Personality Styles: Top Dog, Underdog, Self-Protector

December 16, 2013

By Terence T. Gorski
February 11, 1992

Self-defeating personality styles are composed of habitual ways of thinking, feeling, acting, and relating to others that creates unnecessary pain and problems in our lives.

People who were raised in dysfunctional or addictive families tend to develop one of two general styles of self-defeating personality
– The Top Dog Style,
– The Under Dog Style.

These two styles can combine to create more complex styles:

Unable To Function (“I must freeze!”): Some of us have such severe trauma at the start of our recovery that we are unable to function normally or to maintain a consistent personality style. We are under so much stress that we feel like we are falling apart. With recovery, we begin to stabilize and one of the following personality styles will emerge.

Top Dog Personality Style – The Victimizer: The Victimizer is a person who exaggerates his or her strength. They want everyone to be afraid of them. They believe that they must fight every one in order to survive. The Top Dog personality style is based upon the belief “I must be strong and can never admit to or show weakness.”

Many of us develop this personality style as a result of our abuse. We have been so abused we decide “never again!” We make a commitment to ourselves that we will never let anyone abuse us ever again. Unfortunately many of us are locked into a mistaken belief system. We believe that we have only two choices – to be a victim or a victimizer: We can be a victim and get hurt, or we can defend ourselves by becoming a victimizer and hurting others. To keep from getting hurt we start hurting others and become a perpetrator and do to others exactly what was done to us.

The Under Dog Style – The Victim: Victim exaggerate weakness and by doing so set themselves up to be controlled and victimized by others. They believe that if they ever try to fight back they will be destroyed, so the only way to protect themselves in to lay down and play dead and pretend to be helpless whenever they feel threatened.

The Under Dog Style is based upon the belief that “I must be weak and can never show strength or directly assert myself or I will be attacked and victimized again!” Those of us who use this style have decided to protect ourselves from the abuse of others by convincing them that we are so weak and helpless that we won’t be a threat.

Under Dogs often attempt to find protection by aligning themselves with a strong powerful caregiver who will protect them from others. The problem is that this powerful protectors usually demands a payment for the protection they provide. This powerful protector usually demands the right to victimize the people they protect in exchange for protecting us from the victimization of others other more viscous victimizers.

Switching Styles: Some people switch between the Top Dog Style and the Under Dog style dependent upon who they are with and what they are doing. I have met many people who are vicious top dogs at work, and revert to a victimized Under Dog in their intimate relationships.

Which personality style they use depends upon who they are interacting with, the social role they are playing, and what they are doing or expected to do in the moment.

The Goal of Recovery – Becoming A Healthy Self-Protector

We become a healthy self-protector when we develop the skills to take care of ourselves and those that we love in a healthy and responsible way. We know that we can protect ourselves without hurting others! The personality of the healthy self-protector is based upon the belief that “I can take car of myself without hurting others!”.

When we use this personality style we can keep ourselves safe without victimizing someone else or setting ourselves up to be a victim. Learning to consistently use this personality style is the ultimate goal of recovery.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

The model of using Top Dog – Under Dog personality styles is a starting point. As recovering people get more skilled in recognizing when the Top Dog Under Dog traits in themselves and others. Richer and more helpful ways of understanding can be brought into the process.

The next model that I often move to is The Carpman Triangle which has three roles:

The Persecutor, which is similar to the Top Dog;
The Victim, which is similar to the Under Dog; and
The Rescuer, a version of the Top Dog who protects Victims by attacking the Persecutor.

In a future blog, I will explain the Persecutor-Victim-Rescuer Triangle in more detail.

GORSKI BOOKS: www.relapse.org


Recovery: SAMHSA’s Working Definition

October 15, 2013

SAMHSA’s Working Definition of Recovery  encompasses both mental disorders and/or substance use disorders. This will be a foundational definition for recovery as defined by the Affordable Health Care Act.

You can compare this with GORSKI’S WORKING DEFINITION OF RECOVERY

The Substance Abuse and Mental Health Services (SAMHSA)recognizes there are many different pathways to recovery and each individual determines his or her own way. SAMHSA engaged in a dialogue with consumers,persons in recovery, family members, advocates, policy-makers, administrators,providers, and others to develop the following definition and   for recovery.  The urgency of health reform compels SAMHSA to define recovery and to promote the availability, quality, and financing   services and supports that facilitate recovery for individuals.  In addition, the integration mandate in title II of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., 527 U.S.581 (1999) provide legal requirements that are consistent with SAMHSA’s mission to promote a high-quality and satisfying life in the community for  all Americans.

