Burn Out: What I Do To Avoid It

January 11, 2015

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By Terence T. Gorski
Author, my books can be found at www.relapse.

“The two most important days of your life are the day you were born and the day you find out why.” – Mark Twain

I keep myself from burning out and becoming jaded by doing my best to focus my mind on the following things:

1. Praying: My primary repetitive prayer is: “God teach me of your will for me and give me the courage to carry that out.”

2. Renewing My Commitment To Help: I keep reinforcing that “we keep it by giving it away.” When we help others without trying to control those we are helping and without allowing ourselves to be exploited it helps me keep a balanced perspective.

3. I Dream Big: I see myself as a part of the revolution of the human spirit and human consciousness that will slowly, one person at a time, create a sober and responsible world.

4. I Manage My Expectations: I hope for the best when doing my work. I am prepared for the worst.

5. I Keep Perspective: I can’t do it alone, I can only do my part. I realize the power of a team of people working in harmony towards the same goal is powerful. I strive to stay focused on building a sober and responsible world one day at a time with the help of others.

6. I Take Time For Myself: I have areas of interest that focus my mind on many other things that I find inspiring or helpful. I read voraciously and take the lessons from everything I read that can lift my spirits and give me a positive and heroic fantasy life — kind of like I am “The Walter Mitty of the Addiction Field.”

7. I Dream Big: I strive work day-by-day to contribute things to others that will leave the world a better place. This is called building a legacy in the minds and hearts of others.

8. I Deal With Reality: I Deal With the immediate reality that confronts me by trying to do the next right thing to keep moving toward creating my life goal.

9. I Transcend Fear: I have developed the habit of facing fear without letting the fear control me. My favorite tool for this is Frank Herbert’s Litany Against Fear: “I must not fear. Fear is the mind killer – the little death that brings total obliteration. I will face my fear. I will permit my fear to pass over me through me. When it has gone past I will turn my inner eye to see its path. Where the fear has gone there will be nothing. Only I remain.

10. I copiously reflect upon the deep meaning of The Serenity Prayer: God grant me the serenity to accept the things I cannot change, to change the things I can, and the wisdom to know the difference.”

11. I Collect Quotable Quotes: My two favorites are: “One person can make a difference and every person should try.” ~ John F. Kennedy; and “Great spirits have always encountered violent opposition from mediocre minds. ~ Albert Einstein.

12. I Don’t Take Myself to Seriously: I try to learn something from everyone I meet and everything I do. I strive to be humble by “accepting the things I cannot change, changing the things that I can, and learning to know the difference.” I act upon my strengths without asking for permission. I overcome or compensate for my weaknesses by asking for and receiving help.

To sum it up, I recognize that I am a fallible human being; that I will die and have limited time to live; and that it’s up to me to do the best I can with the cards I am dealt in life. I know that I might be wrong so I stay open to learning, changing and growing. I accept the fact that I am responsible for my life, what I choose to do and not do, and what U choose to focus my mind upon. I look up all words I read or hear to understand what they mean. I realize that language programs the brain/mind so I careful about what I say to myself and others.

Carpe Diem!

Illigitimi non carborundum!

I also renew myself by escaping into Criminal Minds (Spencer is my favorite character) and NCIS (my two favorite character are Gibbs and McGee).

I want to leave a positive legacy and have given a lot of thought to what I want to pass forward to future generations. Here are twenty-five Ideas I want to pass forward to the next generation.

Gorski Books: www.relapse.org

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Fear, Silence, and Speaking Out

January 10, 2015

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Don’t let anyone frighten you into silence.

See the blog on arrogance and courage
https://terrygorski.com/2013/10/18/arrogance-has-a-place/


What Do You Know?

January 10, 2015

The Books of Terence T. Gorski

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There are three things to consider:

1. The things we know that we know.

2. The things we know that we don’t know.

3. The things we don’t know that we don’t know.

The last is potentially the most dangerous.


