DSM 5: Simple Procedure for Evaluating Addiction 

August 15, 2016

The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified.
MILD: Two or three symptoms indicate a mild substance use disorder;
MODERATE: Four or five symptoms indicate a moderate substance use disorder, and
SEVERE: Six or more symptoms indicate a severe substance use disorder. 

DSM: Severe Addiction
SEVERE: six or more symptoms indicate a severe substance use disorder. Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled environment.” 
Here are the eleven symptoms (DSM Criteria):

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
1. Taking the substance in larger amounts or for longer than the you meant to

2. Wanting to cut down or stop using the substance but not managing to

3. Spending a lot of time getting, using, or recovering from use of the substance

4. Cravings and urges to use the substance

5. Not managing to do what you should at work, home or school, because of substance use

6. Continuing to use, even when it causes problems in relationships

7. Giving up important social, occupational or recreational activities because of substance use

8. Using substances again and again, even when it puts the you in danger

9. Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance

10. Needing more of the substance to get the effect you want (tolerance)

11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Take an alcohol and drug use history. Then ask the patient if he/she has ever experienced this (the symptom/criteria). Keep going between the patient’s discussion of each criteria and what they reported in the alcohol and drug use history. 
Then you can add a recovery specifier. They offer four options: 

Clinicians can also add one of four specifiers 

1. In early remission,

2. In sustained remission,

3. On maintenance therapy (such as methadone or Suboxone);

4. In a controlled environment (such as detox, residential living, sober living home, jail/prison, etc.)

Try it with patient or in a group and let me know how it goes by posting on my Facebook Page: www.facebook.com/GorskiRecovery 


What Makes Us Stronger

July 7, 2016


By Terence T. Gorski

What Makes Us Stronger? Why is that question important?
The German philosopher, Friedrich Nietzsche believed this simple principle:

“That which does not kill us, makes us stronger.”

The principle is correct on many levels. It eloquently states Nietzsche’s “superman hypothesis” which proposed that it is best for people to be determined, strong and merciless so that human empathy and compassion did not interfere with people living their lives or supporting their collective causes.

This philosophy of Nietzsche was embraced by Hitler and integrated at the core of the education and training to be a NAZIS.

I believe that ideas have powerful personal and collective consequences. Either for good or evil. The more eloquently and memorably an idea is crafted the more effective it is. Ideologies that are brief, easy to remember and repeat to others are most effective. These brief compelling descriptions of ideologies take on a life of their own as they spread from mind to mind.

I try to be careful about the ideologies I embrace and promote because I realize a well-crafted idea is more powerful than a loaded gun.

Like a virus, once an idea or ideology is released to other minds it spreads and is very difficult to stop.

GORSKI-BOOKS: www.relapse.org


GORSKI ADDICTION MODEL

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

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

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THE DEFINITION OF RELAPSE 

May 10, 2015

By Terence T. Gorski

Here are the key points of the definition of relapse from a wide variety of internet dictionaries :

To experience a relapse means:

1. The return of a disease or illness after partial or full recovery from i

2. To suffer a deterioration in a disease after a period of improvement.

3. To fall back into illness after convalescence or apparent recovery

4. To have a deterioration in health after a temporary improvement.

5. To fall or slide back into a former state of illness or dysfunction.

6. To regress after partial recovery from illness.

7. To slip back into bad habits or self-defeating ways of living; to backslide after a period of progress.

8. To fall back into a former state, especially after apparent improvement.

Origin of the word RELAPSE: the word relapse comes from the Middle English word “relapsen,” and from Latin meaning to to “forswear” (to promise or swear in advance that a change will be made.   A combination of the words: relb or relps-, came to mean to fall back gradually; or to slide back without being able to stop ones self (as could happen when trying to move up a slippery or muddy hill.

The word relapse results from a linguistic process called “nominalization” which means to describe a process (like loving someone or relating to someone) into a thing (like love or relationship).

It is important to do a “cross-walk” between 12-Step language (i.e. dry drunk leading to a wet drunk) and the language of cognitive behavioral therapy (the process of falling back into an illness, condition, or habitual problem behaviors that ends in the act of drinking, drugging, or acting out an addiction or habitual self-defeating behavior.

Using an “addictive release” provided by an addictive drug or behavior is often seen as the start of a “relapse episode,” a single discreet episode of addictive use.

A relapse episode is usually preceded by stressful events (triggers), that raise stress and activate old self-defeating and addictive ways of thinking, feeling, acting, and relating to other people.

Marlatt distinguished between a lapse (a short term and low consequence episode of addictive use) and a relapse (a return to a previous state of out-of-control addictive acting out usually accompanied by a return of secondary problems related to the addiction.