Recovery from Mental Disorders and/or Substance Use Disorders:  A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:

•      Health:  overcoming or managing one’sdisease(s) or symptoms—for example, abstaining from use of alcohol,  , and non-prescribed medications if one has an addiction problem—and foreveryone in recovery, making informed, healthy choices that support physical and emotional wellbeing.

•      Home:  a stable and safe place to live;

•      Purpose: meaningful daily activities, such as a job, school, volunteerism,  family care taking, or creative endeavors, and the independence, income and resources to participate in society; and

•      Community: relationships and social networks that provide support, friendship, love,and hope.

 Guiding Principles of Recovery

Recovery emerges from hope:  The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.  Hope is internalized and can be fostered by peers, families, providers, allies, and others.  Hope is the catalyst of the recovery process.

Recovery is person-driven:  Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives. 

Recovery occurs via many pathways:  Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds including trauma experiences that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities,strengths, talents, coping abilities, resources, and inherent value of each individual.  Recovery pathways are highly personalized.  They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches.  Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks.  Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions.  Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.

 Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit,and community.  This includes addressing: self-care practices, family, housing, employment, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care,complementary and alternative services, faith, spirituality, creativity, social networks, transportation, and community participation.  The array of services and supports available should be integrated and coordinated.

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helpsone’s self.  Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths.  While peers and allies play an important role for many in recovery,their role for children and youth may be slightly different.  Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.  Family members, peers, providers,faith groups, community members, and other allies form vital support networks.Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend,student, employee) that lead to a greater sense of belonging, personhood,empowerment, autonomy, social inclusion, and community participation. 

Recovery is culturally based and influenced: Culture and cultural background in all of its diverse representations including values,traditions, and beliefs are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned,sensitive, congruent, and competent, as well as personalized to meet each individual’sunique needs.

Recovery is supported by addressing trauma:  The experience of trauma (such as physical or sexual abuse, domestic violence, war,disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues.  Services and supports should be trauma-informed to foster safety (physical and emotional)and trust, as well as promote choice, empowerment, and collaboration.

Recovery involves individual, family, and community strengths and responsibility:  Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery.  Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.

Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.  There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.

SAMHSA has developed this working definition of recovery to help policy makers, providers, funders, peers/consumers, and others design,measure, and reimburse for integrated and holistic services and supports to more effectively meet the individualized needs of those served.

Many advances have been made to promote recovery concepts and practices.  There are a variety of effective models and practices that States, communities, providers, and others can use to promote recovery. However, much work remains to ensure that recovery-oriented behavioral health services and systems are adopted and implemented in every state and community.  Drawing on research, practice, and personal experience of recovering individuals, within the context of health reform, SAMHSA will lead efforts to advance the understanding of recovery and ensure that vital recovery supports and services are available and accessible to all who need and want them.

A CRITICAL REVIEW OF THE SAMHSA DEFINITION OF RECOVERY

The big problem with the SAMHSA definition of recovery is that it does not specifically answer the question “recovery from what?” By including chemical and behavioral addictions and then expanding the universe to all mental disorders, it misses the mark.

I believe the research clearly shows that there are non-addictied substance abusers who have episodes of abuse related to stage of life and life circumstances. A key defining idea of the DSM-III and IV criteria is that there are substance dependence disorders, generally called addiction, that are marked by a pattern of compulsive use, the description of matches the idea of progressive loss of control discussed, is consistent with early research which has be reexamined over more the forty years and found to be powerful descriptions.

The treatment of recovery from non-addictive substance abuse is different, in many ways from the treatment o substance dependence (addiction). Substance dependence (addiction) with carries with it an underlying impairment of the reward centers of the brain that do not rapidly return to normal and produce long-term cognitive impairment often described as Post Acute Withdrawal (PAW) or Protracted Withdrawal. PAW is stress sensitive (i.e. stress increases the degree of impairment in cognitive functioning) and as a result is highly correlated with stress-induced relapse models.

We must deal with this critical question: What exactly is the disease or disorder we are dealing with? How severe? What stage of severity? What past treatment? What coexisting mental or physical disorders?
The over-generalization of a recovery process from everything, implies that addiction, abuse, and mental disorders are essentially the same thing. There is compelling evidence that this is not the case. There are critical differences between disorders which dictate disorder specific treatment and differences in the recovery process.

