Addiction Can Be Understood and Treated

August 15, 2014

RECOVERY IS POSSIBLE
STRAIGHT TALK ABOUT ADDICTION

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Straight talk means giving clear, honest, and plain-English descriptions of important issues related to addiction, recovery, relapse prevention. Straight Talk means discussion the artistes for addiction — sobriety and responsible living.

This book tells it like it is without a great deal of concern for political correctness or the tentative guarded language that so often hides the truth about addiction, recovery, and relapse.

After 40 years of following the new research and treatment practices for addiction, Terry Gorski became frustrated at the misinformation about alcohol and other drug addictions and the narrow and incomplete approaches to treatment, recovery and relapse prevention.

In this book, Terry provides the best information on the current science-based upon an accurate understanding of what the core addiction syndrome is and what the an effective addiction treatment process needs to look like if it is to increase the chances of recovery and decrease the risk of relapse.

This book is easy to read and loaded with useful information. The book can be quickly read from beginning to end, and then kept as a handy reference to find specific information that can be used as a guide to manage the problems and crises that are so often a part of the addiction and recovery process.

The message is simple: addiction is a biopsychosocial disease. science-based understanding of what the core addiction syndrome is and what the core addiction treatment process needs to look like if it is to increase the chances of recovery and decrease the risk. Here are some of the key ideas developed in depth with the book:

Addiction is a biopsychosocial disease. Bio means biological or of the body, Psycho means psychological or of the mind, Social means the relationships that develop among people and with the social and legal systems that are needed for responsible living.

Biologically, addiction is marked by brain dysfunction that disrupts the reward chemistry of the brain creating cycles of intense euphoria and powerful craving.

Psychologically addicted people slowly adjust their ways of thinking, feeling, acting that allows them to deny and rationalize the problems caused by the it addiction.

Gradually, over time, an addictive beliefs develops that create a powerful denial system. This denial blocks the ability to recognize the addiction, interferes with the ability to ask for and accept help, and creates a deadly spiral of progressively more severe relapse episodes.

Socially, addiction pushes away sober and responsible people while attracting and feeling attracted to addicted and irresponsible people. The result is a tragedy. The addict abuses, disregards, and destroys those who love and try to help them. Active addicts set themselves up to be exploited by other addicted people and are vulnerable to predators who use and abuse them.

Most importantly Straight Talk About Addiction provides hope. Addiction and be understood, recovery is possible, and relapse can be prevented it effectively managed should it occur.

This book is easy to read and understand. It is loaded with useful information. Many people read it from beginning to end to get a comprehensive understanding of addiction, recovery, relapse, and related problems. Many people keep the book handy so they can use it as an easy-access reference to find useful information that can be used to effectively manage addiction-related problems.

The message is clear: Recovery is possible. Relapse can be prevented or effectively managed should it occur. There is hope.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

Get The Book By Terence T. Gorski
STRAIGHT TALK ABOUT ADDICTION


PAY IT FORWARD

August 14, 2014

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by Terence T. Gorski,
Author

Paying it forward is the giving back to posterity an equal or greater benefit than we have received in our lives.

Today I received a message that asked me why I was publishing the links to sources that support Addiction as Biopsychosocial Disease, Recovery as a development process of growth and change, and Relapse Prevention as a critical tool in the lifelong battle against a chronic relapse-prone illness.

The answer is simple. I am paying forward the great joy and benefits I was so freely given by others in my life.

There are effective research-based treatments that produce high recovery rates. It is important that we know this and that we are a able to stand our ground when people challenge our positions.

The books, articles, citations, references in text books, and new spin-off treatment approaches are all part of a knowledge-base that has taken thousands of professionals many decades to develop and organize.

Now is the time to pass this knowledge-base forward. The mantle of leadership is being transferred to a new generation. These dynamic new-era clinicians need to build upon this historical foundation, including the principles and practices that have stood the test of time and research. They need to transcend the limitations of popular yet ineffective approaches.

Our motto needs to be INCLUDE and TRANSCEND.

We need to develop a living stream of dynamic frameworks that can integrates new knowledge with the wisdom of the past at the speed if the internet. We need to set a high standards.

Our goal needs to be to relegate the problem of addiction to the trash piles of other diseases that humanity has suffered and died from, but eventually found ways to eliminate.

Knowing the history of the profession and the sequence in which treatment approaches were developed is critical to rapidly developing the knowledge and skills needed to keep the addiction profession moving forward.

The future is upon us, and like it or not, we all a part of history.

“One person can make a difference. Every person should try!” ~ John F. Kennedy

You may be that one person. Strive to leave the world a better place than you found it.

LIVE SOBER — BE RESPONSIBLE –LIVE FREE

GORSKI BOOKS: www.relapse.org
GORSKI BLOG: www.terrygorski.com


GORSKI Relapse Prevention Certification School (RPCS)

August 5, 2014

THE RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS)

Earn 44 CEUs, In 5 Days, for $695!

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Instructed By: Terence T. Gorski and Dr. Stephen F. Grinstead

November 10-14, 2014
Ft. Lauderdale, FL

Terence T. Gorski’s advanced relapse prevention training has been “a turning point” in both the professional and personal lives of many former participants. The Gorski schools began in 1982 in Chicago, IL. Since that time, over sixty schools have been conducted with over 4,000 people completing the training.

This advanced clinical skills training experience is designed for professional therapists who are good and want to get better. It may be the most challenging and effective training that you have ever attended.

Upon completion of this training, participants will be able to develop comprehensive Relapse Prevention Plans for identifying and managing both high risk situations in early recovery and the core personality and lifestyle problems that lead to relapse in later recovery, after initial stabilization.

The Gorski Relapse Prevention Certification School (RPCS) is continuously updated with the latest research and uses a proven training method that includes:

(1) Brief Lectures that explain the purpose of each technique and why it is important;
(2) Clinical Demonstrations of each RP technique,
(3) Role Play to practice and receive feedback on your use of each technique,
(4) Small Groups to discuss progress, problems, and applications to your personal style;
(5) Discussions of how to apply the techniques in your professional setting.

