TreatmentTalk – clinical psychology

“There’a a phrase, “the elephant in the living room”, which purports to describe what it’s like to live with a drug addict, an alcoholic, an abuser. People outside such relationships will sometimes ask, “How could you let such a business go on for so many years? Didn’t you see the elephant in the living room?” And it’s so hard for anyone living in a more normal situation to understand the answer that comes closest to the truth; “I’m sorry, but it was there when I moved in. I didn’t know it was an elephant; I thought it was part of the furniture.” There comes an aha-moment for some folks – the lucky ones – when they suddenly recognize the difference.” ~ Stephen King

April is alcohol awareness month.

A month to just notice and observe.

Are your drinking habits feeling healthy?

Are you concerned about a family member?

From the National Council on Alcoholism and Drug Dependence, Inc.,

“Alcohol Awareness Month, held every April, was founded by and has been sponsored by NCADD since 1987 to increase public awareness and understanding aimed at reducing the stigma that too often prevents individuals and families from seeking help.

During Alcohol Awareness Month, NCADD and NCADD’s National Network of Affiliates reach out in communities across the country to bring the American public information about alcohol and alcoholism as a chronic, progressive disease, fatal if untreated, and genetically predisposed.

The disease of alcoholism is a family disease that is treatable, not a moral weakness, from which people can and do recover.

In fact, millions of individuals and family members are living lives in long-term recovery from alcoholism!”

Alcohol not only affects the person who is abusing alcohol. It affects their spouse, children, parents, siblings and friends. Don’t let the stigma hold you or your family back from getting help.

Keeping with the theme of alcohol use, I would like to share my interview with Lisa Frederiksen, author of Crossing the Line, from Use to Abuse to Dependence. Lisa shares great insights regarding the myths that many of us believe regarding alcohol use.

I hope you enjoyed the interview.

Lisa and I are thrilled to announce our upcoming webinar for parents and family members who are concerned about their loved one’s drug or alcohol abuse.

Learn the science behind addiction, understand the emotional toll it takes on a family, and what steps you can take to help your loved one, as well as yourself.

Sign up now through my contact page and indicate that you are interested in learning more about the webinar.

Has alcohol been an issue in your life? What tips do you have for others that might be experiencing the effects of alcohol abuse? Please share in comments.

take care,

This is a guest post by Todd Branston.

Having a difficult time staying sober?? Maybe it’s not you – maybe it’s brain chemistry.

You know the drill: you have spent countless hours in meetings, on the phone with your sponsor asking endless questions about your desire to use. You have worked the steps and you’ve even consulted specialists. In a moment of desperation you found help by attending treatment.

You’re able to rack up six to twelve months, but eventually you find yourself in the throes of your addiction. None of this seems to work. You find yourself questioning your commitment and ability to stay sober. Maybe your sponsor was right when he said you lack willingness.

Not so fast….

What you are likely experiencing is Post Acute Withdrawal Syndrome or PAWS.

PAWS consist of a set of impairments that occur immediately and at times simultaneously after the withdrawal from alcohol or other substances. These impairments affect three distinct areas of functioning and last six to eighteen months from the last use of alcohol or drugs as your brain tries to regain homeostasis.

Some of these impairments include cognitive problems like racing thoughts, rigidity, numbing of emotions, difficulty with abstract thinking and poor attention span, all of which are prevalent during this time. Emotional difficulties include shame and guilt, as well as difficulties with resentments. Depression is common during this time and may lead to relapse as the addict is generally not prepared to deal with the wealth of emotions they experience. The dearth of emotions can lead people close to the addict to believe they might have relapsed.

While some counselors and organizations support 100% abstinence as the only way to resolve addictive behaviors, this approach tends to come across as a ‘one size fits all’ solution to dealing with these impairments. While recovering from addictive behaviors it is remiss to not include an alternative approach without the mention of anti-craving medication as a treatment for PAWS.

Anti-craving medications may be appropriate for some individuals. The use of medication does not represent a weakness in one’s ability to recover from addictive behaviors. If anything, it should represent the idea that there is ‘another way’.

There are various medications that have been found to have efficacy in dealing with alcohol/drug cravings:

Prazosin is often prescribed to deal with PTSD and night terrors. It has been found to be successful among Opiate addicts and individuals using Cocaine and Methamphetamine.

Acamprosate is used to treat Alcohol cravings. In addition to its apparent ability to help patients refrain from drinking, evidence suggests that Acamprosate is neuroprotective. It has been shown that it can protect neurons from damage and death caused by the effects of alcohol withdrawal.

Naltrexone has been prescribed for Opiate cravings but is largely recommended as a treatment for alcohol abuse. It is also available in a monthly injectable form under the trade name of Vivitrol.

Baclofen and Topiramate have found therapeutic utility for Cocaine and Alcohol cravings.

While Methadone and Antabuse have found success in treating addictive disorders, they are not seen as anti-craving medications. Antabuse is a deterrent to drinking as it prevents the breakdown of alcohol. Some 5–10 minutes after alcohol intake, a person will experience the effects of a severe hangover for a period of 30 minutes up to several hours.

Methadone is a synthetic Opioid and has been used as part of an Opiate substitution regimen. The drug has found success in supporting long-term Heroin addicts to wean off the drug. In addition, Methadone has been used as a pain management protocol due to its long duration of action.

There is a fair amount of controversy around Methadone for Opiate substitution as the detractors point to length of time a patient uses the drug, suggesting that addicts are essentially substituting one drug for the next. Conversely The Addiction Recovery Institute points out the following benefits of Methadone Maintenance Treatment:

Reduced or stopped use of injection drugs
Reduced risk of overdose and of acquiring or transmitting diseases such as HIV, hepatitis B or C, bacterial infections, endocarditis, soft tissue infections, thrombophlebitis, tuberculosis, and STDs
Reduced mortality – the median death rate of opiate-dependent individuals in MMT is 30 percent of the rate of those not in MMT
Possible reduction in sexual risk behaviors, although evidence on this point is conflicting
Reduced criminal activity
Improved family, employment and pregnancy outcomes

It is important to reinforce the notion that an approach of 100% abstinence as a singular modality is not for everyone. Medications can provide additional support but they should not be seen as a complete solution. The goal of the medication should be to offset cravings and free up “emotional space” for the newly recovering person to add support in the form mutual aid groups, group or individual therapy, connection with a community of faith, exercise or involvement in an alcohol and drug treatment program.

Todd Branston has been working in the field of addictions for over 27 years, within the inpatient and outpatient settings, as well as working in the Department of Corrections, the Director of Counseling for a large chemical dependency hospital, to where he’s currently employed doing in-home chemical dependency engagement with (mostly) seniors.

He is part of an experts forum on chemical dependency, and has a contract gig running the chemical dependency program for a long-term transitional program to support people to overcome homelessness. His sense is that sobriety is a skill and that recovery looks different for everybody. Feel free to check out his podcasts at askanaddictioncounselor.com.