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Hope for Depressed Addicts

December 27th, 2012

Not so long ago Alcoholics Anonymous was regarded with condescension by many professionals working in the addiction field. A common view was that science-based techniques, like Cognitive Behaviour Therapy (CBT) had made the Anonymous Fellowships seem like a quaint and outmoded quasi-religious cult.

At the same time, there were encouraging signs of scientific method being employed in the evaluation of both AA’s effectiveness, and of the value of the 12-step based Minnesota Method as practised in many treatment centres (Cook, 1988; McCrady & Miller, 1993). But the critical event leading to greater respect from the scientific establishment for the practices of AA was the publication of the results of Project Match in the 1990’s. This large-scale definitive study found that teaching alcoholics the basic tenets of AA philosophy and practice and encouraging participation in AA was at least as effective in facilitating recovery as was CBT. Subsequently, research into how AA works has continued unabated, and I wish now to highlight in particular a recent study from the USA that has examined the role of 12-step attendance with respect to current concern with the problem of “co-morbidity” – that is, the presence in an individual of a psychiatric condition like major depression alongside that of drug/alcohol addiction.

It’s now generally recognised that addicts with a “co-morbid” diagnosis of major depression present a particular challenge in treatment. Participation in AA/NA was shown in 2003 to have a beneficial effect on abstinence, whether or nor co-morbid depression was evident (Kelly et al 2003). A very recently published study shows just how important attendance can be for clients with both diagnoses (Worley et al 2012). 12-step treatment of co-morbid substance use and major depression was investigated,
in comparison with use of CBT. This study shows that 12-step attendance in itself, regardless of strength of affiliation, mediated a significant reduction in depression. In turn, the lower depression mediated an improvement in substance use. The improvement in depression in those treated by 12-step facilitation (TSF) actually exceeded that in a CBT group. Moreover, the beneficial effects of 12-step attendance on depression were also evident in those clients in the CBT treatment group who chose to attend the 12-step meetings. In summary, major depressive disorder is not an exceptional problem for those attending 12-step groups because AA attendance itself has a beneficial effect on depression, and lower depression leads to successful recovery from addiction. Read the rest of this entry »

How it was, how it is now…

December 10th, 2012

This is a poem from one of our patients about her recovery for those that might not be able to see a way out; there is always hope and a different way of feeling, living and being.

How it was

The wall to the west is built of fears
The eastern one of unshed tears
The other two are made I know
Of loneliness that wont let go

Its cold in here, the light is thin
Its damp and silent, deep within
Locked in this place its seems I’ll be
From now through all eternity

This prison haunts my mind and soul
It fragments me, I don’t feel whole
It never seems to move away
It saddens me night and day Read the rest of this entry »

PROMIS Research in Progress: Some early findings

November 28th, 2012

Some 7 months ago, following the start of my work as Director of Research, PROMIS agreed to conduct an experimental trial of new interventions based on proven practices that have emerged within the broad framework of the Positive Psychology movement (Peterson, 2007). Our intervention programme has been carefully designed in consultation with the VIA Institute on Character (University of Pennsylvania, and will be introduced shortly when staff training has been completed.

In the meantime we have been gathering the information that will be required to conduct a controlled evaluation of the intervention following its incorporation into the PROMIS Programme. Some interesting findings have already emerged, and I would like briefly to give the flavour of the kind of things we are discovering, in relation to just two small aspects of our ‘benchmark’ studies of clients at PROMIS, prior to implementation of the experimental intervention.

Aspects of Well-being

Working effectively with clients is problematic if they are feeling angry, depressed, anxious or ashamed, or another state indicative of a negative mood. Our ‘benchmark’ findings indicate that although clients do generally arrive in a negative, neutral or only slightly positive mood, this does not persist for long. The mood of the vast majority of clients soon greatly improves, and remains at more or less the same significantly more positive level throughout treatment.

But a positive change in mood, whilst desirable and important, is only the start. It may facilitate progress in treatment, but it may or may not be linked to progress in the long term. We’ll have to wait and see. The evidence we now have, already shows that the pattern of change over time is very different for our measures of psychologically more important states of mind. Let’s take just one example: Satisfaction with Life (SWL) is an important judgement about how satisfied with life one generally is, and is independent of transient moods. We measure it by asking clients to judge in their own way, using their own criteria, how closely their lives are to what ideally they might wish was the case. Our findings so far indicate that SWL, like mood, also improves markedly. Most importantly, this increase in positive judgements increases over the time in treatment, whether that is one week, two, or three weeks. The longer a client stays, the more satisfied they become. Similar findings are emerging with respect to other aspects of positive psychological progress, but to varying degrees. ‘Insight’, for example, seems to be more resistant to change. The overall picture will be clarified in time; the research is still in its early stages.

