Termination of Treatment and/or Recovery

September 29, 2014

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By Terence T, Gorski
Author

The blog will briefly address three questions:

1. Are addiction and recovery the same thing?

2. Is it appropriate to think in terms of “treatment termination?”

3. Is is appropriate to think in terms of “recovery termination.”

I believe that there is compelling evidence that chemical addiction is a chronic lifestyle-related illness similar to diabetes or heart disease. Once the disease is activated it can be effectively managed and move in and out of remission.

It is important to make a distinction between treatment and recovery. Treatment is a set of specific interventions provided by trained professionals to manage acute symptom episodes. It is appropriate to initiate and terminate treatment based upon the symptoms the person is experiencing. Recovery is the day-to-day lifestyle management, often support by a nonprofessional support group, that is needed to promote sobriety and overall health and avoiding relapse and stopping relapse quickly should it occur.

As a result episodes of treatment can be initiated and terminated as determined by active symptoms. Since the chronic disease of addiction will need lifestyle management for life, the idea of termination of a recovery lifestyle would be in appropriate. The Recivery program, will need to be modified as a person moves through different stages of recovery, the progressive stages of life development, and changes in the environment caused by major life change.
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Gorski’s Blog: www.terrygorki.com

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Exploring Recovery and Relapse

September 29, 2014

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By Terence T. Gorski,
Author

People learn almost everything as a result of trial and error. We decide we want to do something, get some training or instruction, and then give it a try. Most people, even professionals, collect a large tally of failures before they succeed.

This is also some true in learning how to manage chromic life-style diseases. Addiction, of course, is a lifestyle-related disease with similar rates of recovery and relapse.

Let’s explore recovery from addiction as a learning process.

People learn that they are addicted though periods of loss of control and attempts to control drinking. These failures to control prompt people to attempt abstinence, usually without professional or 12-Step Help. Some of these people make it into long-term recovery but I have no current numbers.

Most people, however, find that abstinence without recovery/treatment causes a progressive build-up of unnecessary pain and problems that impairs judgment and self/control and start using again. Does this constitute a relapse episode or a continuation of untreated addiction? There is no professional consensus.

Many people who fail to staying sober without help. Most end up at AA or another’s 12-Step Program

AA surveys of membership show that:
1. 48% stay sober.
more the five ears.
2. 22% 1- 5 years.
3. 30% less than a year.
4. Average Sobriety if most members is more than 7 years

Having a sponsor increases the recovery of 77% and consistently attending a home group meeting raises it to 88%.

Many 61% of recovering people receive help before starting AA and 74% say they were directed to AA by a treatment provider.

64% received some type of treatment or counseling such as medical, psychological, spiritual, etc. 85% of those who sought Professsional treatment after starting AA said that it played an important part of their recovery. (www.soberrecovery.com)

Studies that follow people who complete treatment for 20 to 40 years after treatment shows that people fall into three groups of life-long recovery:

1. Recovery Prone (they do no have an alcohol or drug relapse episode)

2. Transitionally Relapse Prone (they have one to five relapse episodes but then achieve long-term recovery). These persons seem to learn something new from each Relapse Episode and appropriately change their recovery program to accommodate what they learned.

3. Chronically Relapse Probe who continue to periodically relapse although many do achieve longer periods of higher quality abstinence over time while others have progressively more frequent, longer, and more severe consequence from relapses episodes leading to progressive decline and eventual death from addiction or related problems.

There is evidence that Relapse Early Intervention Plans can shorten the duration of a relapse and lower its consequences making it easier to get back into recovery.

Relapse Prevention methods that focus upon learning the skills needed to identify and manage early relapse warning signs can increase recovery rates and decrease relapse rates.

Chronically relapse prone patients often have coexisting disorders such as depression or other affective disorders and have a problematic profile of socio-economic problems including child abuse.

