April 26, 2016

 The Gorski Comprehensive Addiction Model is a a science-based system that incorporates both chemical and behavioral addictions in a comprehensive biopsychosocial perspective.

THE HUMAN CONDITION: The Gorski Model builds upon a recognition that all addiction is based within the human condition. The human condition is organized and directed by the CORE HUMAN PROCESSES OF PERSONALITY

DEVELOPMENT. The human process begins with an intangible but self-evident primal life force which motivates human beings to survive and thrive in the physical world. The frustration resulting from the collision of the infinite potential of the human spirit with the finite limitation of the physical world results in ANGST, the normal pain of life and living. ANGST is managed by people in one of three ways: DENIAL, it doesn’t exist – everything is beautiful;

DEMORALIZATION, since life hurts I will just give up and stop trying; or MOTIVATION, in spite of the psi of living there is a counterbalancing joy in living that makes it worth while. Motivated people to STRIVE to find safety, security, excitement, and accomplishment in an often difficult and hostile world. They maintain their motivation because of the capacity human beings have for with PASSION. With maturity passion becomes focused into psychological and spiritual practices that help people find peace, serenity, and security without the constant need to strive, perform, and produce.

Many people find that a state of euphoria induced by the addictive use of alcohol and other drugs can give them short term relief from the angst of life. Unfortunately, people who experience this addictive brain response are at high risk of developing addiction. The addictive release leads to obsession I have intrusive thoughts about how good the euphoric response felt. I feel a COMPULSION to repeat the experience.

As the compulsion becomes stronger it turns into CRAVING which turns wanting the addictive release into the need for the addictive release. This creates a self reinforcing pattern of addictive use which is called ADDICTION, which is marked a compulsive pattern of DRUG SEEKING BEHAVIOR.

Over time, the cycle can be described as a EUPHORIC RESPONSE to addictive use, a DYSPHORIC RESPONSE to abstinence, a CRAVING or perceived need to use, DEPENDENCE or being unable to function normally without addictive use, and TOLERANCE the need to use more in order to get the same level of euphoria.

Once the ADDICTION CYCLE BEGINS, addictive THOUGHTS, FEELINGS, URGES, and ACTIONS become engrained in automatic and unconscious habits. These habits attract people who support the addictive way of life or are willing to become committed to enabling it.

These Social and Cultural Reactions to addiction create a permissive environment for early stage addiction when addictive use makes people feel good and be more productive and stigma reaction when people lose control and begin stepping outside of social, cultural and legal limits.

This is all part of the addiction, which is a health crd problem that is best dealt with using a Public health Addiction Policy:

(1) TOXIC SUBSTANCE: Identifying the toxic substances causing the illness;

(2) VULNERABLE HOST: Identifying the people who are predisposed to addiction); and

(3) PERMISSIVE ENVIRONMENT: Changing the societal and cultural norms that make ready access to and heavy regular use of the toxic substances and behaviors socially, culturally, and personally unacceptable.

Gorski Books: http://www.relapse.org

Gorski Training: http://www.cenaps.com

Gorski On Facebook: http://www.facebook.com/gorskirecovery


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Treatment Manuals That Work

December 30, 2013

Well designed treatment manuals
make recovery easier for everyone.

By Terence T. Gorski, Author
December 30, 2013

Many clinicians feel frustrated when they are “mandated” to use TREATMENT MANUALS with patients. Here are some points to consider:

1. Treatment manuals are either well designed or poorly designed. WELL DESIGNED MANUALS are easy to use, present exercises in a logical series of progressive skill-building steps, and have exercises to practice the skills in real-life situations.


2. The language in well-designed manuals avoids both “PSYCHO-BABBLE”, highly technical psychological language, and RECOVERY TALK, the heavy use of 12-Step language, slogans, and platitudes.

Therapists require training in how to use a manual in individual and group therapy. They also need experience in treating the addiction or related problems that is the focus of each manual. Here are the basic steps that therapists need to take to become proficient in “manualized” treatment:

Step 1: Understand the therapeutic purpose of the workbook and the goal of each exercise. Review the way the sequence of information, questions, and suggested activities are used . Use each exercise to take the patient on a journey of new understanding.

STEP 2: Take ownership of the manual content by integrating it into your own personal style and be prepared to clarify or elaborate on the concepts in the manual in words, ideas, and examples that you are comfortable with.

STEP 3: Adapt the use of the manual to the structure and needs of the program you are working in.

STEP 4: Adapt the use of the manual to the needs of each individual patient. The key question is: Does the manual  meet the needs of the patients? If yes, the manual can be a valuable addition to traditional psychotherapy. If no, don’t use the manual.

Using a manual that does not address the important problems of a patient is the equivalent of giving patients the wrong medications. DON’T DO IT! Match specific manuals to the individual needs and treatment plans of patients.

It is important for therapist to work with management when adapting the use of manuals for use within a specific clinical program. How clinical staff negotiate with management for the appropriate use of treatment manuals is critical. Some negotiation styles cause head-to-head conflicts and power struggles. Others invite a collaborative process of evaluation that looks for the most effective way to use the manual with an individual patient.

Here are ways that the use of the manual can be adjusted to meet patient needs:

1. Sometimes the content of the manual needs to be delivered in smaller or bigger “chunks” of information that fit the patient’s cognitive ability and learning style.