Do you want to take your current clinical skills and integrate them with new and powerful approaches for identifying and managing the high-risk situations and core personality and life-style patterns that lead to relapse? If you do, this is the training for you!

Important Notice: An optional RPT Competency Certification that requires the completion of a competency portfolio and an additional fee.

Training Fee: The cost of the training is $695 for the five-day training experience (travel, meals, and lodging are not included in this fee).

Florida Location: HYATT REGENCY PIER SIXTY SIX, 2301 SE 17th Street Causeway Fort Lauderdale FL 33316 USA Telephone: 1-954-525-6666 on November 10-14, 2014 (Special hotel rates will be available for those who register early!

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For information and Registration:
Tresa Watson at 1-352-596-8000 or tresa@cenaps.com.


Using Stress Management In Relapse Prevention Therapy (RPT)

August 3, 2014

thBy Terence T. Gorski, Author

This blog is an excerpt from the book:

Starting Recovery With Relapse Prevention
by Terence T. Gorski. 

GORSKI’S RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS)
November 10 -14, 2014 at the Hyatt Regency Pier Sixty Six

2301 SE 17th Street Causeway, Fort Lauderdale, FL 3331
Iinformation: Tresa Watson: 352-596-8000, tresa@cenaps.com
Course Description: www.cenaps.com

Stress management is a critical key to staying away from alcohol and other drugs[i] [ii]during the critical first two weeks of recovery.[iii] It is important for people in recovery to learn how to recognize their stress levels and use immediate relaxation techniques to lower their stress. [iv] [v]

Recovering people are especially vulnerable to stress.[vi] There is a growing body of evidence that many addicted people have brain chemistry imbalances that make it difficult for them to manage stress in early recovery. The regular and heavy use of alcohol and other drugs can cause toxic effects on the brain that create symptoms that cause additional stress and interfere with effective stress management.

SEE RELATED BLOGS:
Stress Self-Monitoring and Relapse ,
The CENAPS Model and Mindfulness in Relapse Prevention,  and
Mindfulness Made Simple.

Many people who are in recovery from addiction have serious problems with Post Acute Withdrawal (PAW). PAW is a bio-psychosocial syndrome that results from the combination of brain dysfunction caused by addictive alcohol or drug use, and the stress of coping with life without drugs or alcohol. PAW is caused by brain chemistry imbalances that are related to addiction. PAW disrupts the ability to think clearly, manage feelings and emotions, manage stress, and self-regulate behavior.

PAW is stress sensitive. Getting into recovery causes a great deal of stress. Many recovering people never learn to manage stress without using alcohol or other drugs. Stress makes the brain dysfunction in early recovery get worse. As the level of stress goes up, the severity of PAW symptoms increase. As PAW symptoms get worse, recovering people start losing their ability to effectively manage their stress. As a result, they are locked into constant states of high stress that cause them to go between emotional numbness and emotional overreaction. Since high stress is linked to getting relief by self-medicating stress with alcohol or other drugs, high stress gets linked with the craving for alcohol or other drugs. So one of the first steps in managing craving is to learn how to relax and lower stress without using alcohol or other drugs.

The severity of PAW depends upon two things: the severity of brain dysfunction caused by addiction and the amount of stress experienced in recovery. The first two weeks of recovery is the period of highest stress in recovery. This high stress occurs before you have a chance to learn how to manage it in a sober and responsible way. Since you cannot remove yourself from all stressful situations, you need to prepare yourself to handle them when they occur. It is not the situation that causes stress; it is your reaction to the situation.

According to the National Institute on Drug Abuse, exposure to stress is one of the most powerful triggers for relapse to substance abuse in addicted persons, even after long periods of abstinence. Stress can cause a problem drinker to drink more, a person using prescription medication to use more than prescribed, and an illicit drug user to get more deeply involved in the drug culture than they could ever imagine. The high stress of the first two weeks of recovery can activate powerful cravings that make people want to start self-medicating with alcohol or other drugs in spite of their commitment to stop and stay stopped.

There is a simple tool called The Stress Thermometer that can help you to learn how monitor your stress. There is a simple immediate relaxation technique called Relaxed Breathing that can help you noticeably lower you stress in two to three minutes. First, let’s talk about the Stress Thermometer.

The Stress Thermometer

The Stress Thermometer is a self-monitoring tool that teaches people to become aware of their current stress levels, notice increases and decreases in stress at different times, and encourages the use of immediate relaxation techniques to lower stress as soon stress levels begin to rise. The Stress Thermometer makes it possible to manage stress before craving for alcohol or other drugs is activated. Lowering stress can also lower cravings. Lowering cravings can help you to turn off denial and addictive thinking. (More about this later).

The concept of using a stress thermometer came from thinking about how we use a temperature thermometer to measure our body temperature. When we take our body temperature we use a thermometer to tell us accurately and objectively what our body temperature is. When we use a stress thermometer, we use a system for self-monitoring our stress levels that can tell us accurately and objectively how high our stress levels are.

The stress thermometer is divided into four color-coded regions: blue – relaxation, green – functional, yellow – acute stress reaction, and red – trauma reaction.

What the Stress Levels Mean

Low Stress/Relaxation: Stress levels 1, 2, and 3. These stress levels are coded blue because they are cool and relaxing.

  • Stress Level 1: Deeply Relaxed/Nearly Asleep: At Stress Level 1 you are in a state of deep relaxation and nearly asleep. Your mind is not focused on anything in particular and you feel like you are waking up in the morning to a day off and can just let your mind drift in the deeply relaxed state.
  • Stress Level 2: Deeply Relaxed/Not Focused: As you come back from a state of deep relaxation you enter Level 2, during which you stay very relaxed, but begin to notice where you’re at, what is going on around you. You can stay in that state and just be aware and deeply relaxed. Eventually we will either go back down to Level 1 and then perhaps falls asleep or else you will move up to Stress Level 3.
  • Stress Level 3: Deeply Relaxed/Focused:At stress level 3 you get focused and start to think about getting yourself back into gear and getting going. In other words, you are getting ready to “kick-start your brain” so you can move into a functional stress level to begin getting things done.