Concerned Veterans for America

January 10, 2015

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Learn from the few who have stood between you and the guns of the enemy.

“We sleep safe in our beds because rough men stand ready in the night to visit violence on those who would do us harm.” ~ George Orwell

Concerned Veterans for America
http://cv4a.org


The Progression of Alcohol and Other Drug Problems

January 10, 2015

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By Terence T. Gorski, Gorski Books

This is an excerpt from the book by Terry Gorski
entitled: Straight Talk About Addiction

In this blog, we’re going to look at the problems people have with alcohol and other drugs.

Let us start with a simple fact: Alcohol and drug problems are common.

About two-thirds of all Americans drink. About one-third do not. Of those who drink, about half develop alcohol-related problems.

Somewhere between 6 and 10 percent of all Americans will become alcoholics.

In addition to alcohol, many people use illegal drugs and abuse prescription medications.

When you add it all together, about 15% of all people will have serious problems with alcohol or other drugs at some point in their lives.

One thing is certain – no one starts drinking or drugging with the goal of getting addicted. People do not wake up in the morning and say: “Gee, this is beautiful day, I think I’ll go out and get addicted! That’s just not how it works.

Addiction is a slow and insidious process. It sneaks up on people from behind, when they are not looking. Here is how it happens.

When some people start using alcohol and other drugs, they feel really good. The drugs make them feel better than they have ever felt before. Therefore, they keep drinking and drugging.

They focus on enjoying the good times and get in the habit of pushing the bad times out of their minds. This allows the disease of addiction to quietly sneak in through the back door. The “Big Book “of Alcoholics Anonymous says it better than I ever could – Addiction is “cunning, baffling, and powerful.”

Addiction comes into our lives posing as a friend and then slowly grows into a monster that can destroy us.

There was once a man named Ted. His best friend gave him a little kitten. Ted loved that soft cuddly little cat and made it a part of his life. As time went by the cat kept growing and growing. It started to get so big that it was causing problems. It would knock things off the counters, break things, and tear up the house.

Ted loved the cat so much, that he decided to ignore the problems. By the time the cat was six months old, it was clear to everyone that this was no ordinary cat. Ted’s friend had given him a baby mountain lion.

Knowing this, however, didn’t change Ted’s feelings. He loved his “cat so much that he decided to keep it. After all, what harm could it do? He would just take some extra precautions and everything would be fine.

About eight months later a friend came over to visit. Ted’s mountain lion attacked his friend. When Ted tried to pull the cat off of his friend, the mountain lion turned on him and clawed Ted so badly that he nearly died.

Addiction is a lot like Ted’s mountain lion. It starts out as a cute and cuddly little thing that brings a lot of joy, fun, and excitement into our lives. Then the addiction starts to grow up.

As it grows, our addiction turns into a vicious monster that destroys our lives. In this section, we will look at how this happens.

This is an excerpt from the book by Terry Gorski
entitled: Straight Talk About Addiction

Gorski Books: www.relapse.org
Gorski Home Studies: www.cenaps.com<

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Relapse Prevention Therapy (RPT) – An Affordable Evidence-based Practice

November 8, 2014

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By Terence T. Gorski, Author

 

Relapse Prevention Therapy (RPT) is an Evidence-based practiced that is recognized by both the National Registry of Evidence-based Programs and Practices (NREPP) and the National Institute of Drug Abuse. This is important because relapse following drug treatment is quite common and a collection of tools have been forged into a system for both preventing relapse and stopping it quickly should it occur. “RPT is a behavioral self-control program that teaches individuals how to anticipate and cope with the potential for relapse” (NREPP). In addition, RPT serves to normalize relapse as part of the overall recovery process, thus reducing the negative feelings and behaviors that result from a setback. RPT also provided relapse tools and techniques that patients learn early in treatment that can stop relapse quickly should it occur.

