T he Art o f Wo rking with the Addic te d Jo hn Ca tro n L - - PowerPoint PPT Presentation

T he Art o f Wo rking with the Addic te d

Jo hn Ca tro n L MHC, L CAC Clinic a l Ma na g e r Ba ue r F a mily Re so urc e s

Co nte nts

 Unde rsta nding a ddic tio n a s a dise a se .  T

he impo rta nc e o f ra ppo rt a nd ho w to b uild it.

 Wha t is the b e st a ppro a c h whe n wo rking

with the a ddic te d.

 Ho w to he lp fa c ilita te c ha ng e re g a rdle ss

• f o ur ro le .

Bio Psc ho So c ia l Dise a se c o nc e pt

Wha t is a dise a se ?

 Ac c o rding to We b ste r’ s Dic tio na ry, a dise a se

is de fine d a s “a c o nditio n o f the living a nima l

• r pla nt b o dy o r o f o ne o f its pa rts tha t impa irs

no rma l func tio ning a nd is typic a lly ma nife ste d b y disting uishing sig ns a nd sympto ms”.

 F

urthe rmo re , the me dic a l mo de l de sc rib e s a dise a se a s “a ny c o nditio n tha t is Chro nic , Pro g re ssive , Prima ry, a nd F a ta l.

Wha t is me a nt b y Chro nic

 Chro nic : the re is no c ure . Altho ug h

pe o ple who a re a ddic te d to sub sta nc e c a n sto p using a nd g o into re c o ve ry, the y a re no t CURE

• D. I

f drug use c o ntinue s ye a rs la te r, the a ddic tio n c o ntinue s b o th b io lo g ic a lly a nd psyc ho lo g ic a lly. T he re is no c ure fo r a ddic tio n.

Pro g re ssio n

 Ge ts wo rse o ve r time if no t tre a te d. Any

a ddic tio n will b e c o me wo rse if no t tre a te d. So me a ddic tio ns suc h a s Me tha mphe ta mine pro g re sse s muc h fa ste r tha n a ddic tio n to a a lc o ho l. Ho we ve r, o nc e a ddic tio n ta ke s ho ld, it will pro g re ssive ly wo rse n until the pe rso n e ng a g e s in tre a tme nt. So me o ne c a n sto p using a sub sta nc e b ut the n c o ntinue to pro g re ss in the ir a ddic tio n psyc ho lo g ic a lly thro ug h e a ting , sho pping , wo rk, g a mb ling , se x, dysfunc tio na l re la tio nships, e tc .

Prima ry

 Me a ns the pro b le ms a re no t a sympto m

• f so me o the r dise a se . Addic tio n is no t a

sympto m o f a no the r dise a se . So me o ne ma y b e g in using fo r va rio us re a so ns suc h a s de pre ssio n, b ut o nc e a ddic tio n is pre se nt, the a ddic tio n will re ma in e ve n if the de pre ssio n is tre a te d. T his is why in a ddic tio n tre a tme nt the me nta l he a lth issue s ne e d to b e tre a te d simulta ne o usly with the a ddic tio n.

F a ta l

 Re g a rdle ss o f the sub sta nc e , a ll drug

a ddic tio n will sho rt the pe rso n’ s life spa n. So me sub sta nc e s like c a ffe ine ma y no t ha ve a dra stic e ffe c t o n lo ng te rm life spa n whe n c o mpa re d to he ro in, ho we ve r da ta sho ws e ve n we a ke r drug s whe n use d e xc e ssive ly will sho rt a n individua l’ s life e xpe c ta tio n.

Addic tio n me e ts the se 4 c rite ria

 Re g a rdle ss o f ho w a ddic tio n b e g ins, o nc e

e sta b lishe d it b e c o me s a dise a se .

 T

his is impo rta nt b e c a use a dise a se c a n b e tre a te d.

Why the a rg ume nt?

 Pe o ple misunde rsta nd the de finitio n o f

“dise a se ” a nd b e lie ve we a re sa ying its a ll a b o ut Ge ne a lo g y.

 Pe o ple wish to a rg ue tha t a ddic tio n is

a b o ut c ho ic e s no t b io lo g y ho we ve r the de finitio n o f dise a se sa id no thing a b o ut c ho ic e s, b io lo g y, o r mo ra l issue s.