Poly-drug addiction, new and more addictive medications, and the fact more people are offered medication as a substitute for addiction counseling and other forms of psychotherapy makes relapse more likely.

I know of no treatment that produces anywhere near 100% abstinent. Addiction is a chronic lifestyle-rated Illness that changed many times over the course of a lifetime.

Relapse does not mean treatment failure. Many people relapse and learn important lessons that lead to the achieving long-term recovery.

Composite studies of relapse and recovery rates cannot be trusted because their is no universally-recognized standard for when recovery begins, what constitutes recovery (if you don’t drink but commit suicide is that successful addiction recovery?) and what constitutes relapse (caffeine and nicotine are drugs. Does using them mean you relapsed?)

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Are Athletes Arrested More Than Others?

September 15, 2014

Arrest Rate Among Athletes

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MINNEAPOLIS (WCCO) – The arrest of a Minnesota Vikings player over the weekend for domestic assault brought the team into the lead of a very dubious category: most arrests of any team in the NFL over the past 11 years. But do professional athletes get arrested more than the rest of us?

Chris Cook’s arrest for felony domestic assault over the weekend, brought the number of Minnesota Vikings players arrested since 2000 up to 36, according to the database created by the San Diego Union-Tribune. Cincinnati follows with 35, Denver has 32 arrests, and Tennesse has 30.

Considering NFL teams are allowed to carry a roster of 53 players, that brings the Vikings average over that time period to about 1 in 15 players ending up arrested.

“These are males trained to be aggressive, they have higher levels of testosterone,” said John Tauer, head coach of the University of St. Thomas basketball team. He is also a professor of social psychology.

“Part of it is thinking, I won’t get caught, there won’t be consequences for this,” he said.

Since 2000, the San Diego Union Tribune has found 573 NFL players arrested for things bigger than speeding. That’s an arrest rate of 1 in every 45 players.

“That certainly seems high, but if you contrast with overall public, you see the picture’s a little more murky,” Tauer said.

Indeed, according to the FBI, the national arrest rate in 2009, for all arrests, is 1 in 23.

So even though you see all of the mug shots of NFL players arrested, the general public gets arrested at a higher rate than pro football players.

“Anytime a NFL player gets arrested, you’re going to hear about that story, you aren’t going to hear about it the other times someone gets arrested,” Tauer said.

When you compare DUI arrests, it’s almost identical. In the NFL, one in 144 is arrested on suspicion of DUI. The national rate is 1 in 135.

According to an infographic on sports crime rates, in 2010, Major League Baseball players were arrested 16 times for major crimes like drug offenses and violent crimes. 34 pro football players were arrested for those offenses, which puts football and baseball at a similar rate of arrest (there are twice as many NFL players than MLB players). The NBA is the smallest league, and with 23 arrests, that puts their arrest rate at the top, at least for 2010.

http://minnesota.cbslocal.com/2011/10/24/do-athletes-get-arrested-more-than-other-people/


Desiderata

September 15, 2014

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By Max Ehrmann

Go placidly amid the noise and haste, and remember what peace there may be in silence.

As far as possible without surrender be on good terms with all persons.

Speak your truth quietly and clearly; and listen to others, even the dull and ignorant; they too have their story.

Avoid loud and aggressive persons, they are vexations to the spirit.

If you compare yourself with others, you may become vain and bitter;
for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans.

Keep interested in your career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs; for the world is full of trickery.
But let this not blind you to what virtue there is; many persons strive for high ideals; and everywhere life is full of heroism.

Be yourself.
Especially, do not feign affection.
Neither be critical about love; for in the face of all aridity and disenchantment it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings.
Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself.

You are a child of the universe, no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be,
and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul.
With all its sham, drudgery and broken dreams, it is still a beautiful world. Be careful. Strive to be happy.

© Max Ehrmann 1927


People and Defining Ourselves

September 8, 2014

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By Terence T. Gorski , author
September 8, 2014

People pass in and out of our lives. Some touch us and others are distance shadows. Some touch us gently and with love. The touch of others is harsh and painful, perhaps even cruel and brutal.