The GORSKI-CENAPS Model of RPT brings proven evidence-based practices to recovery and relapse prevention by providing effective and easy to use methods for identifying and managing early relapse warning signs and high risk situations. It also presents methods for planning to stop relapse quickly should it occur. All of the key practices of evidenced-based Relapse Prevention Therapy (RPT) are made available in practical and easy to use workbooks. Training is available to teach the most effective ways to make use the workbooks in individual and group therapy and in support groups. There is also an internationally registry of Certified Relapse Prevention Specialists (CRPS) that are trained to support RPT program implementation.

The Research Supporting RPT Effectiveness

Prevention (RP) is an evidence-based intervention. There is compelling evidence in the literature documenting its effectiveness.

First, let’s look at the results of a meta-analysis of 26 published and unpublished studies with 70 hypothesis tests representing a sample of 9,504 participants. (Irvin et al, 1999)

  • Relapse Prevention (RP) was found to be a widely adopted cognitive-behavioral treatment (CBT) for alcohol, smoking, and other substance use.
  • RP was generally effective, particularly for alcohol problems.
  • RP was most effective with alcohol or polysubstance use disorders combined with the adjunctive use of medication

Validation of Gorski’s Relapse Warning Signs

Though it has enjoyed widespread popularity, Gorski’s post-acute withdrawal syndrome (PAWS) model of relapse has been subjected to little scientific scrutiny. A scale to operationalize Gorski’s 37 warning signs was developed and tested in a larger prospective study of predictors of relapse. Of central interest were: (1) whether the warning signs hypothesized by Gorski are interrelated in a meaningful single factor and (2) whether the hypothesized syndrome would accurately predict subsequent relapses.

A sample of 122 individuals (84 men) entering treatment for alcohol problems was followed at 2-month intervals for 1 year. The Assessment of Warning-signs of Relapse (AWARE) scale was administered at each assessment point, and the occurrence of both slips (any drinking) and relapses (heavy drinking) was monitored during each subsequent 2-month interval. Principal factor analysis was used to study the factor structure of the warning signs.

The results showed that: (1) Of the 37 warning signs, 28 clustered as a robust single factor with excellent internal consistency (Cronbach’s alpha: 0.92-0.93); (2) A conservative evaluation of test-retest stability across 2-month intervals estimated reliability at r = 0.80. (3) After covarying for prior drinking status, clients’ AWARE scores significantly predicted subsequent slips and relapses. Relapse rates for clients with highest AWARE scores, as projected by regression equations, were 33 to 46 percentage points higher than those for clients with lowest AWARE scores, after taking into account prior drinking status.

The conclusion is that this scale of Gorski’s warning signs appears to be a reliable and valid predictor of alcohol relapses. (J. Stud. Alcohol 61: 759-765, 2000)

Relapse Prevention (RP): Controlled Clinical Trials (Carroll 1996)

(1) More than 24 randomized controlled trials have evaluated the effectiveness of cognitive-behavioral relapse prevention treatment on substance use outcomes among adult smokers, alcohol, cocaine, marijuana, and other types of substance abusers. Review of this body of literature suggests that, across substances of abuse but most strongly for smoking cessation,

(2) There is evidence for the effectiveness of relapse prevention compared with no-treatment controls across all drug categories.

(3) Relapse Prevention is most effective at:

  • Treating patients with long histories of chronic relapse after attempting recovery with other treatment methods.
  • Maintaining the positive effects of improvements made during treatment (enhanced durability of effects)
  • Reducing the length and severity of damage caused by relapse episodes when they occur;

(4)      The positive effects of RP are enhanced by patient-treatment matching.

(5) Patient-treatment matching improves outcomes for patients at higher levels of impairment along dimensions such as psychopathology or dependence severity.

Manualized Treatment

Manualized Treatment Improves Effectiveness of treatment (i.e. increases recovery rates, decreases relapse rates, and produces shorter less destructive relapse episodes. The results are achieved while reducing time in therapy.