By practicing the Relaxed Breathing Technique (this will be explained on page 19) most people can learn to put themselves in a relaxed state (Stress Level 1, 2, or 3), stay there for a few minutes, and then come back feeling refreshed and relaxed. It is important to remember that this will take time and practice. In our culture people are taught to work hard and burn themselves out. People don’t get much training on how to relax. People who get a euphoric effect from using alcohol or other drugs don’t need to. When they get the “right amount” in their system they shut down their stress chemistry, turn on the pleasure chemistry, and feel relaxed.

It is important to practice relaxation four times per day. I recommend linking it to meals: Take five minutes in the morning before breakfast, five minutes at lunch, five minutes at dinner, and five minutes to relax before going to sleep. Taking these stress breaks will make it easier for you to stay at a functional stress level and bounce back quickly from high stress situations.

With that in mind, let’s look at the “Functional Stress levels.”

Functional Stress: Stress levels 4, 5 & 6 designate the zone of functional stress. They are coded green because green is a color that represents “go”.  At stress levels 4, 5, and 6 we are experiencing stress levels that are high enough to give us the energy to get started, keep going, and get things done. The stress, however, is not so high that in interferes with what we are doing.

  • Stress Level 4: With effort we get Focused and Active.
  • Stress Level 5: We operate at high performance, a state of free flow with little or no effort.
  • Stress level 6: We can keep on going but it takes effort and we notice we are getting tired. It’s called free flow with effort. This is a good time to take a short break if you can to get your stress level back down to a level five.

Acute Stress Reaction: Stress levels 7, 8, and 9 are coded yellow. The color yellow represents caution. At stress levels 7, 8, and 9 we are experiencing an acute stress reaction. The word “acute” means immediate and severe. The good thing about acute stress is that if we notice it early and know how to relax, by taking a short break and using a relaxed breathing technique for example, we can lower our stress and get back into the functional zone. When we enter stress level 7 it means that our immediate levels of stress have gotten so high that we can’t consistently function normally. We’re in danger.

  • Stress level 7: Space Out: at a stress level 7 we space out. Our mind goes somewhere else and we don’t even know we were gone until our mind comes back on task.
  • Stress level 8: Driven and Defensive: at stress level eight we are driven and defensive. Our stress chemical has been activated and we are running on an adrenaline rush that is keeping us compulsively on task. The problem is that if someone or something interrupts us we become defensive and can easily move into stress level 9.
  • Stress level 9: Overreaction/Survival Behavior: at stress level 9 our automatic survival behavior takes over. The three basic survival behaviors that everyone has are: fight (irritated, angry, agitated); flight (anxious, fearful, panicked); and freeze (we feel an agitated sense of depression and indecision. We freeze up and can’t make a decision or move.) On top of these three core survival behaviors we learn more sophisticated survival behaviors from our family of origin, life experiences, education or special training in stress management, emergency management, martial arts, or combat. For that training to automatically come into play, we must have practiced it over-and-over again until it became habitual. In sports, emergency services, police work, and military operations these are called trained response. When our stress hits level ten our brain won’t allow us to rise to the situation. The emergency brain response will always lower us to the level of our training. In an emergency, all we can rely on are our automatic responses that we learned to perform on cue without having to think about it.

Traumatic Stress Reaction: Stress levels 10, 15, and 20 are coded red. Red is for stop. At this point our stress levels are so high that our brains and minds are at risk of shutting down. There are three levels of stress that can occur in the red zone of traumatic stress.

  • Stress level 10: Loss of Control: We automatically start using our survival behavior and we can’t control it. We are on automatic pilot and we will go through our learned survival responses one-by-one. This means we will cycle through stages of extreme anger (fight), extreme fear (flight, and extreme inner conflict or ambivalence (freeze). It is important to remember that all people with serious alcohol and drug problems have conditioned themselves with a survival behavior called “seek and use drugs to handle this.” So it is not unusual for a person at a stress level ten to get into drug seeking behavior and start using alcohol or other drugs.
  • Stress level 15: Traumatic Stress: At level 15 our high stress overloads the brain and we mentally disconnect from what is happening to us. Our stress is so high that we can’t stay consciously connected with out bodies. We may go into a state of daze, shock, and dissociation. Our mind can start to play tricks on us and things around us may seem bigger, or closer or farther away than they really are. We may start feeling confused and disoriented. It may seem like we are moving in slow motion. Some people feel like they have floated out of their bodies and it seems like they are watching themselves go through the experience.
  • Stress level 20: Collapse/Psychosis: When our stress levels hit a level 20 our brains can’t take the high level of stress and fatigue. We may collapse, enter an exhausted state of stupor or restless sleep, move into a vivid fantasy world or a world of memories or dreams, or become unconscious.

Any time people experience a “level 10 plus” state of stress; it will take a while after the stress stops for our brain to start functioning normally. When this is a short-term period of adjustment it is called an “acute trauma reaction.” When in it is a longer-term reaction it is called post traumatic stress disorder.

If you have ever experienced a “level 10 plus” stress experience – which can happen when you are the victim of crime, accidents, caught in a burning house, participating in combat, having been assaulted, etc. – it is important to discuss these experiences with your doctor or therapist. This is especially important if the high stress experience you had causes problems that you did not have before it occurred.

