Comments on: Three critical lessons from neuropsychology

By: Nellie M

Nellie M — Mon, 25 Jan 2010 21:40:46 +0000

I liked the reading on Healing Trauma: A Therapists Reflection on What Works because I thought it was relative to how the brain reacts to trauma in comparison with drug use and addiction, but is stimulated by a negative memory while telling and re-experiencing the traumatic event, because it includes the physical experience which has been neglected by verbal therapy alone and your ability to hear and connect with the patients experience allows for validation and “trust”. Great reflection!!

By: Jodi O.

Jodi O. — Wed, 20 Jan 2010 04:15:47 +0000

I think the power of visually presenting the effects of a drug (or anything reckless) on a persons body is an effective tool in prevention or cessation. I remember driver’s ed class showed a powerpoint presentation of people’s maimed bodies after car crashes involving people not wearing seat belts. The pictures were horrific and needless to say I wore my seat belt after that presentation. I think the same concept applys to these neuropsych scans. If I saw an example of these brain scans during or before my “experimental phase” I would have stopped “experimenting” or maybe never even started. The Oregonian even did an effective before and after presentation with the front page pictorial of “the faces of meth;” seeing is believing.

By: Gerald Flynn

Gerald Flynn — Fri, 11 Dec 2009 04:56:10 +0000

I had a friend who was a meth addict. She probably checked into five different treatment centers starting at the age of 16. She would get sober for different amounts of time but always eventually relapse and hit the drug harder. At age twenty-eight she started landing in jail for misdemeanor offences. She would be held for about a week at the most, required to complete an addictions package (90 AA or NA meetings, stay out of bars, get a mandatory evaluation, and commit no more crime). The cycle continued over and over for about a year, until one day I got a desperate call from the Columbia County Jail where she had been recently detained. A judge had told her that if she could get somebody with a current license to drive her to a in-patient treatment center, complete treatment without any setbacks he would waive her sentence. If she failed in anyway he would giver her no less than eight months for her latest crime. I agreed to take her to treatment and wished her well. Thirty-three days into a forty-five day treatment program she walked out the center and caught a bus back to Portland where she relapsed and ended up serving eight and half months in jail. After jail she was mandatorily checked into another program and completed it and has been sober since. That was seven years ago. When I asked her what the difference was this time she told me that there was no way she could have utilized the tools of treatment until she had been forced to be sober for six months. It was at this point she felt the emotional and physical cravings finally subsided enough to use treatment. I bring her story up as living evidence to the idea most treatment is completed before effective detox is accomplished. While it is unreasonable to suggest that all addicts hoping to get clean be forcibly locked up in order to complete treatment, couldn’t we use the evidence we have and make detox, even at 120 to 150 days, part of in patient treatment?

By: Kevin Govro

Kevin Govro — Thu, 10 Dec 2009 19:26:43 +0000

I think the concept of emotional intelligence is very important. I have a friend who is struggling with addiction and emotional problems stemming from early childhood sexual abuse. When she is intoxicated she speaks extremely softly and uses “baby talk.” I used to get very frustrated with her but I think I now realize that she got “stuck” at that early level of emotional development. When sober, if she’s really stressed out she will speak in “baby talk” as well. Unfortunately, she refuses to seek help and continues to believe that she can “think” her way out of addiction. This isn’t working. My hope for her is that she will find the courage to confront the emotions and experiences from her childhood that continue to hold her back and constrict her emotionally.

By: Molly

Molly — Thu, 10 Dec 2009 00:09:23 +0000

I’m gonna go out on a limb here as to what a person should do between detox and treatment – how about yoga? Yoga can further help detox and support the physical body, and it doesn’t really matter what your emotional maturity level is, one still tends to get something out of it! I know many people who credit yoga with being the main thing that helped them overcome their addiction.

By: Molly

Molly — Wed, 09 Dec 2009 23:20:38 +0000

I wanted to comment on Michael’s comment – I was talking to my friend yesterday who teaches in the Speech Pathology program at PSU and she was saying that there is a very high rate of suicide in adults with autism. She feels that it is a population of people that is often forgotten about. As Michael was saying, people with autism often have a difficult time with social skills, so one can imagine how isolating life could be once someone with Autism leaves high school may no longer have the strong support of the school or their families.