 Pe rso na l e xpe rie nc e s with the a ddic te d

le a ding to re se ntme nt.

Po int if tho ug ht

 Ca nc e r is wide ly a c c e pte d a s a dise a se ,

ye t we c a ll a ll c a nc e r a dise a se e ve n whe n the c a nc e r is the re sult o f po o r c ho ic e s.

 T

he re ma y b e so me pe rso na l judg e me nts, b ut in b o th situa tio ns, we still re fe r to the c a nc e r a s a dise a se (b e c a use it is c hro nic , pro g re ssive , prima ry, a nd fa ta l).

T he 3 fa c to rs o f a ddic tio n

 Bio lo g y

 Che mic a l imb a la nc e  L

ive r e nzyme s

 Psyc ho lo g y

 Be lie fs a nd e mo tio ns  Ra tio na l ve rsus e mo tio na l thinking

 So c ie ty

 E

nviro nme nt

Bio lo g y

Bio lo g y (c o nt.)

 I

nhe re nt c he mic a l imb a la nc e .

 e x. untre a te d de pre ssio n, ADHD, o r Bipo la r diso rde r

c a n le a d to sub sta nc e use / a b use if drug e xpo sure a ids in le sse ning c he mic a l imb a la nc e .

 Alc o ho l a nd live r e nzyme s

 Alc o ho l b e c o me s Ac e ta lde hyde whic h is to xic to the

live r. T his is the ma in c a use o f ha ng o ve rs. T he live r o f so me c a n to le ra te Ac e ta lde hyde a llo wing fo r a hig he r to le ra nc e a nd no ha ng o ve rs. So the use r e xpe rie nc e s a ll b e ne fits a nd no ne g a tive e ffe c ts o f a lc o ho l a b use . Ho we ve r the live r is still e xpe rie nc ing da ma g e fro m o ve r c o nsumptio n.

Psyc ho lo g y

 Ra tio na l ve rsus e mo tio na l thinking .

Psyc ho lo g ic a l (c o nt.)

 Addic tio n is a c ho ic e , ho we ve r huma n

c ho ic e s a re se ldo m ra tio na l.

Psyc ho lo g y (c o nt.)

 I

n re g a rd to da ily de c isio ns, we o fte n ma ke c ho ic e s a c c o rding to e mo tio na l thinking no t ra tio na l tho ug ht.

 We se e k c o mfo rt a nd o fte n ma ke

a tte mpts to a vo id thing s tha t a re unc o mfo rta b le o r c a use us pa in.

 T

he se de c isio ns c a n b e b a se d in “fig ht o r flig ht” a nd typic a lly ma ke little se nse to

• the rs b e c a use the y la c k lo g ic .

Psyc ho lo g y (c o nt.)

 E

mo tio ns a re the g re a te st mo tiva to r fo r b e ha vio r.

 e x. Ob se ssive Co mpulsive Diso rde r

 Ob se ssio n is the hig hly unc o mfo rta b le

e mo tio na lly drive n tho ug ht pro c e ss.

 Co mpulsio n is the re pe titive illo g ic a l b e ha vio r

tha t le sse ns the unc o mfo rta b le na ture o f the

• b se ssio n. Co mpulsio ns ma ke no se nse to o the rs

a nd e ve n the pe rso n do ing the b e ha vio r is a wa re tha t the b e ha vio r is e xc e ssive .

Psyc ho lo g y (c o nt.)

 Co mpulsive b e ha vio rs a re e mo tio na lly drive n

a nd no t so me thing the pe rso n wa nts to do , b ut b e lie ve s the y ha ve to do in o rde r to sto p the unc o mfo rta b le o b se ssive tho ug ht pro c e ss.

 Addic tio n c a n b e se e n a s a c o mpulsive

b e ha vio r in tha t it is re pe titive , a nd o fte n no t e njo ye d b y the pe rso n, b ut so me thing the y “ne e d” to do in o rde r to func tio n o r to “c o pe ” with e mo tio na l o r b io lo g ic a l sympto ms.

Psyc ho lo g y (c o nt.)

 I

f a ddic tio n is a c o mpulsio n, the n a ddre ssing the o b se ssio n will le a d to re c o ve ry.