The Stress Thermometer

Developed By Terence T. Gorski (© Terence T. Gorski, 2011)
www.cenaps.com; www.relapse.org; www.facebook.com/GorskiRecovery

Level 20: Dissociation/Unconsciousness: I get dissociated and feel like I am floating out of my body. Things seem unreal, and I eventual pass out.
Level 15: Traumatic Stress: Stress overloads the brain and we go into a state of daze, shock or dissociation. We may feel like we are floating out of our bodies and watching ourselves go through the experience.
Level 10: Lose Control: Fight = Anger-based, Flee = Fear-based, Freeze = Depression-based.
——————————–The Brain Shift Gears ——————————–
Level 9: Overreact: Anger, fear, or compulsion get out control & starts running our intellect.
Level 8: Get Defensive: Automatic defenses are used; we start acting out compulsively. The ability to think becomes a servant to hidden fear, anger, & depression. Strong craving and urges to fight, run, hide, find a rescuer, blame others, or lose motivation & hope.
Level 7: Space Out: My brain can’t handle the stress, turns off for a second, and I gone blank and don’t even realize it until my brain turns back on a few seconds later.
——————————– The Brain Shift Gears ——————————–
Level 6: Free Flow Activity With Effort I’m getting tired and have to push myself to keep going.
Level 5: Free Flow Activity With No Effort: I’m totally into what I’m doing and get lost in the process. I’m on automatic pilot.
Level 4: Become Focused and Active With Effort: I make a decision to dig in and get to work. It takes an effort to get started.
——————————– The Brain Shift Gears ——————————–
Level 3: Relaxed – Aware But Not Focused: I’m relaxed and aware of what’s going on around me. I’m beginning to realize that I need to get going.
Level 2: Very Relaxed – Not Aware & Not Focused: I’m so relaxed that I’m not aware of what’s going on around me. I’m disconnected and don’t want to notice anything.
Level 1: Deeply Relaxed – Nearly Asleep: I’m so deeply relaxed that I’m drifting in and out of a dreamy type of sleep state filled with active fantasy or daydreaming.
The Most Important Stress Management Tool is
The Conscious Awareness of the Rise and Fall of Your Stress Levels.
This is Achieved Through Self-monitoring.

 

Measuring Levels of Stress

Notice that you are measuring your personal perception of stress, which is a combination of three things: (1) the intensity of the stressor (the situation activating stress); (2) your ability to cope with or handle the stressor; and (3) your level of awareness while you are experiencing the stress.

It is possible for you to score yourself very low on the stress thermometer even when your stress is very high. This can happen because: (1) you are distracted and involved in something else (like managing the crisis causing your stress); (2) your stress is so high that you are emotionally numb and don’t know what you are feeling; (3) if you have lived with such high stress for such a long time that you consider it normal; and (4) you have trained yourself to ignore your stress.

The first step in learning how to manage your stress is to learn how to recognize and evaluate your level of stress and by learning how to quickly get back into a low stress level by using a Relaxed Breathing Technique. Let’s start by looking at how you can improve your stress awareness.

 

Improving Stress Awareness

The best way to learn to be aware of your stress level is to get in the habit of consciously monitoring your stress level. You can do this by using a mental tool called The Stress Thermometer, (page 17). The first step is to imagine that you have an internal stress thermometer that starts in the pit of your stomach and ends in your throat. The lowest reading on the stress thermometer is zero and represents a deep sense of relaxation that is so complete that you want to fall asleep. At a stress level seven or eight, your stress becomes so intense that you start shutting down, getting defensive, or avoiding the issue that is causing the stress. If you can’t manage or get away from the stressful situation, at a level ten you lose control and start believing that you can’t handle the situation and that you or someone you love may be hurt or killed. These extreme feelings of stress are called trauma.

When most people hit a stress level of seven or higher they are not able to respond to constructive criticism or to make sense out of their emotional experiences. At stress levels between seven and nine most people start acting compulsively, overreact to things going on around them, and start using automatic habitual survival behaviors that may or may not solve the problem and lower stress.

This is why it is so important for you to learn to recognize your stress levels when they start hitting a level seven and learn how to quickly lower them. You can do this by using an immediate relaxation response technique called Relaxed Breathing any time you notice your stress hitting a level seven or above. So you have four goals in this exercise:

(1)        To learn how to get into the habit of noticing when your stress is getting up to a level seven or eight;

(2)        To learn how to quickly lower your stress by using the Relaxed Breathing Technique;

(3)        To figure out what is happening and how you are thinking and feeling about what is happening that is causing your stress to go up; and

(4)        Manage the stressful situation by responsibly getting out of the situation or learning how to manage your thoughts, feelings, and behaviors that will allow you to stay cool and relaxed even tough you are in a tough situation.

Monitoring Your Stress – Body Awareness

Body awareness is a technique that allows you to recognize how your body physically reacts to stress. It can be a powerful skill to use in stress management because as you notice the stress in different parts of your body, you will start to relax the part of the body you are noticing. With enough practice your body will automatically start identifying and releasing stress before you become consciously aware of it. Muscle tension is the primary way your body let’s you know that you are experiencing stress. Consciously using a systematic body awareness technique whenever you think about it and at least four times per day will start you on the road to teaching your body to automatically recognize and release stress. Here’s how the technique works:

Begin by closing your eyes. You will concentrate on one muscle group at a time, tensing and releasing and being aware of how tight the muscle is as you focus on it. If the muscle feels tight as you begin, this may indicate you store stress in this muscle. Begin with focusing on your toes and slowly move up your body. Tighten your toes and release, flex your calves and release, tighten your thighs and release, tighten your stomach muscles and release, fist your hands and release, tense your shoulders and release, clench you jaw and release, squint your eyes and scrunch your face and release. Any time you encounter tension in a muscle, record that muscle tension and be aware that you are holding stress there. This will help you in developing a personal stress reduction plan and using exercises and techniques to release pent-up tension.

Reducing Your Stress – Relaxed Breathing

There are a number of different relaxation methods. For the purpose of this workbook I am going to teach the easiest and most effective. It is called Relaxed Breathing. It is so effective that military, police and firefighters are taught to use it to lower their stress when responding to emergencies. Here’s how it works:

Relaxed Breathing, often called combat breathing in the military or tactical breath by police and emergency responders, is designed for both before and during stressful times to calm you down and help you relax. In terms of the stress thermometer, relaxed breathing is used before a stressful situation to calm you down and get you ready to be at your best. It is used during a stressful situation to keep your stress from going above that critical Level 7, where your brain turns off and automatic defensive behavior and cravings kick in.

