face is planned
    • Never download image files from an unknown source, they could contain sexually explicit images that could put you in a compromising legal situation
    • Avoid chat rooms or discussion forums that are sexually proactive
    • If you receive uncomfortable or frightening material, end the communication, block the person from contacting you and report them to the dating site or the social networking site
    • If you receive an unwanted solicitation call 911, contact the dating site or the social networking site and report the perpetrator immediately

    Sexual assault and date rape are definitely not common occurrences when meeting an online date. Read and follow the safety advice for first date meetings that have been outlined on your online dating site, so you are well-prepared. In addition, here are some of tips that will be useful too.

    • Always take the time to get well-acquainted with someone before you plan a meeting. Talking to this person online or on the phone for three weeks is a good amount of time to ensure this person is safe to meet
    • Bookend the date, which means you notify a friend where the date is, whom the date is with and when the date starts and then again, contact the same friend when you leave the date, to ensure you are home and are safe
    • Meet in a public place, like a restaurant, coffee shop, and drive your own car or know the public transportation schedule in order to leave to catch the last bus. At no time should this first date drive you home
    • While on the date, always be very aware of your surroundings. Keep an eye on your drink at all times. Date rape drugs are very easy to drop into any drink. Drinking coffee with a lid on the cup is probably your best defense against this kind of occurrence
    • Getting a girl drunk is a common ploy for a predator, so watch how much alcohol you drink. In fact, many online dating site guidelines do not recommend going to a bar or having a drink on the first date
    • Be cautious during your first few meetings with this person. Have the dates in open public places and stay away from dark and deserted situations
    • Never go to this person’s home or to a hotel until months into your dating experience

    What do you do if you have been assaulted?

    If you believe you may be a victim of sexual assault, the first thing you should do is immediately contact the police and report the crime, no matter how small you might think the crime is. It is common for victims to blame themselves in a case of assault, however you must always remember that this predator had absolutely no justification to attack you. It is also very important to protect your health, go to the hospital and request to have a sexual assault forensic exam, the staff will administer some tests that are compiled into what is sometimes known as a “rape kit.” These exams will preserve possible DNA evidence and you will receive important medical care. You don’t have to report the crime to have this exam, but the process gives you the chance to safely store evidence, should you decide to report the crime at a later time.

    • If you feel you cannot handle going to the hospital alone, try asking an understanding family member or friend to escort you to the hospital.
    • If necessary, you can also speak with a rape hotline operator, an experienced therapist or social worker who can help you deal with it. For more information, reference the local hotlines and services that are featured below
    • If you choose not to have a sexual assault forensic exam, it is also a good idea to to go to a clinic or to see a doctor who can test you for sexually transmitted diseases (STDs)
    • To find a location near you that performs sexual assault forensic exams, call the National Sexual Assault Hotline at 800-656-HOPE (656-4673) or talk to your local sexual assault service provider

    Here are some National Resources for Victims of a Catfisher

    General Information:

    Internet Crime Complaint Center (IC3)                             https://www.ic3.gov/                                                                                                           A partnership between the Federal Bureau of Investigation (FBI) and the National White Collar Crime Center (NW3C).

    National Sexual Assault Hotline: National hotline, operated by RAINN, that serves people affected by sexual violence. It automatically routes the caller to their nearest sexual assault service provider. You can also search your local center here. Hotline: 800.656.HOPE (656-4673)

    National Sexual Violence Resource Center: This site offers a wide variety of information relating to sexual violence including a large legal resource library.

    National Organization for Victim Assistance: Founded in 1975, NOVA is the oldest national victim assistance organization of its type in the United States as the recognized leader in this noble cause.

    National Online Resource Center on Violence Against Women: VAWnet, a project of the National Resource Center on Domestic Violence hosts a resource library home of thousands of materials on violence against women and related issues, with particular attention to its intersections with various forms of oppression.

    U.S. Department of Justice: National Sex Offender Public Website: NSOPW is the only U.S. government Website that links public state, territorial, and tribal sex offender registries from one national search site.

    The National Center for Victims of Crime: The mission of the National Center for Victims of Crime is to forge a national commitment to help victims of crime rebuild their lives. They are dedicated to serving individuals, families, and communities harmed by crime.