 Simply sto pping use do e s no t a ddre ss the

psyc ho lo g ic a l issue s b e hind the a ddic tio n. (e x. Avo iding c o mpulsive wa shing o f ha nds do e s no t ta ke a wa y the

• b se ssive fe a r o f g e rms).

Sub pic

So c io lo g ic a l

 Huma ns a re pro duc ts o f the ir e nviro nme nt.  F

a mily is o ur first e xpo sure to a so c ia l g ro up a nd so fa mily no rms b e c o me instille d a t a n e a rly a g e , o fte n pre -me mo ry.

 T

he a dults in the fa mily se t the no rms, b e lie fs a nd a ttitude s a nd te a c h/ indo rse wha t is a c c e pta b le a nd wha t is no t.

 So if drug use is pre se nt in the a dult me mb e rs, it

is se e n b y the c hildre n a s a no rma l pa rt o f life whe the r the c hildre n a re e nc o ura g e d o r disc o ura g e d to use .

So c io lo g ic a l (c o nt.)

 Our c ulture a nd sub c ulture s ha ve the

g re a te st impa c t o n o ur va lue s a nd b e lie fs

• fte n sha ping ho w we ide ntify o urse lve s.

 T

he drug sub c ulture is o fte n lo we r inc o me whe re drug s a re o fte n use d a s a c o mmo dity to b e use d to b a rte r fo r g o o ds a nd se rvic e s. e x. E xc ha ng ing pa in pills fo r a ride o r fo r fo o d sta mps.

So c io lo g ic a l (c o nt.)

 Multig e ne ra tio na l Cyc le

 T

ra uma , a ddic tio n, a b use , a nd unhe a lthy b e ha vio rs pa sse d to ne xt g e ne ra tio n due to no le a rning o f ne w b e ha vio rs whe n a ddre ssing life issue s.

 T

rue re c o ve ry re q uire s the individua l to c ha ng e “pe o ple , pla c e s, a nd thing s” a nd b re a k the c yc le .

 F

• r so me o ne who wa s ra ise d in the drug

sub c ulture , this wo uld b e the e q uiva le nt o f mo ving to a fo re ig n c o untry whe re the y do no t spe a k the la ng ua g e , unde rsta nd the c usto ms,

• r kno w ho w to na vig a te the so c ia l syste m.

Adve rse Childho o d E xpe rie nc e s

 Adve rse Childho o d E

xpe rie nc e s We re c o g nize a nd tre a t c hildre n who fa c e ACE s, a nd do no t b la me the c hild fo r the tra uma the y e xpe rie nc e d. Ho we ve r o nc e the y turn 18; so c ie ty te nds to b la me b e ha vio r o n po o r de c isio ns a nd disre g a rd the ACE s fo rme d in c hildho o d. T he a c t o f turning 18 do e s no t re se t tra uma e xpe rie nc e d in ACE s.

Re c o ve ry:

 All three aspects of addiction need to be addressed.

 Biological: Detoxification. Either outpatient such as

with assistance of medication assisted treatment, or short term inpatient.

 Psychological: Treatment programming meant to

educate on relapse prevention, challenging unhealthy thought processes, identify and devope coping skills for triggers such as core issues (obsessions), and development of a long term recovery plan.

 Sociological: Replacing drug social network with

healthy recovery network.

Wo rking with Re sista nc e

I mpo rta nc e o f ra ppo rt

 Addic tio n invo lve s de fe nse me c ha nisms

me a nt to pro te c t the pe rso n fro m fe e ling unc o mfo rta b le e mo tio ns suc h a s g uilt a nd sha me .

 By the time mo st drug e ffe c tive pe rso ns a re

re fe rre d fo r tre a tme nt, the y ha ve b e e n c o nfro nte d re pe a te dly b y fa mily, frie nds, a nd the le g a l syste m to a c kno wle dg e the ir a ddic tio n. T his c o nfro nta tio n o fte n b uilds mo re re sista nc e a s a me a ns o f se lf pre se rva tio n.

Ra ppo rt (c o nt.)

 As with the a na lo g y o f the fo rtifie d c a stle .

Co ntinuing the sa me a ppro a c h a s o the rs to “pro ve a ddic tio n” a nd fo rc e a c c e pta nc e o f the a ddic t la b e l, o ne will do no thing o the r tha n inte nsify the fro nta l de fe nse s.