Early in recovery, thinking about and talking about your use of alcohol or other drugs will cause some of your highest stress. The catch 22 is this – if you don’t talk about it, the thoughts will keep coming back like a ghost in the night that haunts moments that should be quiet and restful. Each time you expel the ghost by refusing to think and talk about the “real problems” the ghost goes away for a little while and comes back stronger. Your denial and resistance is strengthened, the intensity of your craving goes up, and your ability to think rationality about what you need to do goes down. As a result the voice of this “stress ghost” grows into a full-blown “stress monster” that can literally take your brain hostage and make you believe that self-medication with alcohol or other drugs is the best or only way to get back in control of yourself and your life.

Step 1: The first thing you need to do is to convince yourself that you can manage and reduce stress without having to self-medicate. There is another way. That way involves learning how to control your breathing.

Step 2: Practice relaxed breathing in a safe environment when you are not stressed. Just go through the steps and get used to them.

Step 3: Get used to rating your stress level. Initially you may need to use the stress thermometer, but with a few times of practice (four times per day for three or more days) the use of the scale will be an automatic tool that you will use whenever you check out you stress level.

Step 4: Take control of the process by stressing yourself out and then relaxing yourself using the relaxed breathing technique.

Sit in a quiet place where you will not be disturbed for ten or fifteen minutes. Take a deep breath and do a quick body checks. Then on a sheet of paper write the word START and underneath or next to it rate your stress level.

For example, I would do a body check and write: START = 6. I am still relaxed and able to think and respond, but I am tired and on the edge of spacing out.

Step 5: Stress yourself out! Your heard what I said. Think about the things you usually think about that raise your stress. Be sure to beat yourself up about your drinking and drugging, how stupid you were, the problems it has caused and how you will never-ever be able to repair the damage you have done to your life. Stop the process before your stress hits a level 9 or 10 and you go running out of the room. Then write the words: AFTER STRESS and rate your stress level. Most people find it easy to raise their stress.

For example, after beating myself up for about 60 seconds I would write: AFTER STRESS = 8. I feel myself driving myself and notice the thoughts start to take on a life of their own. If someone interrupts me at this moment I could easily over-react.

Step 6: Relax yourself! You heard me. Do what you need to do to relax. This is the problem for many people, especially people who use alcohol, prescribed medication, or other drugs regularly and heavily. They can stress themselves out easily enough, but other than self-medication they have no way to calm themselves down. So try this:

Take a deep breath and hold it for a moment until your lungs feel just a little uncomfortable, hold your breath for a moment, and then exhale all the way out. Hold your breath for a moment with your lungs empty and then slowly inhale again. Start to breath a slow rhythmic count of four: “INHALE– two- three – four; HOLD – two – three – four; EXHALE – two – three – four; HOLD – two – three – four. Then start the cycle over by inhaling to the count of four. Repeat the cycle five times. Imagine the stress gathering in your lungs as you inhale and hold. Imagine the stress releasing from your mouth as you exhale and hold. That’s it.

Now rate your stress again. Look at the stress thermometer and see what happened. Then write the words: AFTER followed by your stress rating.

For example I would write: AFTER RELAXING = 4 (remember I’ve been practicing a long time). So the record of my session looks like this:

START =6; AFTER STRESS = 8; BREATHING REPS = 5; AFTER =4.

Don’t force yourself to relax, just do the relaxed breathing, and focus on counting and imaging the stress leaving your body ever time you exhale.

Practice four times per day, at breakfast, lunch, dinner, and before bed. Keep track of your progress. Use relaxed breathing if you notice your stress going up during any of the following exercises.

Footnotes

[i] Stress and increased Relapse Risk: Stress is an important factor known to increase alcohol and drug relapse risk. This paper examines the stress-related processes that influence addiction relapse. First, individual patient vignettes of stress- and cue-related situations that increase drug seeking and relapse susceptibility are presented. Next, empirical findings from human laboratory and brain-imaging studies that are consistent with clinical observations and support the specific role of stress processes in the drug-craving state are reviewed. Recent findings on differences in stress responsivity in addicted versus matched community social drinkers are reviewed to demonstrate alterations in stress pathways that could explain the significant contribution of stress-related mechanisms on craving and relapse susceptibility. Finally, significant implications of these findings for clinical practice are discussed, with a specific focus on the development of novel interventions that target stress processes and drug craving to improve addiction relapse outcomes.

  • Reference: The role of stress in addiction relapse. Curr Psychiatry Rep.  2007; 9(5):388-95 (ISSN: 1523-3812) Sinha R. Department of Psychiatry, Yale University School of Medicine, 34 Park Street, Room S110, New Haven, CT 06519, USA
  • Stress Identification and Management: Stress as verified by clinical observations, patient self-reports, and subjective and behavioral measures have been correlated depressive symptoms, stress, and drug craving during withdrawal. All of theses factors predict future relapse risk. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. This study suggests that stress management would be helpful in preventing relapse especially during the period of withdrawal

[ii] Stress Identification and Management: Stress as verified by clinical observations, patient self-reports, and subjective and behavioral measures have been correlated depressive symptoms, stress, and drug craving during withdrawal. All of these factors predict future relapse risk. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. This study suggests that stress management would be helpful in preventing relapse especially during the period of withdrawal.

[iii] The Role of Stress In Addiction: Both animal and human studies demonstrate that stress plays a major role in the process of alcohol and drug addiction and that a variety of stressors can increase both self-reported stress and measures of biological stress. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. This study suggests that stress management would be helpful in preventing relapse especially during the period of withdrawal.

Reference: New findings on biological factors predicting addiction relapse vulnerability. Curr Psychiatry Rep.  2011; 13(5):398-405 (ISSN: 1535-1645) INTERNET: http://reference.medscape.com/medline/abstract/21792580

[iv] Stress and Addiction: Stress plays a major role in the process of drug addiction and various stressors are known to increase measures of craving in drug dependent human laboratory subjects. Animal models of stress-induced reinstatement of drug-seeking have also been developed in order to determine the neuropharmacological and neurobiological features of stress-induced relapse.

  • Reference: Pharmacologically-induced stress: a cross-species probe for translational research in drug addiction and relapse. Am J Transl Res.  2010; 3(1):81-9 (ISSN: 1991) See RE; Waters RP. Department of Neurosciences, Medical University of South Carolina, Charleston SC USA.

