Addiction Management Blog

Posts Tagged ‘Treatment’

The College on Problems of Drug Dependence 2013 – my update

Sunday, June 23rd, 2013

For the past half-dozen years, I have been attending The College on Problems of Drug Dependence, better known as CPDD. The conference has been in existence since 1929 and this year is celebrating 75 years! It is the longest running conference on drug addiction problems in the US and is attended by the brightest minds in the field from all over the world (it even has its own blog). This year it was held in San Diego and included poster sessions, oral presentations, and plenty of networking. Usually I go it alone, but this year decided to drag my family along to make up for the year I brought them to the same conference in Reno where, ironically, gambling, drinking and smoking permeated the hotel and conference (yuck!).

There was a lot of great stuff this year as usual, so I thought I would highlight just a few things that really caught my attention.

  • traumafiveAdverse childhood experiences predict later substance abuse and addiction. We have known for a long time that 80-90 percent of those who go down the path of addiction start their journey early in life – during teenage-age years – most often as an adaptive response to coping with one or more adverse childhood experiences. I have written about the ACE study on this site, but what is new are studies that continue to evolve these findings in more detail, and help us really understand just how complex, pervasive, and critical it is to evaluate and treat underlying traumas in those who struggle with addiction. Current stats on abuse and neglect are frightening, and sadly addiction is not the only outcome of these cases. The British Journal of Psychiatry recently published a paper linking childhood adversity to all classes of mental health disorders. At the conference Cathy Spatz Widom presented some of her work that has involved following 1,575 kids from childhood through adulthood. This amazing study included 908 substantiated cases of childhood abuse and neglect processed by the courts from 1967 through 1971, and then matched this group with a control group of 667 children with no official record of abuse/neglect. The results from interviews over multiple decades provides strong evidence that early life experiences make a difference in the trajectories of our lives. Bottom line for those who struggle with addiction: intervention must involve addressing unresolved issues from the past that perpetuate addictive behavior.
  • Legalization of marijuana. I have not written about this topic on this site before, largely because I continue to struggle with exactly how I feel about it. While it is now legal in two states (Colorado and Washington) many other states are moving to legalize recreational use as well. On many fronts I agree that legalization makes sense, as the drug war has been a miserable failure. At the same time, Nora Volkow, the Director of NIDA, in cannabisher keynote address pointed out that marijuana use among teens is at an all-time high, while research findings are absolutely clear about the dangers of THC in young developing brains. This year the public policy forum was dedicated to this topic, and two great speakers from the RAND Drug Policy Research Center – Beau Kilmer and Rosalie Pacula – provided a lot of food for thought. Beau reviewed his seven P’s and Rosalie addressed the four primary public health goals: 1) prevent youth access, 2) prevent drugged driving, 3) regulate product content and form (potency), and 4) minimize concurrent use with alcohol. The “how” of accomplishing these goals is beyond this post, but if you dig into the RAND site you will find a recent publication that provides all the details.
  • Abuse of prescription drugs. If the 80′s were about cocaine, the 90′s about meth, we are now deeply entrenched in a time where “the” object of addiction are prescription drugs. In the past decade there has been a five-fold increase in treatment admissions for abuse of opioids, and overdose deaths related to pills have tripled in the past two decades. In some states more people die of pill overdoses than motor vehicle accidents. It is a problem that has gained national attention by many government agencies (and non-government groups), and was a hot topic this year at CPDD. Much of the focus was on abuse-deterrent formulations, which studies have shown have reduced abuse and diversion. This is a good thing, but at the same time such formulations are not necessarily reducing the number of people who struggle with abuse/addiction – they are just pushing them in another direction to other more easily abusable products or illicit drugs (what we call the “balloon effect”). The key point goes back to my first bullet point. We need to invest far more resources into prevention and early intervention since this is really the origin of the problem for most who struggle.
  • psilocybinPsilocybin and quantum change. Of all the cool things I learned this year, the one that surprised me the most was a workshop focused on the treatment benefits of psilocybin, a hallucinogenic compound from mushrooms that operates mostly on 5-HT-2a/c serotonin receptors. The session, led by Roland Griffiths and Herb Kleber, reviewed studies where psilocybin produced some remarkable mystical experiences for participants that rated among the most important events in their life! Here is a video clip describing one of the studies. The hope for those who struggle with addiction is that psilocybin may be an accelerated way to induce spiritual experiences that result in profound and lasting behavioral changes. The compound, when used appropriately in controlled conditions, appears to be non-physically toxic and virtually non-addictive. While the early findings are intriguing, I am not so sure we will see it on the list of evidence-based practices any time soon.