Some people pass through our lives quickly and are suddenly gone. Others stay for a long while.

Some people leave us when we need them most. We can also leave others when they need us most. Fortunately, ther are many time we are there for each other at just the right moments when we need them most.

Every one of these people influence us. It makes no difference how they come into our lives, how long they stay, or the way we touch each other while we are together. It matters little how or why they move in and out of our lives. It just matters that they show up, are there for awhile, and then move on They they influence us — that is what counts.

They shape us in ways both subtle and profound. Even the distant shadows of those we never meet ice as specters at the edge of our consciousness.

There is one thing, however, that they cannot do — they cannot define us. Whether we know it or not we all define ourselves. We do this by choosing what we believe about those who pass through our lives — and more importantly what we choose to believe about our selves.

That choice is ours, but only a precious few of us know and believe that we have this incredible power. The rest of us live the big lie that we are victims of a world too big and complicated to understand and of other people who are too strong, or smart, or important to stand against.

The truth is tat even in victory, we can decide that we are victims; and even in the midst of our greatest of defeats we can decide we are are survivors, or heroes, or even winners.

In the end the choice is ours — and the way we define ourselves may be the most important choice we ever make.

In the end we will all stand alone gazing into the sunset of our lives contemplating the story we have written by the choices that we made. Hopefully we will have grown to the pony where we see that it is what it is; we did what we did; and somehow it is all OK.

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Ketamine

September 7, 2014

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http://www.thegooddrugsguide.com/ketamine/index.htm

Ketamine is an anesthetic drug used in human and veterinary medicine, usually in combination with some other sedative drug. It is used for the induction and maintenance of general anesthesia. The person or animal is usually unconscious during the period of anesthesia and has no memory of what happened during that time.

Ketamine was developed by Parke-Davis in 1962 and started to be used as a recreational drug because it produced a pleasant dissociative state, characterized by a sense of detachment from one’s physical body. As a result Ketamine gained the reputation as a drug that would let you get away from your pain and problems.

Ketamine is a fast-acting ‘dissociative anesthetic.’ Rather than blocking pain like traditional painkillers, it shuts off the brain from the body. With the brain no longer processing information from nerve pathways, awareness expands resulting in a hallucinogenic state.

On the street Ketamine is also known as Special K, K, or Ket. It comes in a clear liquid and a white or off-white powder. It can be injected, mixed in a drink, or combined with tobacco or marijuana and smoked.

Ketamine makes users feel disassociated or disconnected from their bodies and can cause hallucinations. The user may feel sleepy or sluggish, or confused and clumsy. They may babble, appear drunk, or have trouble remembering who they are.

Ketamine started to be used as a date rape drug because it is clear and virtually tasteless. This makes it easy to slip into someone’s drink, causing them to become disoriented, confused, dissociated, and compliant. They are suggestible, confused, and easily manipulated.

The victim is usually compliant, suggestible, and shows no overt resistance. As a result they can be easily led into a private setting and usually do not resist whatever is done to them. When given in a sufficient dose the victim has no memory of what happened. On the street this period of dissociated amnesia is called “being stuck in the K hole.”

As with any drug purchased illegally, you don’t know what you are getting when you buy ketamine. The Exact dose of the Ketamine is unknown and it may be mixed or laced what other substances. In short, you really don’t know what you are buying or using. You don’t know how much of the drug you are ingesting and that can be dangerous or even lethal.

Since ketamine is an anesthetic, there is a risk of vomiting associated with its use. Eating or drinking before taking the drug increases the risk of choking on one’s own vomit.

Ketamine affects the central nervous system, and can reduce the amount of oxygen getting to the brain and other vital organs. With repeated use this can cause cognitive impairment and set the stage for a variety of medical complications.