[v] Stress-Induced Craving and Cognitive Behavioral Therapy: The Division of Clinical Neuroscience, Medical University of South Carolina, Charleston, South Carolina 29425, USA. (backs@musc.edu) has found that stress-induced craving and stress reactivity may influence risk for substance use or relapse to use. Interventions designed to manage stress-induced craving and stress reactivity may serve as excellent adjuncts to more comprehensive treatment programs. The purpose of this study was to (1) tailor an existing, manualized, cognitive-behavioral stress management (CBSM) intervention for use in individuals with substance use disorders and (2) preliminarily evaluate the effects of the intervention using an experimental stress-induction paradigm. Twenty individuals were interviewed and then completed a psychological stress task, the Mental Arithmetic Task (MAT). After this, participants were assigned to either the CBSM intervention group or a non-treatment comparison group. Approximately 3 weeks later, participants completed a second MAT. In contrast to the comparison group, the CBSM group demonstrated significantly less stress-induced craving (p<.04) and stress (p<.02), and reported greater ability to resist urges to use (p<.02) after the second MAT. These findings are among the first to report on the use of an intervention to attenuate craving and stress reactivity among individuals with substance use disorders. Although preliminary, the findings suggest that systematic investigation of interventions specifically targeting stress management in individuals with substance use disorders should be undertaken.

  • Reference: Source: Back SE, Gentilin S, Brady KT. Cognitive-behavioral stress management for individuals with substance use disorders: a pilot study J Nerv Ment Dis. 2007 Aug;195(8):662-8

[vi] Research Society On Alcoholism: This report of the proceedings of a symposium presented at the 2004 Research Society on Alcoholism Meeting provides evidence linking stress during sobriety to craving that increases the risk for relapse. The initial presentation by Rajita Sinha summarized clinical evidence for the hypothesis that there is an increased sensitivity to stress-induced craving in alcoholics. During early abstinence, alcoholics who were confronted with stressful circumstances showed increased susceptibility for relapse. George Breese presented data demonstrating that stress could substitute for repeated withdrawals from chronic ethanol to induce anxiety-like behavior. This persistent adaptive change induced by multiple withdrawals allowed stress to induce an anxiety-like response that was absent in animals that were not previously exposed to chronic ethanol. Subsequently, Amanda Roberts reviewed evidence that increased drinking induced by stress was dependent on corticotrophin-releasing factor (CRF). In addition, rats that were stressed during protracted abstinence exhibited anxiety-like behavior that was also dependent on CRF. Christopher Dayas indicated that stress increases the reinstatement of an alcohol-related cue. Moreover, this effect was enhanced by previous alcohol dependence. These interactive effects between stress and alcohol-related environmental stimuli depended on concurrent activation of endogenous opioid and CRF systems. A.D. Lê covered information that indicated that stress facilitated reinstatement to alcohol responding and summarized the influence of multiple deprivations on this interaction. David Overstreet provided evidence that restraint stress during repeated alcohol deprivations increases voluntary drinking in alcohol-preferring (P) rats that result in withdrawal-induced anxiety that is not observed in the absence of stress. Testing of drugs on the stress-induced voluntary drinking implicated serotonin and CRF involvement in the sensitized response. Collectively, the presentations provided convincing support for an involvement of stress in the cause of relapse and continuing alcohol abuse and suggested novel pharmacological approaches for treating relapse induced by stress.

  • Reference: George R. Breese, Kathleen Chu, Christopher V. Dayas, Douglas Funk, Darin J. Knapp, George F. Koob, Dzung Anh Lê, Laura E. O’Dell, David H. Overstreet, Amanda J. Roberts, Rajita Sinha, Glenn R. Valdez, and Friedbert Weiss. Stress Enhancement of Craving During Sobriety: A Risk for Relapse, Alcohol Clin Exp Res. 2005 February; 29(2): 185–195.

See the related blog: Stress Self-Monitoring and Relapse

Stress Management Is Used In The Gorski Relapse Prevention Certification School (RPCS)

Relaxation Training and Mindfulness Meditation are a big part of Relapse Prevention Therapy (RPT). When patients are under high levels of stress, their ability to understand, integrate, and use new skills is diminished. Gorski RPT teaches therapists how to use a form of immediate relaxation training to keep clien’s stress low during the session. It also teaches them to use relaxation methods in the moment so they are more likely to use them in real-life events. For an overview of how relaxation training and a simple tool called the stress thermometer can be used with RPT check out Terry Gorski’s Blog:

GORSKI’S RELAPSE PREVENTION CERTIFICATION SCHOOL (RPCS)
November 10 -14, 2014 at the Hyatt Regency Pier Sixty Six

2301 SE 17th Street Causeway, Fort Lauderdale, FL 33316
For further information: Tresa Watson: 352-596-8000, tresa@cenaps.com 

SEE RELATED BLOGS:
Stress Self-Monitoring and Relapse ,
The CENAPS Model and Mindfulness in Relapse Prevention,  and
Mindfulness Made Simple.


Managing Grief and Loss In Recovery

June 13, 2014

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By Terence T. Gorski, Author

If you lose someone you love and you don’t miss them there is something seriously wrong. Grief from the loss of a loved one is a normal part of life. People recovering from addiction need to learn how to cope with the loss Ina sober and responsible way. Mismanaging grief and loss lead to depression and activate the relapse process. (see Depression and Relapse).

I find the loss of a loved one is a strange thing. The better the relationship we had with someone we lose, the more it hurts to lose them. The pain never goes away because there remains a hole in our soul — an emptiness that cannot be filled by anyone else.

Anniversaries of a loss are tough. At best they are bitter-sweet. I find, however, that dealing with loss is a skill that can be learned — must be learned — if we want to mature as a human beings.

The stages of mourning and grief are universal and are experienced by people from all walks of life. Learning about the steps and stages of managing grief and loss can help us accept the process as normal and natural and develop skills for managing the different steps of the process. It still hurts, but the pain is more easily managed when we know we are not crazy for experiences.