If you want to read more about the conference, check out the CPDD Blog.

Lastly, I know many of you won’t believe this, but CPDD has workshops that go from 8pm until 10pm at night, even Sunday – on Father’s Day! My wife never believed me until she saw it for herself. This is a dedicated group of people! So, after one of these very long evenings, I ventured out into the evening and did a little picture taking. Here are two of my favorites:

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Hitting Rock Bottom: New docu-drama about addiction needs your help!

Monday, June 3rd, 2013

I don’t think I have ever done this before on a post, but here goes. I need your help.

Not long ago I was contacted by some folks who have been working hard on a show called Hitting Rock Bottom. It tells the real stories of people who have struggled with addiction, hit rock bottom, and found a way out. Unlike reality television that often turns tragic stories about addiction into entertainment, this show has a far more noble and broader reaching aim. The creater and Director, Corey Snyder, who has been in recovery for the past five years and also happens to be a very talented film maker, wants to instill hope (and action) in those who still struggle. He portrays challenges with addiction through docu-drama storytelling that utilizes actors to dramatize real stories. He and his team have already completed the first four episodes of season one which you can watch right now for free on the Hitting Rock Bottom homepage. Each episode is a few minutes, so watching them all will not take you that long.

HRBThe first season tells the story of Daryl Brown, a very likable young man who sets out in life with no idea of what is ahead for him. The show is more than engaging, and realistically captures the underlying risk factors that contribute to going down a path of addiction. It is real, scary, and unfortunately a story that plays out far too often.

Fortunately, the story of Daryl has a positive ending, but that is where I need your help!

The show is need of funding to finish filming the first season and complete the story of how Daryl overcomes addiction. It’s the best part of the story and has the potential to motivate many struggling souls to seek help. To complete the season, the crew are presently running a fund-raising campaign on Indiegogo. The goal is $57,500 which will cover all costs to finalize filming the remaining episodes. Even with these funds, many involved in this project are giving their time and energy to see this project to its successful completion. By contributing whatever you can, be assured that your donation will go towards a project that has the potential to transform how we understand, treat, and address addiction in this country. Also, there are only 13 days left in the campaign, so please contribute now. And be sure to check out some of the cool perks at various donation levels.

Thank you.

Ah-hah moments to move beyond addiction

Saturday, May 11th, 2013

Not long after my wife and I were married, we decided to proactively increase our chances of staying together by enrolling in one of Dr. John Gottman’s weekend couples workshops in Seattle. At the time I was deeply immersed in my graduate studies in counseling and was excited to spend some time with the world-famous marriage guru. What I had not realized was that 1000 other people would be crammed into the Seattle Center taking the workshop as well, so my chances of a little one-on-one time were not so good. Fortunately, he circulated around while we all were doing exercises and I told my wife that if he ever came within 200 yards we should wave our hands wildly and grab his attention.

The moment came and sure enough my plan worked. He sat down and we began talking about some martial issue that escapes me now. During our conversation I began challenging him a bit about how people really change behavior, at which point he brought up focusing. Because I had told him I was nearing completion of my graduate program he assumed I would know all about focusing, but my deer-in-the-headlights response gave me away. I had to admit that never in any of my classes had the word focusing ever been mentioned. I was clueless and a bit embarrassed. He said it was the key to behavior change and I needed to know about it.

focusing_book_2007_medCoincidentally, the relative I mentioned a couple of blog posts ago who had given me a bunch of psychology books, had included the book  Focusing! Written in the 1970s by Eugene Gendlin, the book is based on about two decades of research analyzing what happens in therapy sessions that explain good outcomes. What Gendlin found is that it has little to do with the therapist or the specific type of therapy one gets, and far more to do with what happens inside the client. In essence, he discovered that positive outcomes occur when clients have “ah-hah” moments during sessions that awaken them to deeper truths about themselves and life. These moments occur when we (and clients) go inside and connect with what he calls a felt sense – a pre-verbal inner knowledge or awareness that comes from paying attention to an integrated and holistic aspect of our being that we can access at any time. If this sounds a little new-agey it really is not, it is just hard to describe something that cannot be easily put into words.