Ketamine is an addictive drug which means that with frequent us tolerance, the need to use more to get the same effect, and dependence, getting trapped in a pattern of out-of-control compulsive use can occur.

It is possible to overdose because high doses of ketamine slow down a person’s breathing. It can cause the user to lose consciousness, and in some cases, may be fatal. If any signs of a potential overdose occurs 911 should be called.

Most people who overdose are addicted users who have developed tolerance. So Once the emergency is stabilized, a referral for addiction assessment and treatment is usually appropriate.

Taking ketamine with other “downers,” like alcohol or heroin, only increases the drug’s sedative effects and increases the risk of slowing or shutting down the central nervous system.

Most drug tests don’t specifically look for ketamine, but it can be detected in urine for two to four days after use.

Detox for ketamine addiction is more emotionally than physically painful and should be supervised by trained personnel.

In the United States, it is illegal to possess ketamine unless you are a licensed medical practitioner or have a prescription. Under U.K. law, ketamine is a Class C drug, which means it is illegal to possess or use it.

Medical Uses

Since 1970, it has been popular in medicine in the UK and US and all over the world as a safe anesthetic for children and the elderly. Doctors in the Emergency Room may use K for certain procedures, including intubating youngsters.

Special K is also used as a sedative for patients in the Intensive Care ward of the hospital and to treat bronchial spasms. It is also used by vets on animals for short operations, hence it being dubbed a “horse tranquilizer.”

People Who Abuse Ketamine

Ketamine users tend to be teenagers and young adults. This drug may be bought at dance clubs and raves. According to a survey conducted by the University of Michigan’s Monitoring the Future Survey, approximately three percent of high school students had tried K at some point.

Street prices vary, depending on the dealer involved, the quality of the product and the geographic area involved. In some cases, ketamine can be bought for as little as $10 per gram, although some dealers charge between $20-$50 per gram of the drug at parties and special events.

Ketamine comes in three main forms:
– powder,
– tablet and
– liquid.

The most common form is white powder which is snorted. It looks like cocaine but is smoother and less likely to form hard rocks or a flowery texture if damp.

Most users start out by taking Ketamine in powdered form as it allows them to introduce themselves to the drug with small amounts. When ketamine is being ingested
in this way, the dosage ranges from 15-200 mg.

Ketamine in tablet or capsule form often masquerades as a brand of Ecstasy.

Ketamine pills are usually very diluted and cut with a stimulant like ephedrine (a natural amphetamine-like chemical) to produce a mildly trippy speedy effect.

Ketamine in Liquid Form is known as Ketamine Hydrochloride and is intended for use as a hospital anesthetic. It is sold in liquid form in small 10 ml bottles, often with the brand names Ketaset, Ketavet and Ketalar.

It is dangerous to inject liquid liquid Ketamine into a muscle because many people pass out immediately.

It is also dangerous to drink liquid ketamine because is irritates the stomach lining and can cause severe nausea and profuse vomiting. Since it is fast acting, the used can pass out, you may choke on their own vomit.

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Include and Transcend: An Evolutionary Clinical Model

September 4, 2014

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By Terence T. Gorski, Author

The goal of devoloping a clinical model that will stand the test if time is to clearly define its core clinical principles in a way that encourages new and creative ways to bring those principles to life in the real world of clinical practice.

THE GORSKI-CENAPS Model has stood the test of time because it includes a broad foundation of evidence-based core principles and practices and organizes them in a way that transcends old and more limiting principles and practices. In this blog, I want to explore the clinical models that have been integrated and systematically applied to the treatment of addiction.

The Theoretical Models

There are three primary theoretical models upon which the GORSKI-CENAPS model is constructed. These are: 

  • The Biopsychosocial Model of Substance Use Disorders, 
  • The Development Model of Recovery, and 
  • The Relapse Prevention Model. 

