Evidence-Based Addiction Treatment Explained

12-step programs are an incomplete approach and do not meet the requirements for evidence-based treatment because they lack biomedical and psychological components, and they use a one-size-fits-all approach.

When looking for treatment for addiction, there is a lot of information out there and countless opinions. Friends, family, doctors, researchers, and people in recovery all have their own beliefs about what you need to do to get well.

Unlike in other areas of healthcare, addiction treatment is often deemed “effective” based on anecdotal reports. In fact, most people who seek or are forced into treatment do not receive health care that is aligned with evidence-based practice.

A frequently-cited definition comes from a 1996 article in the BMJ Medical Journal: evidence-based “means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Other definitions also include the patient’s individual circumstances, preferences, expectations, and values.

These variables are not necessarily constant, and there is no one-size-fits-all solution; any list of evidence-based treatments is going to include a wide variety of approaches.

What Is Addiction?

In the United States, addiction is still treated more as a crime than as a chronic illness or disorder. Until that perspective changes, treatments will not meet their full potential and will not be as effective as they could be. Addiction, or substance use disorder (SUD), is a chronic medical condition that has remissions, relapses, and genetic components.

Are Relapses Normal?

A relapse is not a failure but a symptom. The brain of a person with SUD has gone through neurobiological changes that increase the risk of relapse because the damaged reward pathways stick around much longer than the substances stay in the body. Stressful events and other painful life experiences can trigger that maladaptive coping mechanism and cause a relapse.

For other chronic illnesses we would consider a relapse to be an unfortunate symptom of the disease, and we might call it a recurrence instead of a relapse. When successfully managed, the condition is considered to be in remission. Remission is a term that is relatively new in addition treatment; substance use disorder was not always believed to be a disease but rather a moral failing and a problem of willpower. We now understand that addiction is a chronic medical condition and that remission is the goal of treatment. Remission, as defined by the American Society of Addiction Medicine, is “a state of wellness where there is an abatement of signs and symptoms that characterize active addiction.”

What Is Successful Addiction Treatment?

Let’s take a look at what it means to have an effective treatment outcome in terms of addiction. The primary goal is usually abstinence or at least a “clinically meaningful reduction in substance use.” To measure effectiveness, we must look at how and if treatment improves the quality of life for the patient. Improving quality of life is the aim when treating all chronic conditions that have no cure.

Evidence-based therapies do not support the notion of “hitting bottom.” As with any chronic disease, early intervention is going to provide the best outcomes.

Even more effective than early intervention is prevention because SUDs are both preventable and treatable…

Find out more about evidence-based treatment — including different therapies, holistic care, and whether 12-step programs are evidence based — in the original article What Is Evidence-Based Addiction Treatment? at The Fix.

from World of Psychology https://psychcentral.com/blog/evidence-based-addiction-treatment-explained/

Angry? Consult a Comedian

How much more grievous are the consequences of anger than the causes of it.

~Marcus Aurelius

You’ve seen them. You know them. Road-ragers, violently aggressive parents at children’s sporting events, girl-fighters on YouTube, high school students who kill, perpetrators of domestic violence.

They’re all part of the growing number of angry people in the world who are wreaking havoc with their rage at any given moment. Anger is the source of a tremendous amount of suffering, but it doesn’t have to be.

Jerry Seinfeld observed that, “All comedy comes from anger.” Humor is a means of taking charge of anger and controlling it rather than allowing it to control you. Those who are most adept in the use of humor almost always come from a place of lack of control. This is why you see so many comedians with difficult and painful childhoods, and why gallows humor is so common in the darkest and most dangerous places.

When we have no other tools to escape from overwhelming circumstances, humor acts as a way to both reframe the situation in more tolerable terms and self-soothe our pain. Humor is our final line of defense against otherwise crushing emotional and psychological pain that has the potential to destroy us.

Think about people you know who are perpetually angry. How many of them have a great sense of humor? Typically, people with uncontrolled anger issues aren’t the life of the party and will often respond to humor with anger.

They’re not more angry than seemingly fun-loving comedians and general jokesters. The difference is that comedians are highly skilled at taking control of their anger by redefining it in terms that are psychologically more tolerable and less destructive.