Have you ever lost your keys and banged your head against a wall trying to remember where you left them? No matter how hard you try nothing seems to work. So you go on to something else and then, in the middle of folding laundry, it hits you. You remember exactly where you left them! That moment of remembering is what Gendlin would call a felt-sense, an ah-hah moment that awakened you to an answer that previously was outside your awareness. While focusing can help you find your keys, it really has the power to change your life.

Focusing is the name Gendlin uses to describe the six-step process he developed for helping people – both and in out of therapy – have felt-sense experiences to solve a multitude of life problems, including addiction! If you have never heard about it, I really encourage you to check out the focusing website and read one of the many books written on the topic. What started as a little research project in Chicago in the 1950s has evolved into one of the greatest tools we have for overcoming addiction.

New book out today! Craving: Why we can’t seem to get enough

Tuesday, April 30th, 2013

cravingI am excited to announce that a new book is out today from my colleague, Dr. Omar Manejwala. He is the former Medical Director of Hazelden (one of the oldest and most respected treatment organizations in the world), and current Chief Medical Officer of Catasys, an innovative health management company focused on treating substance abuse problems. I was fortunate to receive an advanced copy of his new book, Craving: Why we can’t seem to get enough, so I have had the past month to review it thoroughly. If you struggle with addiction, or care about someone who does, then I strongly encourage you to get this book!  Why?

First, craving is a universal experience we all share and it also happens to be at the heart of addiction. In healthy doses, it is part of what makes us human. But when cravings become so intense that they lead to out-of-control behaviors, then they are not such a good thing. In fact, they cause significant pain and suffering. For those who have never experienced addiction, imagine holding your breath and then starting to think about air. How long before your desire to breath becomes an intense craving for air? How long until the craving for air becomes almost unbearable? You may think this example has little to do with addiction, but the regions of the brain that control your breathing, heartrate and other survival functions happen to be the same areas of the brain that get hijacked by addiction. By reading Dr. Manejwala’s new book, you will be treated to a very lucid and beneficial explanation of the science of craving. If you are afraid of brain science, have no fear, he makes it very accessible!

2013_0409_omar_manejwala_600x300Second, once you understand cravings more clearly, you will be in a far better position to do something about them. Perhaps what I like most about this book is that he provides an approach to deal with cravings that links back to the science of what we know about them. For example, part of the experience of craving is biological. Cravings are not just obsessive thoughts in your head, but are deeply rooted in physical and chemical changes that take place in the brain and body. Think back to our example about holding your breath. Is your need for air all in your head? Of course not. While we don’t require alcohol or drugs to survive like air, cravings have a similar intensity and feel because of what takes place physically in the body. So interventions focused on addressing the physical aspects of craving are critical. And at the same time, part of what makes cravings so painful is that once they start, they feel like they will never end until acted upon.

The best news of this book is that cravings can be overcome! Dr. Manejwala outlines a wonderful tool box of interventions that address both the physical aspects of craving, but also the painful obsessions that precede addictive behavior. You will learn about the benefits of self-help meetings, meditation, exercise, and being accountable to others. There are also some tools that you likely have not heard about, which is a testament to the comprehensive and holistic approach taken throughout the book.

Third, I really appreciate his view that “Courage is, in fact, the most essential quality of recovery, because without courage, none of the other needed practices are possible.” I couldn’t agree more! Dealing with addiction and all its complicating and co-occurring problems is not for the faint of heart. Those who engage in the process of overcoming addiction and are willing to face their most intense cravings, are among the best examples in our society of courage.

While I have a lot more to say about this book, Dr. Manejwala and I plan to discuss it over a video chat in the next week or so. Stay tuned for the broadcast and in the meantime, checkout the latest on the book on facebook and order your copy today.