 Each of these components is built upon a solid foundation of research studies.
The Biopsychosocial Model 

 The Biopsychosocial Model of Addiction is based upon an integration of four science-based models of addiction: 

  • Neuropsychological Predisposition Model;
  • Neuropsychological Response Model;
  • The Social Learning Model; and 
  • The Cognitive Therapy Model of Substance Abuse. 

 The components of these models have been translated into simple language and carefully integrated for consistency. The basic research-based components of these models will be briefly explained so their application with the GORSKI-CENAPS Model can be easily recognized.
1. Neuropsychological Predisposition Model[2]: 

 The Neuropsychological Predisposition Model describes the preexisting brain and central nervous system problems that increase the risk of becoming addicted. These predisposing neuropsychological risk factors may be related to genetically inherited traits, brain dysfunction caused by improper prenatal care, the effects of prenatal alcohol or drug use, physical neglect (the absence of touching, rocking, and responsive loving human interaction) or abuse in early infancy, severe psychological trauma experienced at different points in childhood and adolescent development.

These preexisting neuropsychological problems make people more vulnerable or susceptible to abuse and addiction to alcohol and other drugs and make them susceptible (i.e. less resistant) to the damaging effects of alcohol and drugs to the brain. These preexisting problems are usually exacerbated by alcohol and drug use and interfere with efforts to stop drinking and using drugs.

These predisposing neuropsychological problems are:

  1.  The tendency to have severe mood swings, 
  2. Fifficulty in concentrating, 
  3. Difficulty persisting in tasks through completion, 
  4. Impulse control problems, 
  5. The tendency to be hyperactive and irritable, and 
  6. Cognitive impairments that interfere with self-awareness, awareness of the immediate environment, abstract reasoning, problem solving, learning from past experiences, and the logical consequences of current behavior to anticipate and avoid future problems.

The early research basis of this neurobehavioral model was the analysis of 139 supportive scientific studies (Tarter et al 1988) [3]

2. Neuropsychological Response Model of Addiction[4]: 

The Neuropsychological Response Model describes the primary reactions of the brain and nervous system to the ingestion of alcohol and drugs that motivate people to keep using in progressively greater amounts and to have difficulty stopping even after serious problems develop.

People start drinking and using drugs as a result of personal curiosity motivated by social pressure to use alcohol or drugs and the availability of these substances.

Neurobiological Reinforcement: People at high risk of addiction experience neurobiological reinforcement when they use alcohol or other drugs because the substances activate brain chemistry responses that cause a state of euphoria that is experienced as a unique sense of pleasure and well being. This feeling of euphoria acts as a positive reinforcement that motivates people to keep using alcohol or other drugs.

Tolerance: People at high risk of addiction develop tolerance when they start using alcohol and other drugs regularly and heavily. Tolerance occurs as neurochemical processes in the brain adapt to the presence of alcohol and drugs in a way that allows people to feel and function normally when using. This means they need to use progressively larger amounts of alcohol and drugs In order to experience the desired euphoric response. The combination of neurobiological reinforcement and tolerance motivates people to use progressively larger amounts of alcohol and drugs more and more frequently.

Physical Dependence: When people at high risk of addiction use alcohol and drugs frequently and heavily they develop physical dependence. This is because their brain requires certain amounts of alcohol or drugs to function normally. If the amount of alcohol and drugs needed for normal functioning is not provided, they experience withdrawal symptoms caused by brain chemistry imbalances that make it difficult to function normally and creates a state of emotional distress. There are two distinct withdrawal syndromes: acute withdrawal which occurs immediately after the cessation of alcohol and drug use; and post acute withdrawal which persists for a prolonged period of time after the cessation of alcohol and drug use. Alcohol and drug withdrawal motivates people to start using alcohol and drugs when they try to stop. Acute withdrawal produces immediate and severe symptoms prompting a return to substance use within hours or days of attempting to stop. Post acute withdrawal produces a chronic state of low grade agitated depression accompanied by difficulty in thinking clearly, a tendency to swing between episodes of emotional overreaction and emotional numbness, difficulties with impulse control, and problems with self-motivation. These symptoms become more severe during periods of high stress. Post Acute Withdrawal motivates people to start using alcohol and drugs during periods of high stress after the acute withdrawal has subsided.