    Child Abuse/Sexual Abuse:

    National Child Abuse Hotline: They can provide local referrals for services. A centralized call center provides the caller with the option of talking to a counselor. They are also connected to a language line that can provide service in over 140 languages. Hotline: 800.4.A.CHILD (800-422-2253)

    Darkness to Light: They provide crisis intervention and referral services to children or people affected by sexual abuse of children. Hotline calls are automatically routed to a local center. Helpline: 866.FOR.LIGHT (367.5444)

    Cyber Tip Line: This Tipline is operated by the National Center for Missing and Exploited Children. Can be used to communicate information to the authorities about child pornography or child sex trafficking. Hotline: 800.THE.LOST (800-843-5678)

    National Children’s Alliance: This organization represents the national network of Child Advocacy Centers (CAC). CACs are a multidisciplinary team of law enforcement, mental and physical health practitioners who investigate instances of child physical and sexual abuse. Their website explains the process and has a directory according to geographic location.

    Stop It Now: Provides information to victims and parents/relatives/friends of child sexual abuse. The site also has resources for offender treatment as well as information on recognizing the signs of child sexual abuse. Hotline: 888-PREVENT (888-773-8368)

    Justice for Children: Provides a full range of advocacy services for abused and neglected children.

    Domestic, Dating and Intimate Partner Violence:

    National Domestic Violence Hotline: Through this hotline an advocate can provide local direct service resources (safe-house shelters, transportation, casework assistance) and crisis intervention. Interpreter services available in 170 languages. They also partner with the Abused Deaf Women’s Advocacy Center to provide a videophone option. Hotline: 800-799-SAFE (800-799-7233)

    National Teen Dating Abuse Online Helpline: This online helpline assists teens who are, or may be, in abusive relationships. Call 1-866-331-9474, chat at loveisrespect.org or text “loveis” to 22522, any time, 24/7/365

    Americans Overseas Domestic Violence Crisis Center: The center serves abused Americans, mostly women and children, in both civilian and military populations overseas. In addition to providing domestic violence advocacy, safety planning and case management, the center assists victims with relocation, emergency funds for housing and childcare, and funds for payment of legal fees. International & Toll-Free 866-USWOMEN (866- 879-6636) (Available 24/7/365)

    National Coalition against Domestic Violence: The national coalition of Domestic Violence organizations is dedicated to empowering victims and changing society to a zero tolerance policy. Call the Nat’l #DomesticViolence Hotline 1-800-799-SAFE (799-7233) if you or someone you love is a victim and needs help

    Incest:

    (See also resources on Child Abuse/ Sexual Abuse above)

    Survivors of Incest Anonymous: They provide information on how to find incest survivor support groups in your area and empowers individuals to become survivors and thrivers.

    GirlThrive: Girlthrive Inc. honors teen girls and young women who have survived incest and all sex abuse through thriverships, opportunity and education.

    Stalking

    Stalking Resource Center: The Stalking Resource Center is a program of the National Center for Victims of Crime. Their website provides statistics on stalking, information on safety planning and other resources.

  • A Call for Clinical Humility in Addiction Treatment

    by William White and video featuring Chris Budnick

    The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help.  The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see endnotes 1, 2 and 3 below) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.

    The challenges for each of us who work in this special service ministry and for william_l_white_portrait_1the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See endnote 4 and 5 for two vivid examples.)

    There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (endnote 6). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (endnote 7 and 8).

    The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”

    Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is: https://www.youtube.com/watch?v=A5MYhZbnhfU)

    Chris-Budnick LCSW,LCAS,CC,MSWMy name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993. 

    There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.

    Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.”  “We can’t help her tonight.”  She was killed within hours of this decision leaving behind a 2-year-old daughter.  I told the officer that we pledge to do better.

    This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.

    While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:

    • I’m sorry for all the barriers you confront when trying to access help.
    • I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.
    • I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.
    • I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.
    • I am sorry for creating unrealistic expectations of you.
    • I’m sorry for provider success statistics that have misled you and your family.
    • I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.
    • I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.
    • I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.
    • I am sorry for my arrogance when I’ve assumed that I am the expert of your life.
    • I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.
    • I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.
    • I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.
    • I’m sorry for turning you away from treatment because you’ve “been here too many times.”
    • I’m sorry for not referring you to different services when you have not responded to the services I offer.
    • I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.
    • I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.
    • I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.
    • I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.
    • I’m sorry for letting society maintain the belief that you used again because you chose to.
    • I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.
    • I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.
    • I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.
    • I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.
    • I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.
    • I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.
    • I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.
    • I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.