The primary treatment manuals that help produce these outcomes are:

  1. Starting Recovery With Relapse Prevention Workbook: A workbook designed to integrate basic relapse prevention principles in to the first attempts at addiction recovery.
  2. Cognitive Restructuring for Addiction Workbook: A workbook designed to teach and apply the basic recovery skills of thought management, feeling management, behavior management, impulse control, the use of mental imagery, and a serious of relaxation methods, including mindfulness meditation, that has been proven to enhance the effectiveness of the cognitive component of relapse prevention. This work allows an easy application of RPT methods to a wide variety of additive and mental health problems.
  3. Relapse Prevention Counseling (RPC) Workbook: This is a guide for understanding and managing craving and high risk situations to avoid relapse during the critical first ninety days of recovery.
  4. Relapse Prevention Therapy (RPT) Workbook: This is a guide for helping recovering people with a stable recovery program to identify and manage the personality and lifestyle problems that can so must pain and dysfunction in recovery that self-medication seems like a positive choice. This workbook takes RPT to a deep psychotherapy level.
  5. Problem Solving Group Therapy (PSGT): There are two simple guidelines for using RPT in problem solving groups. There is a Participant Guide to prepare group members with easy to understand information on how to succeed at group therapy and a group leader guide giving in-depth instruction how to start, conduct, and manage common problems that occur in problem solving groups.

When these five practical tools are brought together into a well designed and comprehensive treatment program the quality of care, moral of the staff, and positive long-term outcomes of treatment tend to improve.

WORKBOOKS  USING RELAPSE PREVENTION THERAPY (RPT) – AN EVIDENCE-BASED PRACTICE  http://wp.me/p11fHz-7s

References

The CENAPS Model of Relapse Prevention was originally developed by Terence T. Gorski and continually updated to integrate new research findings. (Gorski 1990, )

Carroll, Kathleen M., Relapse prevention as a psychosocial treatment: A review of controlled clinical trials. Experimental and Clinical Psychopharmacology, Vol 4(1), Feb 1996, 46-54.

Gorski, Terence T., The CENAPS Model of Relapse Prevention: Basic Principles and Procedures, Journal of Psychoactive Drugs, Vol. 22, Issue 2, 1990, pages 125- 133, ON THE INTERNET: http://www.tandfonline.com/doi/abs/10.1080/02791072.1990.10472538

Irvin, Jennifer E.; Bowers, Clint A.; Dunn, Michael E.; Wang, Efficacy of relapse prevention: A meta-analytic review. Journal of Consulting and Clinical Psychology, Vol 67(4), Aug 1999, 563-570.

Miller, William R. and Harris, Richard J.  A Simple Scale of Gorski’s Warning Signs for Relapse, Journal of Studies on Alcohol and Drugs, Volume 61, 2000, Issue 5: September 2000 ON THE INTERNET: http://www.jsad.com/jsad/article/A_Simple_Scale_of_Gorskis_Warning_Signs_for_Relapse/814.html

 

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Complexity: The Comprehensive Bio-Psycho-Social-Spiritual-Cultural-Economic-Political Profile

September 1, 2014

thBy Terence T. Gorski, Author
President, The CENAPS Corporation

Gorski’s Book, Straight Talk About Addiction,
further explains the implications of the distinction between
the brain and the mind in addiction recovery.

Please view this blog as a work in a progress. See it as a passing glance through a partially opened window of my brain/mind, Forgive me, for the room you are glancing into is still cluttered and poorly organized, yet you will see some interesting things emerge from  this superficial examination of the clutter.  As I said, I have not yet fully explored and organized these ideas. I started this blog with a simple idea and became possessed by something newer and for more complex.
I started to write a simple blog asserting that I believe we have both a physical brain and a nonphysical mind and that both are equally important. I wanted to lash out at the flat-landers who would smash human experience into the single dimension of nerve cells  firing as they rub up against each other and band into the environment. My argument was going to be simple: the brain is an important thing, but it is not the only thing.