Addiction treatment system 14 years later….still in need of an overhaul

Monday, July 9th, 2012

This past week The National Center on Addiction and Substance Abuse at Columbia University released a scathing report of our addiction treatment system: Addiction Medicine: Closing the Gap between Science and Practice. While the report says nothing new, it does a nice job of summarizing the fact that we have made little progress since the Institute of Medicine released Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment on January 1, 1998. Here we are, 14 years later, and well, where are we now?

The new report points out these grim statistics:

  • 15.9% (40.3 million) of US age 12 and older struggle with addiction to alcohol and drugs (the number is higher if we factor in behavioral addictions such as gambling, sex, food, and online activities)
  • 31.7% (80.4 million) of US age 12 and older, while not addicted to anything, engages in risky use of substances that threaten health and safety (again, this number is higher if behavioral addictions are included)
  • 89.1% of those who meet criteria for addiction involving alcohol and drugs (not including nicotine) receive no treatment
  • Of those who do get treatment, about 50% come from criminal justice (only 5.7% are referred from primary care medicine)
  • Over 50% of those who go to treatment drop out
  • Addiction and risky substance use costs our society an estimated 468 billion each year

Not good! I will admit I was a bit depressed reading through the report, but not surprised. Addiction is a problem still very much misunderstood. Take for example this huge 573 page report, that constrains the definition of addiction to substances. How can we possibly make progress evolving our treatment system if we continue to narrowly define addiction. It is not just to substances that people become enslaved, but to food, gambling, sex, and many online behaviors. We now have neuroimaging studies providing empirical support that the brain is an equal opportunity organ that does not care what stimulates it, so long as dopamine provides a nice reward that keeps us coming back for more. In a great book on overeating, cleverly titled, The End of Overeating, by David Kessler (which I plan to blog about soon), he makes the point that animals will work almost as hard for food as they will for cocaine. So, back to my point. How can we make progress in this field when we continue to slice up the addiction problem, and fail to understand that it is not about the objects per se, but the relationships that a person has with these objects – all of these objects?

Accurately defining the problem would be a start, because we could then start building systems of care that leverage interventions for a wide range of chronic conditions, including addiction. But even agreement on a broad definition will likely not be enough. We need big system changes to make big progress. The CASA report provides a list of recommendations for improvement, including:

  • Increasing screening and referral in primary care medicine
  • Improve training on addiction in medical schools
  • Establish national accreditation standards for all addiction treatment facilities and programs
  • Educate non-health professionals about addiction, screening, and referral (dentists, teachers, legal staff, welfare, etc.)
  • Require adherence to use of evidence-based treatments
  • Expand addiction treatment workforce
  • Implement more national public health campaigns

It is a list, but hardly a gutsy one or even close to what needs to be done if we are to make big progress. What would my list look like? Here are my top four suggestions:

  • National Institute on Addiction (NIA): While integrating NIDA and NIAAA into one organization next year is progress, I would like to see an institute called the National Institute on Addiction that puts the emphasis on understanding the relationships people have with all objects of addiction, not just alcohol and drugs. While I know these agencies have invested resources in gambling and food, the money is scant compared to what is spent on substances. One of the primary goals of this organization would be to get all stakeholders (researchers, treatment providers, public) on the same page about how we should define addiction.
  • Leverage the Internet: Over 80 percent of the US population has access to high-speed internet, which means that we have the potential to reach the 90 percent who don’t get care. I am not saying this is easy, but there is a saying in marketing that you go where the customers are – and they are online.
  • Stop criminalizing addiction and treat those who do end up behind bars: The vast majority of folks behind bars suffer from addiction and most don’t get treatment. This needs to change. Because most will get out, why not use their time while in prison to treat their addiction, educate them, and provide them something to live for when they get out? I know, this costs too much money. See my last point.
  • Invest in families/prevention: Addiction is primarily a problem born out of adolescence. Most who develop addictions begin their journey before the age of 15. We need to devote significant resources to helping families flourish. We need programs that help people developmentally obtain the capacities they need for optimal mental health, for intimacy, parenting, and getting along with each other.

What would be on your list?