I had hoped we gotten past the “addiction is anything you want it to be phase” in the development of the addiction treatment profession. Apparently I was wrong.

In my opinion the SAMHSA operational definition of recovery and the DSM 5 reformulation of criteria for addictive disorders is a step back into vague generalities that maintain tired old disagreements that have been settled in the literature.

A precise definition of the disorder being treated and specific principles and practices that professionals and recovering people can use as they progress in recovery are extremely important steps forward. This is a controversial position that has been systematically avoided in the profession for forty years. This is a controversial position that has been systematically avoided in the profession for forty years.

LANGUAGE PROGRAMS THE BRAIN! SLOPPY THINKING LEADS TO DISORGANIZED NEUROCOGNITVE FUNCTIONING.
Unfortunately, I don’t see it changing soon.

ON THE INTERNET:

1.  GORSKI’S WORKING DEFINITION OF RECOVERY
2. SAMHSA’s WORKING DEFINITION OF RECOVERY 


DSM 5 Substance Use Disorders: A Concise Summary

October 15, 2013

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, commonly referred to as the DSM-V or DSM 5, is the latest version of the American Psychiatric Association’s gold standard text on the names, symptoms, and diagnostic features of every recognized mental illness, including addictions. This edition was published in May 2013, nearly 20 years after the original publication of the previous edition, the DSM-IV, in 1994.

The DSM-V recognizes substance related disorders resulting from the use of ten separate classes of drugs:

1. alcohol,
2. caffeine,
3. cannabis,
4. hallucinogens (phencyclidine or similarly acting arylcyclohexylamines), other hallucinogens such as LSD,
5. inhalants,
6. opioids,
7. sedatives,
8. hypnotics,
9. anxiolytics,
10. stimulants (including amphetamine-type substances, cocaine, and other stimulants), tobacco, and
11. other or unknown substances.

Therefore, while some major grouping of psychoactive substances are specifically identified, use of other or unknown substances can also form the basis of a substance related or addictive disorder.

The DSM 5 explains that activation of the brain’s reward system is central to problems arising from drug use –- the rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug. While the pharmacological mechanisms for each class of drug is different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

The DSM 5 also recognizes that people are not all automatically or equally vulnerable to developing substance related disorders, and that some individuals have lower levels of self-control, which may be brain-based, which predispose them to developing problems if exposed to drugs.

There are two groups of substance-related disorders:
1. Substance use disorders and
2. Substance-induced disorders.

Substance use disorders are patterns of symptoms resulting from use of a substance which the individual continues to take, despite experiencing problems as a result.

Substance-induced disorders are symptoms that can be caused directly by the drug during or immediately after individual episodes of use.

The substance-induced disorders include:

1. Intoxication,
2. Withdrawal,
3. Substance induced mental disorders (including substance induced psychosis, substance induced bipolar and related disorders, substance induced depressive disorders, substance induced anxiety disorders, substance induced obsessive-compulsive and related disorders, substance induced sleep disorders, substance induced sexual dysfunctions, substance induced delirium and substance induced neurocognitive disorders.)

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts the you in danger
9. Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified.

MILD: Two or three symptoms indicate a mild substance use disorder,

MODERATE: four or five symptoms indicate a moderate substance use disorder, and

SEVERE: six or more symptoms indicate a severe substance use disorder. Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled environment.”

The DSM 5 is criticized for combining the the DSM IV categories of substance dependence (addiction marked by a pattern of compulsive use or loss of control) and substance abuse disorders (using in a manner that causes problems but does not have a pattern of compulsive use). The 2011 definition of addiction by the American Society of Addiction Medicine (ASAM) is consistent with DSM IV but not DSM 5.

The DSM IV, like the ASAM definition is based upon the idea that there is a DIFFERENCE IN KIND between substance abuse and dependence/addiction.

The DSM 5 is inconsistent with the ASAM definition because it is based upon the idea that there is only A DIFFERENCE IN DEGREE between abuse and addiction based upon the number of symptoms.

This is a critical difference in the underlying theory of addiction between the DSM IV and DSM 5 and a break in the progressive development of the fundamental concept if addiction which began with the DSM III.

GORSKI BOOKS:

Straight Talk About Addiction


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