The truth is, we all have anger issues. Anger is a vital emotion that serves us well. There are times we need to feel it … as when witnessing the abuse of a helpless animal or responding to social injustice. But it becomes a problem when we’re letting it trigger us and control us in ways that become destructive to ourselves or others.

A gun is a great thing to have when an axe murderer is chasing you. But you don’t want to walk down the street pointing it at random innocent people, which is what those with uncontrolled anger frequently do emotionally.

The great news is, the ability to control and channel anger into humor can be learned. Responding with anger to difficult and painful circumstances is a learned behavior, and responding with humor can be as well. 

In a recent interview with Elizabeth Blair of NPR’s “Morning Edition,” comedian Sandra Bernhard said, “Anger is energy. You’ve got to be able to access that side of your psyche and be able to fully express yourself within the confines of it.”

In everyone’s life, there is some pain, struggle and anger. It’s part of being human. But most of us recognize that it is socially unacceptable to express anger openly, so we do our best to keep it under wraps and not let others see that very natural, but unpleasant, side of ourselves.

This is why there’s an audience for jokes about painful and anger-inducing topics. We all need to soothe that pain and find a way to release it. Harnessing the energy of anger to squeeze laughter out of our woes is a skill we would all do well to learn from Nature’s greatest therapists — comedians.

Comedians demonstrate for us the skill of controlling what would otherwise control … and potentially destroy … us. This is a reason those in power and those who wish to oppress others fear humor

Article III, Section 2 of the 1941 legal code in Nazi Germany (the Reichsgesetzblatt I) made anti-Nazi humor punishable by death. Why would a man as powerful as Hitler feel so threatened by the joke of a commoner? Because he knew that humor had the power to reverse control. If someone’s laughing at him, no matter how lowly that person, he no longer has control of that person’s mind. That person has taken the reins.

This is true under all circumstances, not just under oppressive regimes. We all have the power to take control and channel the energy of anger and pain into something that serves us and lifts us above all that threatens to harm or destroy us. We simply need to recognize that power and take those reins … and go to more comedy shows.

HUMOROUS BOOKS FOR THE ANGRY

• Diary of a Mad Fat Girl, by Stephanie McAfee
• The 7 ½ Habits of Highly Humorous People, by David M. Jacobson, MSW, LCSW
• Mama, Get the Hammer! There’s a Fly on Papa’s Head!: Using Humor to Flatten Out Your Pain, by Barbara Johnson
• The Comic Toolbox: How to Be Funny Even If You’re Not, by John Vorhaus
• Diary of an Emotional Idiot: A Novel, by Maggie Estep

from World of Psychology https://psychcentral.com/blog/angry-consult-a-comedian/

Three Tips for Lasting Love

Relationships can be complicated. Yet they can be simplified and enjoyed through avoiding common mistakes. By applying the suggestions below, we can create the kind of marriage or that most of us really want — an emotionally and spiritually fulfilling one that lasts a lifetime.

Whether you’re married or single, you can foster good relationships with others by putting into practice these three tips:

Tip 1: Don’t Complain. Ask Nicely for What You Want, Instead.

When you feel like complaining to your partner about something the latter is or isn’t doing, first say nothing. Become aware of exactly what’s bothering you. You may find it helpful to take a few breaths. Maybe close your eyes briefly or relax in any way that suits you.

Before speaking, turn your complaint into a wish for specifically what you’d like your mate to do. Instead of complaining or sulking, ask kindly for just what you’d like to occur in the future. For example, don’t say, “You never bring me flowers.” Do say, “I’d love it if you’d surprise me with flowers sometimes.

Why do this? Your partner probably wants to please you. But he or she can’t read your mind. You need to say just what will make you happy.

Criticism can create distance and defensiveness. Positive, direct expression of our thoughts, feeling and needs fosters a close relationship.

Tip 2: Keep Your Agreements

We build trust by keeping agreements. Trust often breaks down because one partner thinks the other hasn’t kept an agreement. However, it often turns out that no agreement was really made. For example, if Carol tells Jim, as mentioned above, that she’d love for him to bring her flowers sometimes, and a year goes by with no flowers, she may resent him for not keeping his “agreement.” But was an agreement really made? Carol said what she wanted. But did Jim agree to give her flowers? He may have heard her request but not said he’d honor it. He may have been thinking, but not said, “Flower’s die; they’re a waste of money.” He did not agree that he would ever bring her flowers.