Siddhartha’s path out of addiction

Saturday, June 30th, 2012

I’m not sure how I missed reading Hermann Hesse’s Siddhartha (Hilda Rosner translation) in high school, but I did. It’s one of those enchanting books I wish I would have read earlier! If you are unfamiliar with the story, I encourage you to read it and soak in its many wonderful messages about life. I have no intention of recapping the story here, but instead want to use parts of the story to illustrate one path out of addiction.

Siddhartha is a man on a mission, on a journey to the center of Self, to a place where Self is merged into unity, or the All. On his way to enlightenment he has many interesting adventures, including a period of time where he hangs out with the beautiful Mistress, Kamala. “She played with him, conquered him, rejoiced at her mastery, until he was overcome and lay exhausted at her side.” She enticed him into the world of the ordinary, a life of attachment. “The world had caught him; pleasure, covetousness, idleness, and finally also that vice that he had always despised and scorned as the most foolish – acquisitiveness. Property, possessions and riches had also finally trapped him. They were no longer a game and a toy; they had become a chain and a burden.

I find it interesting that as Siddhartha descends deeper into his attachments, Hesse beautifully describes addiction. “He played the game as a result of a heartfelt need. He derived a passionate pleasure through gambling away and squandering of wretched money….He won thousands, he threw thousands away, lost money, lost jewels, lost a country house, won again, lost again. He loved the anxiety, that terrible and oppressive anxiety which he experienced during the game of dice, during the suspense of high stakes. He loved this feeling and continually sought to renew it, to increase it, to stimulate it, for in the feeling alone did he experience some kind of happiness, some kind of excitement, some heightened living in the midst of his satiated, tepid, insipid existence.

And like so many who suffer from addiction and relapse to numb the pain and despair of an insipid existence, Siddhartha too experiences the consequences of his actions. “And whenever he awakened from this hateful spell, when he saw his face reflected in the mirror on the wall of his bedroom, grown older and uglier, whenever shame and nausea overtook him, he fled again, fled to a new game of chance, fled in confusion to passion, to wine, and from there back again to the urge for acquiring and hoarding wealth. He wore himself out in this senseless cycle, became old and sick.

For those who struggle with addiction, and their family and friends forced to endure a life on the edge, there is an insightful lesson in the story of Siddhartha.

I have had to experience so much stupidity, so many vices, so much error, so much nausea, disillusionment and sorrow, just in order to become a child again and begin anew. But it was right that it should be so; my eyes and heart acclaim it. I had to experience despair, I had to sink to the greatest mental depths, to thoughts of suicide, in order to experience grace, to hear Om again, to sleep deeply again and to awaken refreshed again. I had to become a fool again in order to find Atman in myself. I had to sin in order to live again.

For someone who reaches enlightenment, it’s strange imagining Siddhartha sitting by a river thinking about suicide. But he does. And in the pain of the moment, “he understood it and realized that the inward voice had been right, that no teacher could have brought him salvation. That was why he had to go into the world, to lose himself in power, women and money; that was why he had to be a merchant, a dice player, a drinker and a man of property, until the priest and Samana in him were dead. That was why he had to undergo those horrible years, suffer nausea, learn the lesson of the madness of an empty, futile life till the end, till he reached bitter despair, so that Siddhartha the pleasure-monger and Siddhartha the man of property could die. He had died and a new Siddhartha had awakened from his sleep. He also would grow old and die. Siddhartha was transitory, all forms were transitory, but today he was young, he was a child – the new Siddhartha – and he was happy.”

So often when addiction is the problem we believe heading off to treatment is the answer. No doubt treatment can be helpful and at times life-saving. But this story is a powerful lesson in how change, even the most challenging of changes, are possible when we access what is already inside us. Atman. The All. “To much knowledge had hindered him; too many holy verses, too many sacrificial rites, too much mortification of the flesh, too  much doing and striving.” Too much treatment, too many self-help meetings, too much reliance on evidence-based practices and medications. Too much action. Sometimes, the path of no-action, the path of contemplation – of sitting, listening, and just being is the path out of addiction.

 

Investing in Addiction Treatment: Is it Worth the Cost?