 T

he re fo re the first o rde r o f b usine ss is ra ppo rt b uilding .

Ra ppo rt (c o nt.)

 Cha lle ng e o ur o wn b e lie fs first.

 I

f we strug g le to se e a ddic tio n a s no thing mo re tha n a mo ra l issue b a se d o n unhe a lthy c ho ic e s

• f we a k wille d individua ls, tha n we sho uld no t

wo rk a t a ll with this po pula tio n in a ny c a pa c ity. Do ing so o nly wo rse ns the situa tio n b y inc re a sing de fe nsive ne ss a nd ma king it mo re diffic ult fo r the ne xt pe rso n who will wo rk with the m.

 Pa rt o f c ha lle ng ing o urse lve s is to se e the

a spe c ts o f a ddic tio n in o ur o wn fla we d e mo tio na lly drive n de c isio n ma king .

c a f

sho p

fb

fo o d

Unde rsta nding :

 Re c o ve ry is no t a n a ll o r no thing c o nc e pt. T

• ta l

a b stine nc e is o fte n a n unre a listic c o nc e pt. Ve ry simila r to the ide a tha t so me o ne will ne ve r e a t fa st fo o d a g a in in the ir life . Clie nt will la pse . T ha t is no t a fa ilure , it is a pa rt o f the le a rning pro c e ss. T he impo rta nc e la ys in wha t the y do a fte r the la pse .

T he r e has ne ve r be e n a pr

• fe ssio nal athle te who

star te d the spo r t and wo n the Olympic go ld the fo llo wing day. We wo uld no t e xpe c t that kind o f pe r fe c tio n fr

• m anyo ne e lse , so why do we e xpe c t it

fr

• m tho se in r

e c o ve r y?

Appro a c he s

 Mo tiva tio na l I

nte rvie wing

 Re c o g nize s mo tiva tio n fo r c ha ng e is a

pro c e ss.

 Drug e ffe c te d c lie nts a re no t typic a lly

mo tiva te d fo r c ha ng e tha t is fo rc e d. T he y do re c o g nize the ne e d fo r c ha ng e b ut vie w it a s to o ha rd.

 M.I

. a ppro a c h is the pro c e ss o f first b uilding ra ppo rt a nd trust. T his is o fte n do ne e a sily b y inte ra c ting with the m in a no n- c o nfro nta tio na l wa y.

Appro a c he s

 T

hro ug h b uilding ra ppo rt the c lie nt is le d to unde rsta nding o n the ir o wn tha t c ha ng e is po ssib le a nd tha t the wo rke r c a n b e o f b e ne fit in this pro c e ss.

 As ra ppo rt stre ng the ns, so do e s trust

whic h a llo ws fo r the wo rke r to ma ke mo re dire c t c ha lle ng e s o n the c lie nts thinking a nd b e ha vio rs a s we ll a s o ffe ring sug g e stio ns the c lie nt will fo llo w.

Whe n do we c ha lle ng e

Build Ra ppo rt a nd Pla nt Se e ds

 We c a n no t c ha ng e a nyo ne ’ s vie ws o r

a ttitude s, o nly pla nt ide a s like se e ds.

 T

he mo re we try e nfo rc ing o ur vie w po ints

• n o the rs the mo re the y will re fuse

c ha ng e . Afte r pla nting the se e d whe n c lie nts a re g ive n the o ppo rtunity the y c o me to the sa me c o nc lusio n.

De pe rso na lize

 Ra tio na l ve rsus e mo tio na l suppo rt.  De pe rso na lize the pro c e ss o f the c lie nt. We

a re fo rma l suppo rt, no t the ir fa mily. So we ne e d to re ma in ra tio na l in o ur suppo rt ve rsus ha ving o ur o wn e mo tio na l re a c tio ns.

 Clie nts suc c e sse s a re no t o ur suc c e sse s,

c lie nts fa ilure s a re no t o ur fa ilure s. Whe n we b e c o me e mo tio na lly inve ste d in the ir suc c e ss, we b e c o me e mo tio na lly inve ste d in the ir strug g le s. T hus we lo se o ur e ffe c tive ne ss.

F ina l T ho ug ht

“People care little about

w hat you know, until they know how much you care” - Anonymous