I believe in a Twelve-Step Plus Approach that matches the needs of individual recovering people with a strong recommendation to attend 12-Strep Programs and to participate in other treatment activities (professionally supervised) and recovery activities (peer supported and community based) that meet individual needs, promotes long-term recovery, and uses appropriate relapse prevention methods. There is no wrong door into recovery. There is no wrong treatment or recovery activity if it helps people to live a sober and responsible life filled with meaning and purpose.

Language Programs The Brain,
Focuses The Mind, and
Motivates Behavior.

Think clearly to get results in recovery!

~ Terry Gorski Blog: www.terrygorski.com

~ Terry Gorski, via www.facebook.com/GorskiRecovery

www.relapse.org

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God and the Sunrise

February 15, 2015

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By Terence T. Gorski, Author

Once, in the early morning just before sunrise, I was standing with a student waiting for the sun to come up. I was teaching a class on relapse prevention at a conference center in Arizona. I got up early to watch the sunrise. A young man, one of my students, walked up next to me. We both gazed toward the east waiting for the sun to come up

“Do you believe in God?”  the student suddenly asked.

The question surprised me. Before I could answer,  the first rays of the sunrise broke over the eastern horizon – pushing away the darkness of night and blanketing the sand-colored rock with an incredible mist of swirling colors.

I looked at the young man and for a moment. Then I turned back to watch the brilliantly colored rays role gently role toward us. They seemed, at first, to be boiling above the hot desert sand. As the sun rose higher in the sky, the multicolored mist turned into a blazing ball of silver and gold. it was so bright we had to squint our eyes and look away.

“Well – Do you believe in God?” The boy asked again. I had forgotten he had asked the question. His voice was so insistent and his face was so serious that I knew I had to answer

“Yes,” I Said. “I believe in God. There is certainly someone or something bigger and more powerful than me – Someone who capable making much better sunrises than I ever could. I believe in God very strongly when I watch his powerful works unfold all around me.” The boy seemed satisfied with my answer.

We gave one last glance at the rising sun. We turned and walked back into the conference room. Even though the rising sun was incredibly beautiful, there was no time to waste. We were learning about how to help addicts and their families recovery. As we settled in and I began the class, I could feel the presence of God in the room and I realized that the work we were doing in the classroom was just as powerful and awe-inspiring as the sunrise we had just experienced

The Books of Terence T. Gorski


Lying and Second Chances

January 18, 2015

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By Terence T. Gorski
Author (The Books of Terence T. Gorski)

“For every good reason there is to lie, there is a better reason to tell the truth.” ~ Bo Bennett

When you catch someone telling a lie, should you give him or her a second chance? Or should you follow the advice of William Shakespeare: “Trust not him that hath once broken faith.”

This question, when approached thoughtfully, is more difficult to answer than it first appears.

When I ask people whether they should give a second chance to someone who tells them a lie, the answers I get range from “absolutely yes” to “absolutely no.”

Other people have developed rules for when to give a second chance and when to cut their losses by getting the person out of their life, or at least out of their box of sensitive secrets.

The answer to the question of what to do when you discover they are lying depends upon how we define the idea of telling lies and telling the truth. So let’s ask the tough questions that are not as easy to answer as they may seem.

What is a lie?

Here’s the dictionary definition: “a false statement made with deliberate intent to deceive; an intentional untruth; a falsehood.
Synonyms include prevarication and falsification. Antonyms include truth.

What is the truth?

The dictionary tells us that it is “the true actual state of a matter. That which is really happening or going on. Conformity with the facts or reality.” The the concept of the truth is further clarified as: “the real facts about something: the things that are true: the quality or state of being true: a statement or idea that is true or accepted as true; A statement that is supported by evidence.”

Wow! These are really circular definitions that essentially tell us “the truth is what is true!”

These definitions of truth beg a very important issue: the truth is rarely absolute and is usually relative to what is accepted as truth at the time and the “truth as we see it from our point of view.”

Most of the time to “tell the truth” means to “explain our best understanding given our point of view, the extent of our knowledge, and the currently best known and most widely accepted evidence.”

Honesty and lying are as much about the intent to deceive as it is about giving mistaken information.

If you make an honest mistake in solving a mathematical problem, it is usually not considered a lie. It is a mistake or unintentional error. It might be a lie if you deliberately falsify the answers for some secondary gain.

So, in my opinion, it would make sense to make the distinction between an honest mistake (I believe that what I am saying to be factual or true) and a lie (I know what is true and deliberately try to tell you something else).

I find that most people who tell one lie (i.e tell others that something is true when they know that it is not), tend to tell other lies as well. They use lies as an habitual tool to gain things of value in life or to deny some painful truths.