          This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.

                                  -Chris Budnick, Licensed Clinical Addiction Specialist

    This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling.  WW

    I honor and applaud Bill and Chris for bringing this message to clinical professionals across the nation. It is time to shed and change these old models that have not been working and embrace these new tenants that Bill, Chris and many others espouse.  Truly such client-centered treatment can change the course of recovery for many. MK

    End Notes

    This post was previously published on William White’s web site- www.williamwhitepapers.com on April 29, 2016. William White and Chris Budnick authorized this reposting.

    Video: https://www.youtube.com/watch?v=A5MYhZbnhfU

  • How Adverse Childhood Experiences affects long term health – a TED MED Talk by Dr. Nadine Burke Harris

    Dr. Nadine Burke Harris, during her TED-Med talk presents the benefits of the Adverse Childhood Experience study and the substantiated affects the study has brought forth on how childhood trauma can impact the quality of one’s health and length of a person’s lifespan. The San Francisco based pediatrician explains that the repeated stress of abuse, experience of neglect and living with parents struggling with mental health or substance abuse issues has real, tangible effects on the development of a child’s brain. The ACE study concludes that those who’ve experienced chronic, and high levels of trauma are at triple the risk for heart disease, addictions and lung cancer. She gives an impassioned plea for clinicians to use the Adverse Childhood Experiences questions during intake on all of their patients and confront the prevention and treatment of trauma, head-on.

     

  • Faces and Voices in Recovery Develops an Addiction Recovery Toolkit

    Faces and Voices in Recovery Partnering with Members of Congress to Offer Comprehensive Addiction Resources

    2016 logoFaces & Voices of Recovery, in collaboration with the Addiction Policy Forum and the House of Representatives Bipartisan Task Force to Combat the Heroin Epidemic developed a comprehensive addiction resources toolkit to help the families impacted by the heroin and opioid epidemic. This week, Members of Congress will unveil this toolkit on their websites and in their district offices and will train their office staff to provide key resources to families and individuals in their communities facing addiction. This toolkit is a resource that every recovery community organization, treatment center, doctor’s office, library as well as every family and individual should have access to.

    More Americans die every day from drug overdoses than from car accidents – an average of 129 people per day, with six out of 10 deaths related to opioids. This toolkit was developed in response to the fact that a majority of those who need help with addiction issues are not receiving it. In 2014, only 11 percent of the approximately 22.7 million Americans who needed treatment for substance use received it, according to the Office of National Drug Control Policy.

    “We are honored to partner with Members of Congress to offer individuals, families and communities important resources that will help them find support to achieve long-term recovery. We have offered our expertise for this toolkit and are pleased that Members of Congress understand the importance of making this information easily accessible and available in each Congressional district across the nation.”   -Executive Director Patty McCarthy-Metcalf

    Leading national and community organizations contributed to this comprehensive set of resources that includes resources around prevention, drug treatment, recovery support and general information for families, community organizations, schools, and parents concerned about addiction and seeking support. The groups who contributed to this guide include: Community Anti-Drug Coalition, the National Council, the National Association for Children of Alcoholics, the Partnership for Drug-Free Kids, Shatterproof, Faces & Voices of Recovery, Legal Action Center, National Institute of Drug Abuse, and the Office of National Drug Control Policy.

    In preparing this toolkit, Faces and Voices of Recovery strengthens it’s mission and dedication to organizing and mobilizing the over 23 million Americans in recovery from addiction to alcohol and other drugs, our families, friends and allies into recovery community organizations and networks, to promote the right and resources to recover through advocacy, education and demonstrating the power and proof of long-term recovery.  Faces & Voices of Recovery is the parent organization of the Association of Recovery Community Organizations (ARCO) which unites and supports the growing network of local, regional and statewide recovery community organizations (RCOs). ARCO links RCOs and their leaders with local and national allies and provides training and technical assistance to groups. ARCO helps build the unified voice of the organized recovery community and fulfill our commitment to supporting the development of new groups and strengthening existing ones.