The paradigm of the BRAIN-MIND is emerging to explain how the physical brain, connects with and is sensitive to the nonphysical actions of the mind. THE BRAIN is the physical structure that supports the nonphysical actions of the THE MIND. We, as human being, are sentient beings with a neuroplastic brain is capable of reprogramming itself based upon experience throughout the entire human life span.The ability to self-regulate the brain-mind assigns meaning to life experiences which can become culturally based beliefs that cause the development complex shared beliefs and personalities that influences our behavior, relationships, and social structures. This can lead to stress, conflict, violence, pain, trauma, stress-related illness, , addiction, and mental health problems. The Brain-Mind takes note and moves to correct the problems.

Medicines can certainly save lives and ease suffering, but so can our interactions with other people who care about us and have well-developed helping characteristics.  The environment in which we live has a lot to do with health and illness. It is incredibly important in terms of alcoholism and drug abuse. Certain kinds of neighborhoods become the incubators of drugs dealers, crime, and violence. Where we live, who we live with, and the nature of our relationship with those we live with has a lot to do with getting addicted, getting clean and sober, staying clean and sober, or relapsing. All these things have a lot do with addition, mental health, and lifestyle-related chronic illness.
As I thought about it, the environment also has a lot to do with illness injury and accident. Some of the greatest improvement in public health did not come from medicine, that came from improved sanitation, safer cars, and the awareness of and elimination of toxic substances in our homes and workplaces. Medicine, of course, base a place in the treatment of heart disease, but so does nutritional science, stress management, and motivational counseling to keep people going with the big changes demanded of heart-healthy living. The lifestyle and stress-related illnesses are among the most difficulty  to treating and the most relapse-prone..
Chronic Life-style-related Illness
Is the Most Difficult To Treat
And the Most Relapse Prone.
In my opinion, the future direction for improving our ability to treat chronic addiction and other lifestyle-related illness will not come from a revolutionary new treatment for these lifestyle-related problems. I would celebrate if that were to happen, I just don’t believe that it will. The next big breakthrough that I see coming in the treatment of addiction and other lifestyle-related illness will not be revolutionary. It will be evolutionary and it is slowly unfolding before out eyes right now.
Brain-Mind Cascade

The Brain-Mind Cascade

There are evolutionary changes pushing us inevitably toward conquering addiction and other lifestyle-related diseases. The evolution involves examining everything we have ever done that helped out clients. It also involves bring all these success stories, no matter how small, together. We view each little success story as a piece in the puzzle to a complicated life-long chronic disease management process.    Then we put them into a big pile (the big pile is actually a high power computer) and start looking for similarities and complimentary components. (The computer actually does most of the looking. We push a button and let the computer do the hard number crunching in the cyber-space world of correlations and algorithms.)