Sometimes the habitual liar can convince themselves that a lie is actually true. This can be a useful skill if you have to pass a lie detector test. Some people are skilled at catching people who are telling lies. This can be a useful skill to recognize and avoid getting hurt by con men and habitual liars.

Most actively addicted people tell lies about their alcohol and other drug use. They minimize how much they use and try to cover up the damage caused by their use.

Some addicts don’t actually lie, they just block out some aspects of reality so they are intentionally ignorant. This is called being sincerely deluded.

Must alcoholics, for example, never count the number of drinks they have or add up how much money they are spending on alcohol or drugs. They keep themselves willfully or intentionally ignorant in order to avoid facing the truth.

The truth is a continually evolving thing based upon our best understanding at the time. All we can really tell someone is our best understanding of the truth as Wevsee it at the current time and then explain why we believe it to be true (i.e. Present the evidence we have that makes us believe that it is true).

In the everyday world we operate on a common-sense definition of truth.

– I did or did not do this!
– I was or was not at a certain place at a specific time!
– This is what has happened in the past !
– This is what is happening now!
– This is what I believe will happen in the future!

Anyone who tells you they know exactly what will happen in the future is guessing or is sincerely deluded. No one can be certain about the future.

Many people have beliefs without evidence. They accept things are true without any real proof. Every culture teaches thousands of truths, both little and big, that people are supposed to accept as true.

So what should you do if you believe someone is lying to you?

The first step is to ask the question again and make sure you are understanding their answer. Many accusations of telling a lie are based in poor communication and misunderstanding.

Tell the other person very clearly that you don’t believe it is true and present your evidence. Tell them you are open to reconsider if they have better evidence. This gives the people their day in court. They get to describe the “truth as they see it from their point of view.”

Before jumping to conclusions it is helpful to detach, back up, observe, and investigate. The serious problem is not a single lie told in isolation to deal with a specific situation. The most serious problem is the person who uses deceit and dishonesty as a habitual way to cope with life.

If there is a pattern of lying, it is foolish to trust. Many people are habitual liars. In other words they are in the habit of twisting the truth to get what they want.

Trust must be earned. It must be built little by little, one step at a time. When building a relationship, it is best to self-disclose a little bit at a time. If the person responds by self-disclosing at the same level to you, go back a try again. If they continue self-disclose at the level that you are they are, they are probable trustworthy. If they don’t reciprocate, be wary and ask yourself if they are trying to hide something or to get you at a disadvantage by knowing more about you than you know about them.

If what you told them in confidence ends up on the grapevine, run the other way. People who gossip and tell you the secrets of others that were told to them in confidence will almost certainly do the same to you.

Recovery demands a policy of rigorous honesty this means:

– The willingness to look honestly at yourself and your past behavior;
– The intent to be honest by reporting the truth as you believe it to be while acknowledging that “I might be wrong.”
– To promptly admit mistakes and be willing to correct them;
– To look with a critical eye at what you believe and the evidence you have to support that belief; and
– To be willing to act in faith upon your best understanding of the truth until you find new and more compelling evidence that causes you to change your mind.

Rigorous honesty is a skill that needs to be learned and practiced. This is because, as fallible human beings we are prone to lie to ourselves and it others. It is also because the truth is hard to find.

LIVE SOBER – BE RESPONSIBLE -LIVE FREE

Don’t miss Terry Gorski’s books and workbooks on recognizing and managing denial.

Denial Management Counseling (DMC)

The Books of Terence T. Gorski


My Depression Management Plan

January 16, 2015

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By Terence T. Gorski
Author

Read Terry Gorski’s Book: Depression and Relapse

Major depression is a serious problem for many people, including people in recovery from alcoholism and other chemical addictions. Many people suffer from depression in recovery and I was no exception. After more than twenty-five years of sobriety, depression nearly took me down.

I figured out a way to manage it. Part of the process of figuring out what to involved researching depression and writing a book about what I learned from the process. The book Depression and Relapse.

I wrote this blog today because I have friend suffering from depression in recovery. I wrote a summary of the things I did to help myself get through the dark times. I thought it might be helpful to others.

Let me know what you think. If you have survived serious depression and used some tools or techniques that helped but aren’t listed here, add them in a comment and be sure to identify yourself and a link to your blog or website so I can properly reference the source. It might help send some traffic your way. So, let’s get on with it.

To manage my severe depression I had to self-monitor it’s severity four times per day (breakfast, lunch, dinner, and before bed).
I used a ten point scale:

0 = No Depression/Normal Mood;

1 – 3 = Mild Depression: It is a nuisance, but I can put it out of my mind and do all of my acts of daily living.

4 -7 = Moderate Depression: It is a nuisance but at times is so severe and drains so much energy that at times I can’t stay focused on my normal daily tasks. At other times I can.