So, do make clear agreements. If Jim asks Carol to pick up onions at the store and Carol says, “I’ll get them tomorrow,” they’ve made a clear agreement. If she forgets to get the onions, and she has a pattern of forgetting to keeping agreements, Jim could easily stop trusting her to keep her word.

Of course, a partner’s forgetting to pick up onions isn’t likely to be a deal breaker. It’s not on the level of more emotionally charged broken agreements, such as failing to keep a partner’s secret, being unfaithful, or spending recklessly in defiance of an established budget.

But even around the small things, trust erodes when a perceived or actual agreement isn’t kept. The way to grow and maintain trust is first to make sure you make clear agreements. If things seem hazy, it make sense to ask, “Are we agreeing on this?”

None of us are perfect. Even when an agreement has been made, a circumstance may arise that prevents us from keeping it. If this happens, we’re likely to foster trust by telling the other person in advance why we can’t do what we said we’d do. For example, a partner might tell her or his mate, “I need to put in extra time at work to finish that report for my boss tomorrow, so I’m sorry that I won’t have time to pick up the onions. I’ll get them tomorrow, okay?”

So, if you want a trusting relationship, make clear agreements, and keep them. But if you can’t keep an agreement, don’t leave your partner feeling stranded. Explain your situation, and renegotiate to arrive at a new mutually acceptable agreement.

Tip 3: Marry Someone Who Can Stand You

Actress and singer Estelle Reiner, who was married to comedian Carl Reiner for 65 years, offered this sags advice: “Marry someone who can stand you at your worst.”

Many of us find it easier to notice a partner’s flaws than to recognize our own shortcomings. But it pays to be humble if we want to create a good relationship. The more we can know and accept our own limitations, the more we’ll be able to accept and overlook a partner’s foibles.

Rabbi Yosef Richards would probably agree with Mrs. Reiner. He says, “People are annoying. So find the person who annoys you the least and marry that one.”

Yes, all of us can be annoying. Of course, no one should tolerate an abusive relationship. But most annoyances are minor in the grand scheme of things. Partners can ask each other, tactfully and respectfully, to improve in a specific way. Yet, some annoying behaviors probably won’t change, such as a tendency to run late, be absent-minded, or something else. We can learn to adapt to and work around many of each other’s quirks.

It’s best to cut each other some slack about minor gripes, and to focus on what we treasure about each other.  

from World of Psychology https://psychcentral.com/blog/three-tips-for-lasting-love/

Maintaining Emotional Sobriety: Relationships in Early Recovery

Relationships make us feel good. And if we haven’t done the work to grow in the areas of emotional sobriety, we will quickly find that being in a relationship has become our new fix.

One of the trickiest things to do in recovery is practicing mindfulness and awareness after putting the dope down and learning how to stay sober. Emotional sobriety is paramount when it comes to remaining sober. I believe that if I can grow in the areas of low self-esteem, codependency, anger management, and intimate relationships, then the act of not self-medicating becomes extremely easy.

Those four areas are very important to address and work on while getting sober.

I use because I am obsessed with the desired effect. When I put the drug in me I feel better. So when I’m not feeling good about my image or who I am as a person, I want to medicate. When I’m acting out in a codependent way, I want to medicate. When I’m struggling with anger, I want to medicate. I don’t feel good; I want to feel good. Drugs help me feel great.

If it weren’t for all the consequences that come along with using, I’d be high right now.

Love Is the Drug

Let’s talk about the fourth area: relationships.

A wise man once told me that relationships would be the hardest thing I’ll ever do in recovery. Those words never rang truer in my life than the day I finally got into one. It takes work, it takes patience, it takes a whole lot of faith and trust. It takes looking inward and being mindful of many things: who I am as a person, my morals, my ability to listen and show empathy, and making sure I’m living honestly with integrity. It takes courage and many other things that only come by living a holistic recovery lifestyle. When I do these things, my relationship is very rewarding for myself and for my partner. Even through conflict, we come out stronger.