2. Sometimes patients will respond better if the information is delivered in a different order. Feel free to adjust the sequence to match the patient’s interests and needs.

3. Skip sections of the manual that don’t fit the needs of the patient, or repeat knowledge and skills the patient already has.

4. The manual can be augmented with other handouts and exercises that can powerfully adjust the clinical approach guided by the manual.

5. Manuals are designed to have the exercises completed as homework assignments. These assignments help patients prepare for individual, group, and psycho-educational sessions.

6. When patients present workbook assignments in groups, it is usually not a good idea to have patients read their answers to each questions. This puts people to sleep. It is better to have a group reporting form that asks patients to answer these questions:

(1) What’s the most important thing that you learned from doing the exercise?

(2) What parts of the exercise were most difficult for you to complete?

(3) What parts do you want the group to help you understand and apply to your own situation?

(4) What can you do differently in your recovery as a result of what you learned by completing this exercise?

(5) How can what you learned help you to move forward in your recovery plan?

Treatment manuals provide guidelines and tools for patients to move forward in therapy. When used properly they can enhance the treatment process. Manuals ARE NOT straight jackets that restrict creativity and clinical reasoning.

Most importantly, treatment manuals don’t DO anything. The clinician who understands their value can use them to make their job easier and to improve the effectiveness of treatment. Well designed treatment manuals help therapists accomplish more while investing less time and energy.

Here are some well-designed and useful manuals to use in addiction treatment and relapse prevention:


Addiction Treatment and the Affordable Care Act (ACA)

November 22, 2013

By Celia Vimont
February 26, 2013

An Introduction
By Terence T. Gorski

The following article by By Celia Vimont summarizes the predictions made by Thomas McLellan, PhD, who reported at the 2013 annual meeting of the New York Society of Addiction Medicine that he believes that the Affordable Care Act (ACA) will revolutionize the field of substance abuse treatment.

I am not as optimistic as as Dr. McLellan about the positive impacts of the ACA on overall recovery rates for addiction clients. Here’s why;

1. When addiction services are merged into medical services the addiction tends not be diagnosed and initial referrals are made to individual doctors most who use medication management.

2. Residential Rehabilitation will not be considered an essential services.

3. Brief screening and early intervention will be attempted but relapse rates tend to be high.

4. Stigma and poly-drug abuse that mixes legal and illegal drugs will both deter early voluntary intervention.

Here is the article reporting on Dr. McLellan’s projections, which are far more optimistic than mine.
The ACA Could Provide Substance Abuse Treatment to Millions of New Patients”

“It will have more far-reaching positive consequences for substance abuse treatment than anything in my lifetime, including the discovery of methadone,” he said at the recent annual meeting of the New York Society of Addiction Medicine.

“It will integrate substance abuse treatment into the rest of health care.”

Currently, just 2.3 million Americans receive any type of substance abuse treatment, which is less than one percent of the total population of people who are affected by the most serious of the substance use disorders—addiction, said Dr. McLellan, who is a former Deputy Director of the White House Office of National Drug Control Policy.

Most who receive treatment are severely affected, he said.
“If diabetes were treated like substance abuse, only people in the most advanced stages of illness would be covered, such as those who had already lost their vision or had severe kidney damage,” he said.

A. Thomas McLellan, PhD
Dr. McLellan reported that 23 million American adults suffer from substance abuse or dependence—about the same number of adults who have diabetes.

An additional 60 million people engage in “medically harmful” substance use, such as a woman whose two daily glasses of wine fuels growth of her breast cancer. The new law will allow millions more people to receive treatment, including those whose substance abuse is just emerging.

Under the ACA, substance abuse treatment will also become part of primary care, and will be focused more on prevention.

Substance abuse treatment will also be considered an “essential service,” meaning health plans are required to provide it. They must treat the full spectrum of the disorder, including people who are in the early stages of substance abuse. “There will be more prevention, early intervention and treatment options,” he said. “The result will be better, and less expensive, outcomes.”

By the end of 2014, under the ACA, coverage of substance use disorders is likely to be comparable to that of other chronic illnesses, such as hypertension, asthma and diabetes. Government insurers (Medicare and Medicaid) will cover physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation.

Currently, federal benefits, such as Medicaid and Medicare, focus on inpatient services, like detox programs, but do not cover office visits for substance abuse treatments. In contrast, Medicaid covers 100 percent of diabetes-related physician visits, clinic visits and home health visits, as well as glucose tests, monitors and supplies, insulin and four other diabetes medications, foot and eye exams, and smoking cessation for diabetics.

“These are all primary care prevention and management services, which are the most effective and cheapest way of managing illness,” he said.

The impact of these new rules will be quite substantial, since an estimated 65 percent of insured Americans are covered by Medicaid or Medicare, and the rest are covered by insurance companies that base their benefits structure on federal benefits, said Dr. McLellan.

As addiction becomes treated as a chronic illness, pharmaceutical companies will be much more interested in developing new medications, he added.

“Immense markets are being created,” he said. “Until now, there have been about 13,000 treatment providers for substance use disorders, and less than half of those are doctors. Now, 550,000 primary care doctors, in addition to nurses who can prescribe medications, will be caring for these patients.”

ON THE INTERNET: http://www.drugfree.org/join-together/addiction/affordable-care-act-to-provide-substance-abuse-treatment-to-millions-of-new-patients

CENAPS OFFICES OFFICES: http://www.cenaps.com

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