By: Nikki

Nikki — Wed, 09 Dec 2009 23:03:14 +0000

Since the primary treatment modality for addiction is group therapy, neuropsychological assessments are paramount, in aiding treatment success. One of my favorite in-class stories this term, was regarding Dr. Fitzgerald’s patient who had countlessly been in and out of group treatment. In fact, this client NEVER participated in any individual treatment throughout his disease. Though Dr. F developed a strong rapport with his client, and felt confident they made substantial, collaborative progress, the client consequently relapsed. Post treatment, Dr. F realized he should have worked more specifically, with this client’s developmental constrictions and/or deficits. Neuropsychological testing can help clinicians, more appropriately group patients with others at a similar emotional and cognitive level. Especially in terms of groups, as many different people are receiving the same treatment from 1-2 group leaders. If everyone in the group is not at the same or at least similar developmental level, it certainly will harbor some or all success, and potentially even worsen or perpetuate some underlying issues. Funding is often a barrier to providing clients with optimal care, but as clinicians we should be as astute as possible to identifying such incongruencies and all we can to realign fitting care.
What should a person do following detox and treatment? I wanted to comment how much I’ve enjoyed reading everyone’s creative, responses to this question. I suggested in another post that we implement creative therapies, activities, and workshops following detoxification; in addition, I feel that incorporating a more systemic involvement at this time could also be beneficial. Related to an intervention, this time could be used to emphasize the consequences of the disease on family and loved ones, but also stressing the unconditional love, encouragement, and support of family. Often times family members are enablers and may even be triggers for addictive behavior. Treatment should extend out to the client’s family and train them how to positively interrelate with the addict. Train families to shift the system, under the addict’s feet and make it much less rewarding to use any longer- similar to the Community Reinforcement Approach. Also, while the addict is in treatment, I feel the family should be a consistent, positive, loving and supporting presence throughout the experience, proactively via phone, email, letters, etc. Ultimately addressing at least some of the patient’s therapy with a systems therapy approach could be useful with identifying underlying traumas or relational deficits. Increasing emotional commitment to family and loved ones may increase commitment to healing and self-efficacy.

By: Troy S

Troy S — Wed, 09 Dec 2009 01:29:48 +0000

I worked with a young teenage boy in an inpatient psychiatric facility who was a perfect example of being very traditionally intelligent but emotionally stunted. This kid had a history of trauma and on the few occasions that he was willing to communicate his bottled up thoughts, it was evident that he used his intelligence to support and rationalize the cold and twisted world that he had experienced. Through his intellect he was able to develop a complex and rigid schema that accounted for the people in his life in a very critical and negative way. However he did not seem to integrate an emotional component into his view of the world, perhaps because emotions were foreign and ambiguous to him. Regardless, his advanced intelligence and restricted emotional development may prove to be a huge hurdle for him, as he was aware of his cognitive capabilities and therefore confident that his view of the world was “right” and “accurate”. In the end I’m worried that he may just use that rigid world view as barrier, limiting his chances of future emotional development.

By: Troy S

Troy S — Wed, 09 Dec 2009 01:05:24 +0000

“The brain needs time following detoxification to heal before it can absorb, process, and benefit from information discussed in treatment.”

While my lack of confidence in the above statement may stem from my admittedly limited knowledge of the research, I’m not yet convinced that treatment shouldn’t start right after detoxification. Dr. Fitzgerald states that as the brain recovers to normal baseline functioning, it is impaired in its capacities for “learning, processing, and remembering new information”. However, even though the patient’s impairments inhibit their ability to get the most from treatment, this is also a very critical time to provide a lot of support and structure to prevent a relapse, as the drug affected brain must be very susceptible in this physiologically modified state. Our understanding of addiction as a chronic condition would suggest that treatment should not be aborted as the brain returns to normal functioning, as has been the case, but that is not to say treatment shouldn’t be started prior to this return to baseline as well. While the addicted brain my demonstrate shortcomings, it still likely retains some functions and abilities that can be utilized in treatment.

Perhaps the question should be less about when to start and stop treatment, and more about determining the modes of treatment that will be effectively received by the patient at a given time based on discrete levels of recovering functionality. For example, perhaps simplified deliveries of repeated psychoeducational treatment can be beneficial early on as a way to set the stage for more advanced conceptual deliveries later along with trauma work once the brain has recovered the necessary capacities for the treatment to be practical.

By: AnneW

AnneW — Fri, 04 Dec 2009 05:20:23 +0000

All three of these neurological lessons speak volumes to the importance of understanding a client’s developmental level, both emotional and cognitive, and knowing how and when to therapeutically intervene. Without this knowledge, as therapists we will never be able to meet a client where they are at or create the therapeutic alliance that studies show makes a true difference in client change. Fortunately, we already have the technological tools to identify this valuable information, what’s needed now is better access to proper training on how to implement therapeutic interventions at each corresponding level.

To solve the conundrum of what to do with clients during the period between detox and full brain recovery, I believe a system-wide change is needed in the way health care facilities think of addiction treatment plans. One idea might be to assign a specific health care professional to each individual who is just out of detox to act as the individual’s case manager or “sponsor”. This person would be responsible for helping the individual design a safe and healthy environment to live in – one far away from the triggers that could propel them into relapse. This interim “home” would be built from preexisting resources within the individual’s life or those from the community. The case manager would also perform daily check-ins and weekly home visits to ensure that the individual continued to have the proper emotional, physical, and relational supports in place to maintain sobriety until the brain fully healed and effective addiction management treatment could commence. This idea may seem idealistic and cost-prohibitive, but when you consider that more than half of those treated for drug or alcohol abuse return to active use within a year and will most likely need costly treatment again, perhaps this relapse prevention measure would be worth every penny.