This will allow us to dramatically increase the amount of data that get analyzed and integrated our current knowledge-base of addictive, mental, and stress-related  illness.  This future direction that I believe holds the most promise. We integrate what we already know and look for new combinations and insights. We do this by  organizing the mountain of data into a new grid. I believe that if we could pull off this comprehensive BIOPSYCHOSOCIAL AND ENVIRONMENTAL synthesis of what we have already know, we will be able to find ways of matching patients to treatments and to prevention strategies that could reduce stress-related and life-style related illness by up to 75% in ten years.  It is possible, but it would take a major effort. The necessary funding would require financial reorganization that would probably fail to gain any political traction.
We would need to bring together everything we have learned that helps people to recover across all areas of study. This would mean mapping out a … well a …  Heck, there is no name for the type of map we would be creating. It would be as big a deal as mapping out the human genome, but at least the genome has a name. I can’t think of a good name for dynamic ever-growing map of the human condition so I will call it a comprehensive human bio-psycho-social-spiritual-cultural-ecnomic-political profile. (This name sounds simple and easy to remember, does it not?)
This task is as challenging, perhaps more challenging than mapping the human genome. It would involve getting dozens of different professionals, working in different areas of speciality expertise, who operate in different profession cultures, who use different specialty language, who compete for the same funds, and who usually dislike communicating  across the professional and specialty lines because they don’t really respect what the other professionals are doing. We need to get several million of these professionals to become committed to a collaboration that could change on multiple levels the health of billions of people and the planet they live on.
This collaboration could change on multiple levels
the health of billions of people and the planet they live on.
All specialties would be important. Collaboration and the willing to learn across disciplines would be the cultural organizing theme.  Since each speciality tends to have it own unique professional jargon, it would mean creating a new common-sense language tha could be understood across disciplines and by the common folk who suffer from the illnesses being studied.. It would involve many cross-walks between different ways of thinking: people doing pure science would have t cross-walk their ideas with people doing clinical work.
The people suffering from the human condition, which is nearly every human being alive at some pint in his or her life, needs to be invited to participate. They would be invited to log  onto smart social networking bulletin boards. These smart bulletin boards will allow people to tell the story of their disease and recovery, to describe their symptoms and related issues, and to report what they found helpful, not helpful, and harmful. There would be social networks linking people together to exchange information.
This would require big computer power — and we have that already. It needs to be designed for easy use by ordinary people who can easily enter their experiences with their disease or conditions. This probably means both key-board and voice-activated input — and we have those already.  The computer will organize the information into a big number analysis. The most difficult part of the model is that a wide variety of social, cultural, spiritual, religious, and political factors which affect the health or illness generating capacity of the environment must be included.
The next big breakthrough in the treatment of
addiction and other lifestyle-related illness
will not be revolutionary. It will be evolutionary and
its is slowly unfolding before our eyes right now.
It it were possible to build  this comprehensive multidimensional map of human existence, interesting links and new approaches to cross-disciplinary treatment would begin to emerge.  The technology s here right now. I am sure I am not the only on generating this idea or some variation, so the idea is coming of age.  The financial resources are there, but would need to be redirected which would force a cultural change in values. So what s missing? The only missing element is an army of willing of professionals who are wiling ton take up the challenge. People don’t like change and most people don;t like to take risks. The fear of launching into a new comprehensive paradigm of total  a comprehensive human bio-psycho-social-spiritual-cultural-ecnomic-political profile could open up a whole new environment paradigm and a new way of doing medicine.
This vision is emerging from studying the trends presented by Jeremy Rifkin in his books The end of Work, The Third Industrial Revolution, and the Zero Marginal Cost Society. tThe world is well into the information age that allows us to do things that seemed impossible just two decades ago.  
It is interesting to see the emerging correlations between brain function and such diverse areas as behavior, stress, personality, addiction, violence, interpersonal communication, individual and collective problem solving, and mental health disorders. Looking at these relationships  raise a very old question: does the physical brain or the non-physical mind determine our ability to control our behavior or does behavioral control result from the proper use of the non-physical mind?
There is another factor pushing the process in the information age. Health care is becoming patient driven as the internet provides readily available and scientifically valid descriptions of symptoms, illnesses, medications, and other treatment modalities. The mutual support groups starting with 12-Step programs are expanding through the internet to include high level patient collaboration and even patient initiated studies. Relatively inexpensive websites with smart bulletin boards organizes and sort information into categories to give a bigger picture that could have ever been seen before.

The answer, of course, is yes! At different times the survival responses of the brain (fight, flight, freeze) plus our deeply conditioned habits take over control and we do things we either are not aware of that, in spite of our awareness, we would prefer not to do. (Have you ever had your mouth take on a life of its own during an argument?). At other times we make conscious rational choices governed by the lifestyle we live and the people places and things we choose to associate with.

Today we are coming to the end of a failed paradigm that the physical brain is all that there is. All of the accomplishments and tragedies of mankind ia causes  by a clump of cells that accidentally at some point became self-aware.  Everything is pointing to a non-physical mind that inhabits and works with the physical brain to allow human beings to survive, thrive, maintain health, manage illness and keep moving forward with courage in to an uncertain future.

 

 


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