So factoring in all that, imagine being someone with low self-esteem; somebody that struggles with codependency and is quick to anger. Now imagine getting into a relationship when you haven’t grown in those three areas. On top of all that you’re still figuring out how to simply stay sober. What a beautiful recipe for disaster. It would be a miracle if you didn’t use in the end.

If I haven’t grown in those three areas, it’s safe to say that I still don’t feel good about myself. And if I don’t feel good about myself, my knee-jerk reaction is to find something to make me feel better. And if the lifestyle of a person in active addiction is codependent in nature, imagine how potentially deadly it would be to engage in an intimate relationship.

I mean, let’s be honest. Relationships make us feel good. We feel wanted, we feel important, depending on the situation we feel attractive, the endorphins are flowing, the dopamine is at an all-time high, not to mention the sex is probably amazing! Relationships make us feel good. And if we haven’t done the work to grow in the areas of emotional sobriety, we will quickly find that being in a relationship has become our new fix.

It’s intoxicating and obsessive. The desired effect is immediate. Almost sounds like using drugs. Now the term “drunk in love” isn’t such a stretch, is it?

And that’s why it’s recommended to stay out of a relationship your first year in sobriety. It’s not because sex is bad or being in love is wrong. It’s because relationships make you feel good too soon, too often. I need to give myself an opportunity to recover in all areas of my life before I can think about anyone else.

Essentially, I have replaced the drug with a person, most likely another person in recovery because those bonds are deep. And now there are two lives at stake. It’s dangerous.

I’m not trying to scare anyone away from pursuing a relationship, I’m simply saying to be mindful and aware. Assess where you’re at in your personal recovery before you start messing with someone else. Especially if they are in recovery as well.

That reminds me of a story…

Find out how GHXSTORIES got healthy enough for intimate relationships — and how he dealt with all the times he “fell in love” in the meantime — in the original article Nice to Meet You, Will You Marry Me: Life as a Newcomer in Sobriety at The Fix.

from World of Psychology https://psychcentral.com/blog/maintaining-emotional-sobriety-relationships-in-early-recovery/

25 Quotes to Foster Emotional Resilience

“I ask not for a lighter burden, but broader shoulders,” says a Jewish proverb. That is the essence of emotional resilience … broader shoulders. We can’t control what illness we are diagnosed with, what tragedies come our way, or how many disappointments we will run into in our day.

However, we can control how we face adversity of all kind: the big whoppers that feel as though they are sealing our fate and that we will never ever breathe fresh air again, and the inconveniences and frustrations that can easily put us in a bad mood every day.

Here are some pieces of wisdom from sage philosophers, authors, and shrewd people from different time periods on how to handle difficulty with grace, to recognize specks of light in the dark, and to develop the emotional resilience that will make for broad shoulders.

1. Search for the seed of good in every adversity. Master that principle and you will own a precious shield that will guard you well through all the darkest valleys you must traverse. Stars may be seen from the bottom of a deep well, when they cannot be discerned from the mountaintop. So will you learn things in adversity that you would never have discovered without trouble. There is always a seed of good. Find it and prosper. – Og Mandino

2. If I were asked to give what I consider the single most useful bit of advice for all humanity, it would be this: Expect trouble as an inevitable part of life, and when it comes, hold your head high. Look it squarely in the eye, and say, “I will be bigger than you. You cannot defeat me.” Then, repeat to yourself the most comforting words of all, “This too will pass.” – Ann Landers

3. Live to the point of tears. – Albert Camus

4. There is no coming to consciousness without pain. – C. G. Jung

5. Truly, it is in the darkness that one finds the light, so when we are in sorrow, then this light is nearest of all to us. – Meister Eckhart

6. Life can only be understood backwards, it has to be lived forwards. – Soren Kierkegaard

7. A man can only do what he can do. But if he does that each day he can sleep at night and do it again the next day. – Albert Schweitzer

8. We are healed from suffering only by experiencing it to the full. – Marcel Proust

9. Everything that happens to you is your teacher. The secret is to learn to sit at the feet of your own life and be taught by it. Everything that happens is either a blessing which is also a lesson, or a lesson which is also a blessing. – Polly Berrien Berends