Posttraumatic Growth

The Positive Psychology movement has embraced the finding that traumatic events may lead not only to post-traumatic stress disorders, but to posttraumatic growth, or what has been termed “Benefit-finding” or “Adversarial growth”. The idea is not new. Major religions and philosophies have pointed to the possibilities of character developing positively as a consequence of overcoming, even welcoming, adversities. Psychological studies have now shown that a large array of crises in people’s lives – e.g physical illnesses like cancer, divorce, bereavement, military combat, rape and sexual assault – lead to perception of positive changes in five different but related areas of personal and social functioning, as follows: 1. relating to others, 2. establishing new opportunities in life, 3. increases in personal strength, 4. spiritual change, and 5. appreciation of being alive. These studies have used standardised questionnaire measures of posttraumatic growth, and at PROMIS we have used one of these inventories to assess how clients feel they have benefited from the crisis in their lives that led them to seek treatment. This work is in its initial stages, and some important questions cannot yet be answered. However we do have data that indicates that clients at PROMIS, after only a comparatively short time in treatment, demonstrate at least the same level of positive changes commonly found in those who have faced the extreme physical and stressful crises listed above. Moreover, these changes show signs of being related to length of time in treatment. If substantiated, this will in time suggest new ways of encouraging the processes of personal growth that coping with traumatic events in themselves naturally facilitate.

The research we are conducting at PROMIS indicates the centre’s commitment to defining priority areas of improvement and to implementing practices that are soundly based in replicable research. The most important results will emerge when the experimental intervention has been implemented and evaluated. In the meantime, the examination of changes occurring prior to the intervention is already of some intrinsic interest, and suggestive of therapeutic potential.

Geoffrey Stephenson
(October 25th 2012)

Looking after your Liver – The Healing powers of Nature

November 26th, 2012

The liver is the master organ and the recycling centre of the body. Amongst its many jobs it is responsible for eliminating harmful toxins, breaking food down into energy, manufacturing and disposing of excess hormones, producing bile, fighting infections, balancing blood sugar and storing nutrients. If our liver is functioning less than optimally or is even a little sluggish then this will have a negative knock-on effect to many other areas of our overall health and well-being. Of course we all know that alcohol is a major liver toxin, disrupting its function and depleting essential B vitamins by the mouthful, but there are many other things that can also affect our liver in a negative way, such as smoking, stress, obesity and poor diet. Especially at this time of year when we are all in the midst of the festive overindulgence, it’s good to know that there are many little things we can do on a nutritional level to help our livers function more efficiently; simply by adding in little bits of super food goodness into to our diets and avoiding certain liver toxins. The liver works in 3 different phases known as ‘detoxification pathways’, each of which needs to be supported by basic good nutrition and can also be stimulated to work better by the nutrients provided by nature in certain foods, herbs and spices.

Whether you are an alcoholic just entering treatment or during early recovery, an overeater, drug abuser or just feeling a little sluggish, the following advice will help to aid and rejuvenate your liver to work at its ultimate capacity and therefore improve your overall health and vitality. In fact there’s no need to wait until you feel your liver may have been under particular strain to employ the following suggestions, as they can all be adapted into your long-term diet to ensure that you are always looking after the ‘master organ’ as best you can. The list below isn’t just a list of healthy foods! The foods, herbs and spices that I have specified all contain certain antioxidants, minerals and enzymes that specifically and directly work to improve liver health, by aiding and supporting its function and improving the efficiency of the ‘3 detoxification pathways’.

So here are my top easy tips for ‘Looking after your Liver Naturally’: Read the rest of this entry »

Incorporating Life Coaching into our Treatment Programmes

October 30th, 2012

Our life coaching services are aimed at helping you create an enjoyable, fulfilling and rewarding life and career. Through life coaching, we do not only focus on navigating through the difficulties created during active addiction and making life manageable again but we also develop practical tools and solutions to improve daily life.

A unique aspect of our life coaching services is that it starts as you embark on your recovery whilst at treatment, when you are feeling your most vulnerable, helps you gain the motivation to work out what you want from life and continues on to provide you with the support you need when you feel ready to embark on new ventures.

Our dedicated life coaches help you reconnect with the qualities that are already present in each of our clients and reach their full potential in order to shape and attain the life they desire.

Life coaching is not a mandatory part of treatment but it is a valuable component to ensure that our clients do not feel stuck in defeat or fearful of moving forward. It is the perfect complement to therapy in which clients are encouraged to look forward to a positive future rather than look back at their past.

Walking with our experienced life coaches through obstacles and challenges which might have once appeared as insurmountable, you will unlock a new sense of confidence, self-esteem, empowerment and motivation necessary to make decisions optimistically and realise your dreams.