    Link to Tool kit: http://media.wix.com/ugd/bfe1ed_439f2d84f59c4461a4eef39a7b00596d.pdf

  • Recovery Coaching Texas Prison Style

    Kyle Gage PhotoKyle Gage lives in Longview, Texas, and he is a recovery coach. Longview is a little oil and manufacturing town a couple of hours east of Dallas-Ft Worth and about an hour west of Shreveport, Louisiana. The small town has had some illustrious citizens: Forest Whitaker was born in Longview, and Matthew McConaughey went to Longview High School in the ‘80s. Kyle had less of an illustrious impact on Longview.

    A Hard-Earned Recovery 

    Kyle entered his first rehab at 17. He enrolled in a boarding school for troubled teens. He continued in and out of rehab many times, trying to do it his way. At twenty, he knew he had to change, so he attended some NA meetings, through which he stayed clean for about 6 months. Then he used. He tried to keep things under control, and managed to avoid any serious consequences for about a year, but then one day he was pulled over by the police, who found methamphetamine.

    In lieu of jail time, he agreed to treatment. After his treatment episode he remained clean on probation, in part because he was receiving regular tox screens. Staying clean was motivated by his desire to stay out of jail. For 7 months he was sober, but then he started to drink. Eventually, drinking turned to using drugs. Because of his fear of failing a tox screen, he stopped reporting to probation and went on the run. Kyle was picked up a few months later for the probation violation and was sent to the James Bradshaw State Prison in Henderson, Texas.

    He got no help for his recovery in the state prison, drugs being as easily available there as they were on the streets. Upon his release he began using again and was eventually arrested for burglary. He went to treatment but left against medical advice. He went to live at an Oxford House, and remained clean for 2-3 months. The stinking thinking eventually returned, so he drank and drinking led to using. In a very short time, he was arrested. At 26-years-old, he was facing two consecutive ten-year convictions for burglary and grand theft auto. Kyle knew this was serious.

    He asked the judge for help, and the judge gave Kyle ten years of deferred adjudication. Deferred adjudication is a form of a plea deal, where a defendant pleads “guilty” or “no contest” to criminal charges in exchange for meeting certain requirements laid out by the court. In Kyle’s case, these terms were that he go into an inmate drug-treatment program, attend Drug Court upon his release, make a commitment to outpatient treatment, perform community service and complete probation within the allotted period of time ordered by the court.

    Kyle was sentenced to six months at the Clyde M. Johnston Unit, the Texas correctional institution’s Substance Abuse Felony Punishment Facility in Winnsboro, Texas. This facility is Texas’s drug treatment program for offenders. He received a lot of treatment and therapy at the Johnston Unit, where Kyle realized that he needed to embrace recovery.

    Embracing Recovery

    For Kyle, embracing recovery in prison began by helping others: helping others gave him hope. He was the person that led the NA meetings in his dorm. The counselors at Johnston announced that a recovery coaching certification course for the inmates would start at Johnston. They said they only had room for ten men. Kyle applied. He was hoping they would pick him, but he was nervous because he knew that it was very competitive and they were only picking one person per dorm.

    Kyle’s mother found the book Recovery Coaching—A Guide to Coaching People in Recovery from Addictions on Amazon.com and sent it to Kyle. Kyle read it before he even got accepted into the class, which he eventually was. He excelled in helping others in the Unit embrace recovery. He graduated the recovery coaching class and was even invited to talk to the Unit’s next class of recovery coaches.

    Coaching Other Offenders

    The primary counselor notified Kyle that he wanted him to talk to an offender that was a disciplinary problem. Jason was 19-years-old, (his named has been changed for this post) and faced 10-15 years for aggravated assault. Jason was a first-phase client, which meant he had only been at the Johnston Unit for 30 days. He was a meth addict, and he was having trouble adjusting to the Unit: He had issues with people in his dorm. He didn’t attend AA or NA meetings. He didn’t want to be in recovery. He wanted to give up, and fantasized about “rendering his sentence.” The inmates call it “getting sent back to county.” Rendering a sentence means to go back to the original courthouse and say to the judge “Thanks, but I would rather serve 10 years for aggravated assault than spend any more time in therapy and treatment for my drug addiction.” Sound crazy? According to Kyle, that is what goes through the heads of many offenders. The grip of the addiction is so strong that living life sober is frightening. Many choose to self-sabotage by creating problems, by assaulting or threatening another inmate and receiving an extension of their sentence.