10. You shall be free indeed when your days are not without a care nor your nights without a want and a grief. But rather when these things girdle your life and yet you rise above them naked and unbound. – Khalil Gibran

11.  A clay pot sitting in the sun will always be a clay pot. It has to go through the white heat of the furnace to become porcelain. – Mildred Witte Stouven

12. Turn your face to the sun and the shadows fall behind you. – Maori proverb

13. Instead of seeing the rug being pulled from under us, we can learn to dance on the shifting carpet. – Thomas Crum

14. It may be that some little root of the sacred tree still lives. Nourish it then, that it may leaf and bloom and fill with singing birds. – Black Elk

15. Life is difficult. This is a great truth, one of the greatest truths. It is a great truth because once we truly see this truth, we transcend it. Once we truly know that life is difficult – once we truly understand and accept it – then life is no longer difficult because once it is accepted, the fact that life is difficult no longer matters. – M. Scott Peck

16. Never measure the height of the mountain until you have reached the top. Then you will see how low it was. – Dag Hammarskjold

17. The weariest night, the longest day, sooner or later must perforce come to an end. – Baroness Orczy

18. We could never learn to be brave and patient if there were only joy in the world. – Helen Keller

19. Nothing we ever imagined is beyond our powers, only beyond our present self-knowledge. – Theodore Roszak

20. Believe there is a great power silently working all things for good, behave yourself, and never mind the rest. – Beatrix Potter

21. All we are asked to bear we can bear. That is a law of the spiritual life. The only hindrance to the working of this law, as of all benign laws, is fear. – Elizabeth Goudge

22. I know not all that may be coming, but be it what it will, I’ll go to it laughing. – Herman Melville

23. I am not afraid of storms, for I am learning to sail my ship. – Louisa May Alcott

24. He who has a why to live can bear almost any how. – Friedrich Nietzsche

25. Fall seven times; stand up eight. – Japanese proverb

from World of Psychology https://psychcentral.com/blog/25-quotes-to-foster-emotional-resilience/

Psychology Around the Net: April 27, 2019

This week’s Psychology Around the Net takes a look at the safety of your personal information when mental health apps are involved, expert keys to success and happiness, how dentists can become a first line of defense against domestic violence, and more.

Are You Using Mental Health Apps? They Might Be Sharing Your Data: According to a study published in the JAMA Network Open, your privacy might not be entirely safe with mental health apps. A cross-sectional study of 36 top-ranking apps for depression and smoking cessation, 29 apps shared data for analytics or advertising for Google or Facebook but only a few of them accurately disclosed their data-sharing practices in a privacy policy.

Profound Experiences Linked to Mental Health Benefits: John Hopkins researchers report that after surveying thousands of people who claim to have had a personal encounter with God or an “ultimate reality” (whether spontaneous or while under the influence of psychedelics) they’ve found that a majority of participants attribute positive changes to their psychological well-being — such as increased life purpose, meaning, and satisfaction — to that encounter.

To Understand Political Behavior, Look at How Kids Think: A complete understanding of political behavior must include the beliefs that people find intuitive, and developmental psychology can help with that.

Study Exposes Reasons Behind Poor Mental Health in Bisexual People: A new study out of Australia’s La Trobe University (the largest of its kind to date) examined the reasons bisexual people experience higher rates of psychological distress than heterosexual and homosexual people experience and found significant links between poor mental health and bisexual people who perceive their sexuality as wrong; are in heterosexual relationships; and/or think their partner’s understanding or support of their sexuality is low.

Richard Branson’s 8 Keys Happiness and Success: Probably the first thing that comes to mind when you think of Richard Branson is his wild entrepreneurial success; of course, this is followed closely by how happy he seems to be all the time. Here are eight work and lifestyle practices the multibillionaire follows — and you can follow, too — to achieve both happiness and success without sacrificing one or the other.

Dentists Can Be the First Line of Defense Against Domestic Violence: New findings report that as much as 75% of trauma to the neck and head as a result of domestic violence occurs with oral injuries, suggesting these oral biomarkers could help identify domestic violence victims.

from World of Psychology https://psychcentral.com/blog/psychology-around-the-net-april-27-2019/

Guideposts for Surviving a Loved One’s Suicide

We don’t have conversations about the power and beauty of this crucible in our culture, as we tend to squash down negative feelings and push ourselves to get back to work.