Coaching at PROMIS is designed for creating strategies, goals, learning and plans in some of the following areas:

  • Increase your feelings of happiness and wellbeing.
  • Create a wonderful present & compelling future.
  • Find solutions to any blocks you have to creating the life you want.
  • Take action towards your dreams and life goals.
  • Clarify your personal purpose and mission.
  • Identify your personal values.
  • Focus on what really matters to you.
  • Renew, refresh and re-invigorate your life and recovery.
  • Explore and enhance your inner life and expression (creative, emotional, physical, spiritual and intellectual).
  • Explore and deepen your personal creativity.
  • Improve your work/life balance and enjoyment of life.
  • Develop personal strategies for handling stress.
  • Navigate the change you face in your life be it:
  • from treatment back into life and the workplace,
  • setting new goals and action plans,
  • re-invigorating your recovery,
  • creating a new venture.
  • Identify the things that you love.
  • Create the most fulfilling and rewarding life for you.

 

 

‘Natural Recovery’ from Addiction: Implications for Treatment

October 15th, 2012

‘Natural recovery’ is a term used to describe recovery from addiction without the help of professionals. It’s a term that rather implies there’s something unnatural about the professional or even AA route. However, other terms that have been used are also problematic, given that they all embody an explanation of the phenomenon that is open to question. For example, Tuchfield (1981) was one of the first to describe what he called “spontaneous recovery”, although the recovery his alcohol dependent respondents described were generally the product of a sense of shame that had grown over a long period of time, even if the ultimate decision was sudden. Winnick (1962) described a process of “maturing out” in a group of nearly 17,000 opiate addicts registered as such in the USA in 1954-55, two-thirds of whom failed to appear on the Register over a period of 5 to 6 years. “Self-change” is now frequently used to describe recovery without professional help, but surely all change is self-change, professionally assisted or not.

Whatever the term used to describe the process, recovery without recourse to professional help has repeatedly been shown to account for a greater degree of success than is achieved in clinical populations (Klingemann, 2001). This has encouraged those who question the efficacy of the recovery movement and the mutual help practices of AA; and the suggestion that promoting self-change in the community should take priority as a treatment strategy has put the treatment community somewhat on the defensive. However, the justification for a mutual stand-off is slender, because self-change on the one hand, and professional treatment on the other, are not strictly speaking, antagonistic methodologies. Rather, they are complementary. Those who come for treatment presumably view it as being of value in their personal quest for self-change, so no controlled comparison of self-change and professional treatment is feasible, even in principle.

It is, of course, likely that those who seek treatment, or are encouraged to undergo treatment, are at the serious end of the addiction dependence continuum. Whilst this has been generally acknowledged to be a plausible assumption, there are two questions arising that need to be addressed. The first concerns the ability of those with more serious conditions to recover by themselves. The second concerns the extent to which professional treatment actually improves the prospects of more seriously dependent persons.

The first question has recently been addressed in an important Dutch study (Boschloo 2012). The data reported come from the ‘Netherlands Study of Depression and Anxiety’ (NESDA), which aimed to follow up the long-term consequences of depressive and anxiety disorders in a total of 2981 people, about half of whom had experienced an anxiety and depressive disorder, or symptoms of anxiety and depression.  253 of the participants had a diagnosis of remitted Alcohol Dependence  (AD) or current AD (assessed in terms of (DSM IV ) at baseline and were followed up over a period of two years. Read the rest of this entry »

Strawberries – For Today and Only For Today

October 9th, 2012

I am sharing with you this beautiful story that I read many years ago. It expresses for me a true essence of ‘Reality’. Enjoy!

Oliver Brady

A man had been walking in the desert for so long that he could no longer remember where he came from. He was truly lost & without hope, and laid down in the sand waiting for death to take him.

Just then the figure of a woman emerged from the shimmering heat and took his hand. “Come with me” she said. She helped him to his feet and they walked for some time until they came to a village where she took him into her house. “You can stay here with me.”

The woman nursed him back to health and soon he was well enough to help her with the household chores. One day she asked him to go to the market and bring back food for their evening meal. “Gladly, but I have no money” said the man.

“We don’t use money” she replied. “Choose what you want and when the stall holder asks, ‘Is it for today and only for today?’ all you have you do is say ‘Yes, it’s for today and only for today’ and they will give it to you.” Read the rest of this entry »

Pure White and Deadly – Why addicts should be avoiding Sugar!