7 -9 = Severe Depression: I get yo and try to function but I usually can’t complete my daily acts of living so I shrink my world by avoiding things.

10 = Disabling: The depression is so bad that I can barely function at all. I can’t get out of bed, I can’t do basic tasks, and no matter what anyone says or does I feel buried by the depression.

I kept a log four times per day and started looking for pattens. I noticed my depression would move through my life in up-and-down cycles. There were times of the day when I was more depressed no matter what was going on. There were other times of the day when the depression wasn’t as bad. I began to see that there were predictable cycles to the severity of my depression symptoms.

I noticed that the depression started to increase and get worse at certain times of the day. Knowing this allowed me to anticipate when I would be the most depressed and avoid scheduling important things during those times. I also learned the times when I tended to be the least depressed and most functional. This allowed to plan my most important activities during those time.

I also noticed weekly cycles. On certain days of the week I would be more depressed than on others. In other words, I could anticipate the really bad days and the better days.

I began doing things to try and manage the depression symptoms. I kept it simple:

– I scheduled alone time for 15 – 30 minutes a day and just distracted myself with pleasant mindless things.

– I took a twenty minute walk each day.

– I started to do brief (3 – 5 minute) sessions of mindfulness meditation.

Here is how I did it: https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-simple/

I also used a meditation technique called Magic Triangle Relaxation Methof. It is described here: https://terrygorski.com/2014/05/08/magic-triangle-relaxation-method/

It wasn’t easy to manage the depression and most people didn’t understand what I was going through. They would ask me: “Why don’t you just snap out of it?” The answer was easy: “I can’t because I have a depressive illness!”

Many of the people I knew were really angry because I wasn’t able to work as hard or be there for them in the ways I was before I got depressed.

One of the things that kept me going was the research that showed how serious episodes of clinical depression tend to run a course of about nine to eighteen months. Each major depressive episode tends to go through three stages:

Stage 1: Gradual increase in the frequency and severity of depression symptom episodes.

Stage 2: The period of most frequent and intense symptoms. This is the stage where most people seek help because the depression is causing life problems. It’s much better to recognize depression in stage one and make managing the emerging symptoms as a top priority. When I did this I found stage 2 would to be shorter and the depression symptoms less severe and disabling. Yes, I had more than one ride on this roller coaster to dark side of depression. I learned from each ride and used it to make the next ride shorter and more manageable.

Stage 3: A period of gradual Symptom reduction until a normal mood (whatever that is) returns.

What I found is that I had always suffered from a chronic low-grade form of depression called Dysthymia. I also discovered depression ran in my family so I considered low grade depression to be normal.

I also paid attention to my automatic thoughts that made my depression worse. I figured out how to actively challenge my automatic depressive thinking. Both my personal experiences and the research I reviewed on the cognitive therapy of depression were the same:

1. There are automatic thoughts that made my depression worse.

2. When I let these depressive thoughts bounce around in my brain my depression kept getting worse.

The depressive thoughts that make depression worse are:

1. This is awful (Awful means worse than it could ever be).

2. This is terrible (terrible means that there will be serious losses of everything that I value).

3. It’s always been this way, I’ve never had a single moment in my life when I wasn’t depressed.

4. It will always be this way. I won’t ever be able to feel better.

5. I can’t stand the way I feel! (Although it is obvious I could stand it because what else could I do?)

6. I can’t do anything about it. There is nothing I can do to make the symptoms even in a little bit better.

7. I am helpless and hopeless in the face of my depression.

8. There is nothing I can do! I can’t do anything to manage the depression or make myself feel even a little bit better for a few minutes.

9. Being depressed proves that I am no good as a person.

10. My depression has robbed me of everything I value and has made me a helpless, useless, crazy person.

Before I figured all of this out, I became suicidal. I felt the compulsion to end myself. The impulse to commit suicide was so strong and persistent it was difficult to resist.

I had to tell close friends about it. I put all potential suicide tools in the hands of friends with clear instructions not to let me have them back. This included my guns, and anything in the medicine cabinet that could be lethal. There are many over-the-counter medications that can kill you with as few as thirty pills. 

How did I know this? The Internet is a wonderful tool for the suicidal. I put the prescription medications I was taking in the hands of someone else who would give me the daily doses of prescribed medication.

Recognizing and managing my suicidal preoccupations and compulsions is a story for another time.

I also used prayer and meditation. This helped me to transcend or rise above the worst symptoms of depression and to find a meaning in my suffering.

It is important to remember that THIS TO SHALL PASS. Depression is not forever and there are things you can do to reduce the severity and duration of depressive episodes.

Read Terry Gorski’s Book: Depression and Relapse

The exercises in the COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK can be easily applied to depression.

The principles of 12-Step Programs can also be helpful. See Understanding the Twelve Steps.


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