    Jason was referred to Kyle specifically as Jason reminded the counselors of Kyle, with his sleeves of tattoos just like Kyle. Kyle met with him and talked to him about meth, since they shared the same drug of choice. Kyle asked for Jason’s story, and listened. It was different from Kyle’s, but there were many similarities. Kyle shared many of Jason’s traits: Being an outlaw, an outcast, and a gang member. Jason didn’t think the meetings would be beneficial to him. Kyle shared that it was in the 12-step rooms where he truly felt alive.

    Kyle asked Jason about his plan when he gets out of Johnston and allowed Jason to self-actualize as to where he wanted to be in 5 years. Jason broke down and cried during this meeting. He was frightened at what he was facing, he had a lot of anger issues, and he didn’t know what to do. So, Kyle told him what worked for him.

    During the six months that offenders were at the Johnston Unit, there was no chance of them using drugs. The coaches assisted the offenders with embracing recovery, working the 12 steps and learning to use the steps in their daily prison life. Kyle coached men that were violent, had assaulted another men, were disciplinary problems, and where coaching was the last step before they were “sent back to county.” Kyle was there to stop them from rendering their sentence and losing everything. Sometimes an inmate had a family member pass away and the inmate was not granted permission to attend the funeral.  Although this coaching had nothing to do with recovery from drugs or alcohol, the recovery coaches are assigned to console these inmates through the grieving process.

    When inmates were close to being released, having  no experience with 12-step meetings or recovery on the outside, and  having no intentions of asking for help, Kyle gave them some “recovery capital.” He would give them lists of AA and NA meetings near the half-way house to which they were being released.  Kyle would give them information on Community HealthCore, which is a large, social services agency in Texas with outpatient drug and alcohol treatment programs. He would tell them about drug court classes and behavioral health counseling. Kyle and a few of the other recovery coaches in the Johnston Unit were from the Dallas area. When a prisoner would be going to back to the Dallas area, the coaches would refer the offenders to people on the outside who could take them to a meeting.

    Another prisoner, Caleb (his real named also changed) was in the reentry process—in a few weeks he was being released to a half-way house in Beaumont, Texas. Caleb had been in this position before.  As he got  closer to the “door” he became scared, and he was afraid of going back into the real world. He was so sure that he could to do things his way, but in the back of his head, he knew that doing things his way was what had gotten him into prison several times before. Kyle ran the 12-step meetings, and Caleb would attend as a “woodworker” (working wood means doing the absolute minimum, not participating, not getting involved and not believing this program would work for them).

    Kyle was assigned to speak to Caleb.  Kyle asked him what happened after he drank a beer, and Caleb admitted that after he drank one beer, it would soon be a dozen and very shortly, he was thinking about using crack (his drug of choice). Kyle knew this story very well, because it was Kyle’s story. So he shared his story with Caleb. It didn’t seem to work. Caleb kept wood working and didn’t really engage in the program. Caleb was antagonistic, he would challenge the tenets of the program, ask questions about will power, saying recovery was a choice, and that he was “not an addict forever.” He didn’t think that any program would help him, but he knew that if he went out into the real world, he would use again.

    Many offenders self-sabotage their release process by getting into fights and end up staying in prison a few months longer. This happened to Caleb. He remained at the Johnston Unit a few months longer, which was just enough time to let Kyle’s work with him penetrate. Upon his release, Kyle gave Caleb the information on 12-step meetings in Beaumont and he agreed to attend the meetings. Kyle continues to communicate to Caleb, who is sober and has not re-offended.

    At this point, Kyle Gage has been out of the Johnston Unit for about a year. He is wrapping up his Drug Court commitment. He is enrolled in a community college to get his Associates Degree and also works as a new car salesman. Kyle will continue recovery coaching to help himself and others maintain the recovery that he loves.

  • 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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  • 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.