September 26th, 2012

Can something so seemingly harmless and widely available really be so bad for us? The answer is yes. Sugar is not just bad for us; in reality eating too many refined sugars too often is one of the root causes of many of the chronic health conditions hitting new heights in western cultures including type II diabetes, heart disease, obesity and certain cancers. The physical implications of eating too many refined sugars too often are obvious and common knowledge to most people, however what is often overlooked is the extremely negative impact these ‘substances’ can play on one’s mental health. The truth is sugar and refined, processed carbohydrates can also be addictive and disruptive to one’s life due to the way they disrupt brain chemistry and fuel addictive patterns. Sugar influences the same ‘feel good’ brain chemicals, including serotonin and dopamine, in exactly the same way as most hardcore illicit drugs – creating a quick false sense of pleasure followed by a rapid crash and the need for another ‘fix’ of a stimulating substance. Dangerous ground for an addict of any nature!

Low blood sugar, or ‘hypoglycaemia’ is caused by either not eating frequently enough or by eating foods that release too much sugar too fast into the blood stream, causing a rapid rise in blood sugar levels quickly followed by a huge crash. Additionally, when levels of glucose in the blood are low, stress hormones are released into the system by our adrenal glands. This results in increased production of our natural ‘fight or flight’ hormones called adrenaline and cortisol, which induces feelings of anxiety, stress, irritability, nervousness and desperation. This mental state inevitably sends the brain in search of something else sugary for a quick ‘pick me up’, however for an alcoholic or drug abuser – this can often be the trigger causing them to pick up another substance to get their ‘fix’. Uncontrolled blood sugar levels are so disruptive to the nervous system that in reality the feeling of having a panic attack may actually be the result of low blood sugar! As anxiety, stress and desperation are some of the most common drivers among most substance abusers, proper blood sugar control is beneficial and recommended for addicts during treatment and for the best chance of sustained, successful abstinence. Read the rest of this entry »

Self-licensing: A Route to Addiction

September 5th, 2012

A couple of weeks ago (16th August, on BBC3; “Russell Brand: From Addiction to Recovery”),  Russell Brand launched a hard-hitting attack on conventional approaches to drug addiction: first, he lambasted the view of right wing tabloid commentators who favour the view that addicts recklessly and freely abuse drugs, and could as easily choose differently. And second he castigated, even more passionately, the medical establishment that accepts the apparent inability of addicts to desist voluntarily, and compounds the felony by prescribing medically sanctioned (but perhaps equally, if not more, addictive) substitute drugs.

Brand believes, and he is hardly alone in this, that individuals should not be blamed for their addiction, but that theirs is a lifestyle that can be transformed. The alternative – harm reduction via the use of medically authorised drugs – he regards as a dreary, unremitting failure of nerve that leaves addicts psychologically no better, and maybe worse off.

His version of the disease of addiction – echoing that of 12-step based treatments – suggests that choice is, indeed, important, in fact is fundamental, to recovery. However, his preferred alternative route is not offered to clients in routine medical practice. Providing a residential context in which an extended abstinent way of life is elicited that enables clients to explore potential for reformation, is expensive, and available only to those who can afford to pay for it. Ironically, as Russell Brand reminded us, those compulsorily detained in Her Majesty’s prisons may have this privilege offered to them cost free.  And reconviction rates after discharge are significantly lowered in those taking advantage of the offer – indicating that the financial costs of this treatment may pay substantial economic dividends in the longer term.

We know that lives can frequently be transformed when the residential alternative is appropriately offered and taken up. But even so, individuals’ resistance to personal reform is frequently intense, even amongst those offered the best of circumstances in which to achieve change. And we know that of the many who may start attending meetings of the 12-step based Anonymous Fellowships only a minority succeed in achieving their goals.  So why is it so difficult for addicts to face the imperative of making and maintaining the decision to recover? Read the rest of this entry »

The Emptiness

August 26th, 2012

We have all experienced that deep sense of unfulfillment, that emptiness that is just crying out…screaming to be filled. In these seemingly dire circumstances, we immediately start working out new ways to fill ourselves once more, to fill this seemingly unbearable emptiness. The behaviour is familiar: find someone or something new to make a new beginning with, and if that is not available, we turn to alcohol, drugs, sex…you fill in the blank…whatever is needed to fill the emptiness.

Have you noticed, that none of these solutions ever work! Why? Because the emptiness is absolutely open, it is unfillable! The truth is that we were not created to be self-filling beings, we are meant to be empty, because when we are empty we are available! Available to who, what, you may ask! Available to Life! God! Source! Higher Power…Spirit! You can choose whatever label you wish…I choose Life!

So how can we be empty and available to Life? The only way that I have found, is by allowing everything to be as it is! “I am where I am and it’s okay”. Why is it okay? Because I am where I am, it’s got to be okay!

 

I know, this is not easy. To remain present to a someone or something without trying to judge it or change it! You either want to attack it, avoid it, make it invisible or capture it, possess it, make it bigger, make it last longer and it’s all so hopeless, you’re trying to fill an emptiness that does not exist! Read the rest of this entry »



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