That moment. The heartbreaking, life-altering moment that you find out someone you love has taken their own life is one you will never forget. Twice in the last month, I’ve had friends experience that moment. I lived through that moment five years ago, and have been forever changed by it.

Suicide has been in the news lately, and seemingly on the rise— especially for young people. The CDC found in 2016 that it was the second leading cause of death for individuals age 10-34, and the fourth leading cause of death for ages 35-54. While the suicides of high-profile individuals such as Robin Williams, Kate Spade, and Anthony Bourdain make the headlines, it is when someone we love takes their life that we become eternally bound to the reality of what that means.

Sarah Neustadter, a clinical and spiritual psychologist based in Los Angeles, lived through the suicide of her soul mate at twenty-nine. She chronicles her survival mechanism — writing emails to him — in her book Love you Like the Sky. As a personal journey, she shares her emotional writings to him and then lends her perspective and guidance as someone who counsels those who have lived through the unthinkable reality of a loved one taking their own life.

Neustadter offers three phases as guideposts for those surviving the trauma of a loved one’s suicide:

1. Despair. When the reality of what has happened hits you, and you feel shaken to your core, the level of devastation is unfathomable. Neustadter writes, “Surviving suicide is qualitatively different than other kinds of grief and loss. It’s a specific brand of darkness and terror that is all-encompassing and blinding.” This place I know. The level of shock and pain is beyond what can be imagined. In this place, Neustadter suggests three important steps to take as you sit with your pain and despair: gather community support, (and allow them to hold you), resist suicidal urges, (you do not need to pass the pain on to your loved ones), and seek therapy. Therapy will help if you can find someone who is a trained grief or trauma specialist.
2. Shifting. After my father’s suicide, I was haunted by guilt and regret. I wished I could have done more to help him, to find a way to help him through his anguish. Neustadter insists that “you are not responsible for your beloved’s suicide.” She advises using your anger as you move through your grief. I found that being active and present with both my grief and my anger allowed those emotions to move through me, and on some level I would feel cleansed of one more layer. Another aspect to shifting that Newstadter writes about is around how we consider life after death. A few months after my father’s suicide, I was walking up a stream, surrounded by lush vegetation. I was thinking of my dad, and I felt this incredible wave of love surrounding me. It was such a powerful sensation, and I was moved to tears as I realized some part of him was still with me.
3. Beauty. As you process through the cycles of emotions, you become transformed at a profound level. There is a point where the light begins to again fill your life. You will never again be the person you were before, but you can emerge through to the other side. Neustadter writes about practices that remind us to fully inhabit our aliveness: take time to be in nature, meditate, engage in the magic moments each day has to offer, embrace being alive, and cultivate connections to the important people in your life. We get to embrace our life, even as we realize how fleeting and ephemeral it is.

It takes time to heal from this kind of trauma. My healing has transformed me in ways I could not have imagined. Even five years later, I still have moments where the veil lifts, and I feel the well of sadness that still stirs in my heart. Now though, it is also filled with the light of healing, and the absolute knowing of unbound love. I asked Neustadter how we can sit with the immensity of it, in all of the raw emotion, and she offered this:

There’s a sacredness and a power that needs to be honored in the grieving process. Our feelings of despair and broken heartedness need to be fully felt in order for them to shift into something new that emerges from grief. We don’t have conversations about the power and beauty of this crucible in our culture, as we tend to squash down negative feelings and push ourselves to get back to work. It’s quite difficult and unbearable to be with the pain. Yet, our capacity to be with our pain is where our strength comes from and ultimately reveals a capacity for deep joy on the other side of grief. Taking time to cry, mourn, and heal by yourself and with others in community is crucial, and spiritual work.

Let yourself be present as you move through the “power and beauty of this crucible.” We would never choose it, but when it chooses us, our only way to move through it is to be with it.

This post courtesy of Spirituality & Health.

from World of Psychology https://psychcentral.com/blog/guideposts-for-surviving-a-loved-ones-suicide/