Progressive Brain Dysfunction: People who become addicted develop progressive brain dysfunction that can become so severe that it meets the criteria of a substance-induced organic mental disorder. This severe brain dysfunction creates an inability to meet major life responsibilities and in its severe form disrupts the ability to perform normal acts of daily living.

The early research basis of this neurobiological model was the analysis of 160 supportive scientific studies (Tabakoff & Hoffman 1988) [5]

Social Learning Model: The social learning model is based upon extensive evidence that the development of addiction to alcohol and other drugs is related to a complex interaction among a variety of personal, interpersonal, and environmental factors that motivate people to use alcohol and drugs to cope with a wide variety of experiences. These factors and their relationship can be summarized as follows:

Vicarious Learning: People learn a set of self-regulatory responses to alcohol and drugs by observing people and events around them. These self-regulatory responses are initially learned in childhood and are either reinforced or challenged as a result of critical developmental and other life experiences. These self-regulatory responses include:

  • Beliefs about alcohol and drug use
  • Behavioral skills for acquiring and using alcohol and drugs
  • Self-monitoring skills for observing drinking and drugging behavior
  • Judgmental skills for evaluating the benefits and disadvantages associated with alcohol and drug use,
  • Self-rewarding behaviors that are used when their alcohol and drug use conforms with their beliefs and values
  • Self-punishing behaviors that are used when their alcohol and drug use does not conform to their beliefs and coping skills for dealing with the consequences of alcohol and drug use.


Personal Experience with Alcohol and Drug Use:
The person has initial experiences with alcohol and drugs, uses the learned self-regulatory responses, and develops a set of positive memories associated with alcohol and drug use.

Positive Expectancy: The person develops the belief that the use of alcohol and drugs will produce positive or reinforcing outcomes and comes to anticipate and expect these outcomes.

Conditioned Craving: Specific experiences or sensory triggers become associated with the reinforcing effects of alcohol and drugs and when experienced they activate a craving or urge to use alcohol and drugs.

Adaptation of Self-regulatory Processes: The people slowly adapt their self-regulatory responses in order to maximize positive reinforcement and minimize negative reinforcement. This involves the development of distorted perceptions and irrational ways of thinking that support a positive belief about alcohol and drug use in spite of the presence of progressive, more severe adverse consequences.

Self-Reinforcing Addiction Cycle: The development of a self-reinforcing addiction cycle that locks the person into a pattern of progressively more dysfunctional cognitions and behaviors.

The early research basis of this social learning model was the analysis of 111 supportive scientific studies (Wilson 1988) [6]

Cognitive Therapy of Substance Abuse: The GORSKI-CENAPS® Model is fully consistent with cognitive therapy principles for substance abuse treatment (Beck et al 1993[7]; Ellis et al 1988[8] ). The Cognitive Model of substance abuse is based upon the observation that substance abusers develop a set of irrational beliefs that support their ongoing use of alcohol and drugs while blocking out or minimizing the importance of problems caused by their use. Treatment is based upon establishing a collaborative relationship with the client and helping them to identify and challenge these basic addictive beliefs.

Aaron Beck provides 239 scientific references that support the Cognitive Therapy Model of Substance Abuse Treatment. Albert Ellis provides 139 scientific references that support the application of Rational Emotive Therapy (RET) to the treatment of substance abusers.

The features of these four models were translated into common language and integrated into general framework of the earlier phenomenologically developed Model to provide the basic form and structure of the current GORSKI-CENAPS® Model. The model was later updated to assure it’s consistency with a more recent biopsychosocial analysis of addiction.

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