Each of us must find our own way to cope with grief and loss. Their is no right or wrong way to do it and no universal time-frame for resolving it.

There is, however, a model that helps many people understand and accept the process. A five stage model of normal grief was first proposed by Elisabeth Kübler-Ross in her 1969 book “On Death and Dying.” I’m reality, however, the process is not as orderly or predictable as the five stages of grief make it seem.

I summarize the stages of grief with the acronym DABDA:

D = Denial. This can’t be happening!

A = Anger, usually at life and/or at God. “They can’t take you! You can’t leave me. You have no right to do this to me! What kind of a god would let this happen?”

B = Bargaining. I’ll do anything, pay any price, negotiate any deal to avoid losing this person.

D = Depression. There is a deep sense if traumatic loss that is biopsychosocial. Biologically there are brain chemistry crashes. Psychologically we feel empty and incomplete. Socially there is a big hole in the fabric of our lives.

A = Acceptance. We adapt to the loss, but acceptance does not mean we go back to feeling the way we did before the loss. The loss changes us and we learn to adapt to a new normal as we rebuild our lives.

The stages of grief model suggests people move through grief and get done with the process. In my experience that is not the case. Most people bounce from stage to stage and cues or triggers such as anniversaries and holidays can snap us back into the grief process.

I find that loss is easier to handle if I focus on the good memories and good things and consciously connect with gratitude for having those times with that special person. The only alternative is to stay in anger and forget the gifts this person gave us. This can leave us bitter.

In sobriety we learn to cope with the bitter taste of the loss while savoring the good things that we gained. And we must learn to do it in a sober and responsible way. That means feeling what we feel and developing deeper relationships with other people to help us through the process.

Using alcohol or other drugs to cope with the loss makes things more difficult and painful. It leads to a loss of control of our addiction and hitting a new bottom. When we get back in recovery the unresolved grief is waiting for us. It can complicate our new efforts at recovery and contribute to unnecessary relapse.

The good news is that we can learn to deal with grief and loss in a sober and responsible way. Cognitive Restructuring can help us when the skills are specifically applied to the process of managing grief and loss.

GORSKI BOOKS: www.relapse.org


The Phases and Warning Signs of Relapse

June 4, 2014

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By: Terence Gorski, Author

Complete exercises to show you how to use the warning signs in you recovery are in The Relapse Prevention Counseling (RPC) Workbook.

Phase 1: RETURN OF DENIAL

During this phase the dependent person becomes unable to recognize and honestly tell others what he or she is thinking or feeling. The most common symptoms are:

1. Concern about well being.
2. Denial of the concern.

Phase 2: AVOIDANCE AND DEFENSIVE BEHAVIOR

During this phase the dependent person doesn’t want to think about anything that will cause painful and uncomfortable feelings to come back. As a result, he or she begins to avoid anything or anybody that will force an honest look at self. When asked direct questions about wellbeing, he or she begins to become defensive. The most common symptoms are:

1. Believing “I’ll never drink again.”
2. Worrying about others instead of self.
3. Defensiveness.
4. Compulsive behavior.
5. Impulsive behavior.
6. Tendencies toward loneliness.

Phase 3: CRISIS BUILDING

During this phase the dependent person begins experiencing a sequence of life problems that are caused by denying personal feelings, isolating self, and neglecting the recovery program. Even though he or she wants to solve these problems and work hard at it, two new problems pop up to replace every problem that is solved. The most common symptoms are:

1. Tunnel vision.
2. Minor depression.
3. Loss of constructive planning.
4. Plans begin to fail.

Phase 5: IMMOBILIZATION

During this phase the dependent person is totally unable to initiate action. He or she goes through the motions of living, but is controlled by life rather than controlling life. The most common symptoms are:

1. Daydreaming and wishful thinking.
2. Feeling that nothing can be solved.
3. Immature wish to be happy.

Phase 6: CONFUSION AND OVERREACTION

During this phase the dependent person can’t think clearly. He or she becomes upset with self and those around her or him and is irritable and overreacts to small things.

1. Periods of confusion.
2. Irritation with friends.
3. Easily angered.

Phase 7: DEPRESSION

During this phase the dependent person becomes so depressed that he or she has difficulty keeping to normal routines. At times there may be thoughts of suicide, drinking, or drug use as a way to end the depression. The depression is severe and persistent and cannot be easily ignored or hidden from others. The most common symptoms are:

1. Irregular eating habits.
2. Lack of desire to take action.
3. Irregular sleeping habits.
4. Loss of daily structure.
5. Periods of deep depression.

Phase 8: BEHAVIORAL LOSS OF CONTROL

During this phase the dependent person becomes unable to control or regulate personal behavior and daily schedule. There is still heavy denial and no full awareness of being out of control. His or her life becomes chaotic and many problems are created in all areas of life and recovery. The most common symptoms are:

1. Irregular attendance at AA and treatment meetings.
2. Development of an “I don’t care” attitude.
3. Open rejection of help.
4. Dissatisfaction with life.
5. Feeling of powerlessness and helplessness.

Phase 9: RECOGNITION OF LOSS CONTROL

The dependent person’s denial breaks and suddenly he or she recognizes how severe the problems are, how unmanageable life has become, and how little power and control he or she has to solve any of the problems. This awareness is extremely painful and frightening. By this time he or she has become so isolated that it seems that there is no one to turn to for help. The most common symptoms are:

1. Self-pity.
2. Thoughts of social drinking.
3. Conscious lying.
4. Complete loss of self-confidence.

Phase 10: OPTION REDUCTION

During this phase the dependent person feels trapped by the pain and inability to manage his or her life. There seem to be only three ways out–insanity, suicide, or drug use. This person no longer believes that anyone or anything can help him. The most common symptoms are:

1. Unreasonable resentment.
2. Discontinues all treatment and AA.
3. Overwhelming loneliness, frustration, anger and tension.
4. Loss of behavioral control.

THE RELAPSE EPISODE

During this phase the dependent person begins to use alcohol or drugs again, typically struggling to control or regain abstinence.

Some people, especially those who have developed an emergency plan to stop relapse should it occur, are able to quickly reach out and get help before catastrophic consequences occur.