Saturday, June 11th, 2011

I recently talked with a Huffington Post reporter about the Real Tab for Rehab: Inside the Addiction Treatment Biz. In our discussion, I pointed out that to a large extent we still have an addiction treatment system that provides short-term (acute) treatment for a long-term (chronic) problem (this key point did not make the article). In addition, the current system treats less than 10 percent of those who could benefit from some kind of intervention at a cost that will likely reach $34 billion by 2014, more than double the spending from 2005. In my opinion, a lot of money is being spent on helping a minority of those who struggle with addiction, and sadly being spent on expensive residential treatment stays that research indicates is not more effective than less expensive outpatient care. Bottom line, the billions being spent could be invested in those who struggle far more wisely.

Not too many years ago I was attending an addiction conference where a number of  treatment centers were advertising their services. I struck up a conversation with one of the marketing reps of a well-known residential program. She explained to me that because of the escalating cost of treatment, her team had developed a program that was only ten days in length, thus reducing the total treatment cost to about 15K while maintaining the effectiveness of a longer residential stay. As I always do in these situations, I asked her about proof that the program worked. She had a well-rehearsed answer, but like most treatment programs, no reliable and valid measures had been employed to measure outcomes. Even if some had been used, we know that 10 days hardly scratches the surface of what needs to happen to help someone with addiction.

Am I opposed to residential programs? Not at all. At times I believe these programs are life-savers and provide a strong foundation upon which to build a solid outpatient management plan. Many employ very skilled, compassionate, and hard-working counselors that know how to help patients stuck in addiction. Some charge reasonable rates for their services and avoid the “spa-like” add-ons that contribute nothing to long-term outcomes. What I am opposed to is marketing that feeds on the vulnerabilities of the populations that seek out their help. Many parents will go to the ends of the earth to help their addicted child and not think twice about mortgaging their home and draining their savings if someone tells them their program will save their kid. Even for those with money, the idea that one can “buy good outcomes” if just the right program is utilized is simply not true.

What can you do? You can spend your time understanding the nature of addiction, what science has to say about treatment interventions, and then spend your money wisely on what will result in the best possible long-term outcomes. What are some of the best financial investments in treatment? This slide from a recent presentation provides you a quick reference point for understanding how a number of treatment interventions rank in terms of scientific evidence. Notice that brief interventions, addiction medications (Campral, Revia), the Community Reinforcement Approach (CRA) and motivational enhancement interventions all rank very high in terms of evidence. Also notice what ranks far down the list: residential treatment, Alcoholics Anonymous (AA) and 12-step facilitation therapies, and general counseling. Note that it is not that these things cannot be useful in overcoming addiction, they can be very helpful. But when you compare their effectiveness through the lens of science to other options, and take into consideration the cost of each, it is clear we could be spending the billions of treatment dollars far more wisely.

The goal is to maximize the best possible intervention outcomes over many years (and for some a lifetime), not a few weeks or months. To do this, we need to employ the best interventions at the lowest cost. Combining free community resources, outpatient therapists, medications, self-help groups, and motivational incentives will give you the biggest bang for your buck.

Video, Video…and more Video!

Friday, April 15th, 2011

I learned recently that the number one online  activity is watching videos. My initial guess was email, but as I thought more about how we have grown-up watching television, and that the average American now spends more than five hours a day in front of a screen (TVs, computers and mobile devices, non-worked related), this outcome is hardly surprising. Email actually ranks third behind online banking. These statistics got me thinking about the most effective way to provide you science-based, easy-to-understand information about addiction and how to overcome it as a problem. Call me a little slow, but if watching videos is where all the action is online, then it seems to make sense that I go there as well. So I am excited to tell you that I have taken the leap and completely updated this site with lots of video! You will now find many short snippets, most just a few minutes long, on a wide range of addiction-related topics.

A few words about the clips. Last year I joined the Board of Shangri-La, a nonprofit organization dedicated to helping Oregon’s most vulnerable populations with housing, employment, and a multitude of other needed services. What an amazing group of people! I can’t say enough great things about how they are making a difference in the lives of so many people at a time when so many are struggling. One reason for my involvement has been the increasing prevalence of addiction among the populations they serve. To help out, I presented some material about addiction to about 80 of their managers and staff, and in return, they taped it so I could use it on this site. Thanks again guys!

The first set of clips I am posting are primarily aimed at helping you better understand addiction. Here is one of them focused on addiction being about relationships.


 

A long walk to Tucson

Monday, February 28th, 2011

As I laid in bed thinking about the next day, about my turn, fear flooded my entire body. I was like a pressure cooker with no relief valve, and I knew I had to do something fast. I dressed quickly and left my room, walking outside into the cold Arizona night. The black sky was speckled with a million shining stars lighting up the desert floor, casting shadows on giant, prickly cactuses. I walked quickly along the side of the road, exhaling fear with every breath. I began to feel better, more grounded and intent on making it into town. Every few minutes I would squint as a car’s oncoming headlights blinded me, but I never missed a step. After some time, I felt a sharp pain in my side. Then my left calf began to tense up and I wondered how far I had walked. I wondered even more about how far I had left to go, whether walking alone in the middle of the night on a dark road was such a good idea, and whether I would survive confronting my fears in an experiential therapy group the next morning.

My week-long experience in Tucson was only one of a number of therapeutic journeys I have taken during the past two decades. At the time I took my long walk in the Tucson desert I understood very little about how professional therapy ultimately translates into a better life. I was there because that is what I thought I was supposed to do to get better. It was a challenging experience, like many of the therapeutic journeys I have been on, because the essence of the therapeutic work was emotional. Since I had lived much of my life in my head, learning to connect with my body and feelings was not natural, particularly when I felt I had so little control over these things. Although I can honestly say it was not the most enjoyable week, after it was over I felt more complete, more integrated, more able to be in the world in a broader context. Some of the emotional pressure had been released safely, and I felt more alive. Such outcomes have always been the reason I keep going back for more, even to this day.

What I now realize after years of personal therapeutic work, counseling patients, and studying the research on treatment outcomes, is that good therapy advances developmental capacities that make healthy relationships possible. In addition, by expanding developmental skills, it becomes possible to optimize overall mental and emotional functioning, leading to an expansion of life opportunities, a better alignment between innate talents and employment, and a more meaningful life. What I have also realized is that advancing developmental capacities does not necessarily require professional treatment, but can result from a number of life experiences.

Although medications and various cognitive-behavioral therapies so often used in addiction treatment play an important role in solving the problem of addiction, they fall short of a permanent solution because they are not intended to progress emotional development. When I reflect back on the many therapists I have worked with, self-help groups I have attended, experiential programs I have endured, and the wide range of therapeutic approaches I have subjected myself to, it is clear now that the most important ingredient in all of them was people, not specific therapies, medications, or programs. Treatment works best when in the context of relationships, the skills necessary to initiate, develop, and maintain healthy relationships – skills underdeveloped because of time spent with objects – are nurtured.

The good news is that anyone, at any stage of life, no matter how badly addicted to objects, can evolve their developmental capacities and engage in life in a deeper and more meaningful way.

 

Mark Girard, LCSW & Certified Jungian Analyst: Working with Altered States

Tuesday, December 7th, 2010

For the past few years I have taught a foundations course on addiction treatment to graduate students. An important aspect of the course is helping students understand that longterm successful outcomes  necessitate resolving underlying drivers of addictive behavior, namely, adverse childhood experiences. In an effort to illustrate concretely how this may be done, I enlisted the help of a good friend and colleague, Mark Girard, who is a master at knowing how to help people heal from deep, traumatic wounds. As a Licensed Clinical Social Worker and certified Jungian Analyst with years of experience, he is incredibly skilled at working with a wide range of altered states, or emotional constrictions due to trauma. What impresses me most about Mark is how he uses himself as a tool in therapy. He walks his talk and maintains a presence with patients that is the essence of what a good therapeutic relationship is all about. During his recent visit to my class he agreed to have me videotape his lecture. The approximate 35 minute presentation is a gift to us all. I encourage you to take the time – quiet, focused time – to sit and hear what he has to say.

In the presentation, Mark mentions an article by Dr. Bruce Perry from the ChildTrauma Academy that was required reading in class. The article is titled Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized children and is a nice adjunct to his lecture. He also makes reference to Babette Rothschild’s wonderful book on trauma, The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment, and the classic article on trauma by Bessel van der Kolk, The Body Keeps Score – both among the very best reads on the topic of trauma.