The struggle to control use, however, often leads to shame and guilt when the attempt ultimately fails. Eventually all control is gone and serious bio-psycho-social problems develop and continue to progress. The most common symptoms are:

1. Initial use (the lapse).
2. Shame and guilt.
3. Helplessness and hopelessness.
4. Complete loss of control.
5. Biopsychosocial damage.


Relapse Prevention Therapy (RPT) – The Clinical Process

May 31, 2014

20140531-010803-4083647.jpgBy Terence T. Gorski, Author

Relapse Prevention Therapy (RPT) is an in-depth clinical psychotherapy process that is designed to four outcomes – The development of a core issue list, a relapse warning sign list, warning sign management strategies, and a recovery plan.

1. Core Issue List:

Each person completing RPT develops a list of the core personality and lifestyle problems that create pain and dysfunction while attempting to maintain long-term sobriety and responsibility.

These core personality and lifestyle problems lead a person back into patterns of addictive and irresponsible thinking and behavior during times of high stress and problems. Since these patterns are automatic and unconscious and are activated by situational triggers, the individual can feel confused and powerless as they successfully avoid or cope with high risk situations only to find themselves acting out in other self-defeating ways for apparently no reason. As a result, the failure to identify and address these issues increases the risk of relapse after initial stabilization and return to normal functioning has been achieved.

The Core Issue List identifies the core or central system of irrational or mistaken beliefs about self, others, and the world that leads to feelings of deprivation and hopelessness when practicing habits of sober and responsible living.

These Core issues are based upon the general mistaken belief that “I can’t have the good life, and be sober and responsible at the same time.” The “good life” is subjectively defined by primary childhood experiences that cause the individual to perceive, think about and respond to the world using an automatic cycle of deeply habituated self-defeating behavior.

The core issue list is developed from a careful and systematic analysis of information gathered from three sources:

(1) the client’s original presenting problems,

(2) the client’s life and addiction history, and

(3) the client’s recovery and relapse history.

The goal of completing these three assessments is to guide the client in answering two basic questions:

(1) “What did you come to believe that alcohol, drugs, and irresponsibility could do for you that you could not do for yourself while being sober and responsible?”

(2) “What problems did you come to believe that alcohol, drugs, and irresponsibility could help you to cope with or escape from that you believed you couldn’t deal with while being sober and responsible?”

The client is taught:

(1) To recognize the basic core issues that increase the risk of relapse, and

(2) To write clear statements that describe the general mistaken beliefs and the automatic and unconscious patterns of thinking, managing feelings and acting that is used when that core issue is activated.

The goal is to teach the client to understand and describe the problems that lead to relapse on three levels in clear, simple, and concrete terms.

These three levels are:

(1) The mistaken beliefs or assumptions about self, others, and the world that limit choices in life planning and problem solving;

(2) The automatic and habitual self-defeating thoughts, painful unmanageable emotions, self-defeating behaviors that are activated by the structure of mistaken beliefs; and

(3) The dysfunctional professional and personal relationships that result from the habitual use of those self defeating behaviors.

This allows the client to unmask the big lie of addiction – the mistaken belief that alcohol, drugs and irresponsibility is good for me, can magically fix me and my problems, and can give me a better life.

Applications: The core issue list is designed to both prevent relapse and improve overall effectiveness by teaching the following skills:

(1) The ability to reflect upon past experiences, accurately assign meaning to those experiences, and avoid the thinking errors and self-defeating behaviors that are the logical consequences of mistaken beliefs;

(2) Mapping out the habitual patterns of thinking, feeling, and acting that are related to those mistaken beliefs; and

(3) Understanding how problems with professional and personal relationships are the logical extension of those core beliefs.

2. Relapse Warning Sign List

Each person completing RPT learns how to develop a Relapse Warning Sign List that describes the specific sequence of events and the related irrational thoughts, unmanageable feelings, self-destructive urges, and self defeating behaviors that are acted out when the core mistaken beliefs are activated.

This warning sign list allows the client to describe in concrete and specific terms the subtle changes in thinking, feeling, motivation, and behavior that set the stage for addictive thinking. It also allows significant others to recognize and assign meaning to the subtle changes in communication and behavior and to intervene appropriately before addictive thinking patterns become rigidly reestablished.

Applications: The relapse warning sign list is designed to prevent relapse and improve overall effectiveness by teaching the following skills:

(1) Developing a list of progressive personal problems and behaviors that lead back into a pattern of addictive and irresponsible thinking and behaviors;

(2) Isolating the warning signs that will interfere with performance by writing a Warning Sign List.

3. Warning Sign Management

Each person completing RPT learns how to identify key or critical warning signs and how to use specific skills or tools to manage those warning signs in a way that stops the progressive pattern of self-defeating thinking and behavior.

The coping strategies related to RPT go beyond the situational management strategies learned at the RPC level. They involve recognizing and intervening upon the more subtle patterns of thinking, emotional management and acting out that set the stage for gradually more destructive behaviors.

Applications: The relapse warning sign management strategies are designed to prevent relapse and improve overall effectiveness by teaching the following skills:

(1) Clearly identifying intervention points in the progressive pattern of irrational thinking and self-destructive behaviors that can impair performance and increase the risk of mismanaging critical situations in a way that could lead to relapse;

(2) Learning specific skills for identifying and challenging irrational and addictive thinking patterns;

(3) Learning specific skills for responsibly managing unpleasant feelings and emotions;

(4) Learning specific tools and skills for recognizing and changing subtle patterns of self-defeating behaviors that can lead to serious long-term problems and eventual relapse; and

(5) Learning how to proactively invite others to support patterns of sobriety and responsibility and to point out self-defeating behaviors or problems that clients may be unaware of.

4. Recovery Plan

Each person completing RPT develops a recovery plan consisting of regularly scheduled activities that clearly support the ability to challenge the mistaken beliefs that perpetuate a self-defeating style of living and working.

LIVE SOBER – BE RESPONSIBLE -LIVE FREE

GORSKI BOOKS: www.relapse.org


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