Peaceful – Even For A Moment

May 27, 2012

ImageI want to be peaceful, if only for a moment;
to turn off the pain for a little while;
to stop the ever-present chattering of my mind.

These are the things that most addicts want. The only thing they know that will give it to them is their drug if choice. At first it works well, right whenever the addict uses it.  Then, like a fickle friend, the drug of choice plays the ultimate trick.

The addict needs to use more and more to find that moment of peace! It takes less and less to release the monster of intoxication. All too soon the drug of choice stops working and starts destroying. It becomes a problem instead of a problem solver. It causes pain instead of taking it away. It creates inner turmoil and destroys any chance of finding the peaceful state that it originally promised. The big lie of alcohol and drugs becomes clear – they will not permanently peacefulness to the troubled mind. They will not take away my pain or solve my problems.

My drug of choice no longer gives me what I want, but the pain and emptiness of stopping seems unbearable. I am addicted. Trapped by that which once set me free. This is the reality of addiction. It is a game for losers who want to believe in the quick fix and the easy way out. It’s easy to start and difficult to stop. Admission is free but addiction makes you pay a big price to get out.



The Mind Is A Powerful Thing

May 13, 2012

The mind is a powerful thing. It grows and changes in response to our experiences and willful choices. The concept is known as brain plasiticity. The brain grows and changes in response to our experiences throughout the entire human life cycle.

As a result of brain plasticity, the mind – within a set of limits not yet known – can heal the body . We push those limits by focusing our conscious thoughts upon setting goals, developing plans, and working hard to actualize those goals. We do it by thinking, imaging, and creating a vivid and compelling vision of what we want to become. By this imaging or vivid re-imaging process, we expand the capacity of our mind-brain and actually rewrite our programing and our potential. This is how we actualize our dreams. To actualize means to make real through action. 

The brain is the physical foundation of the mind. The mind is the non-physical aspect of human consciousness that makes us self-aware or self-conscious. This self-awareness makes us capable of not only knowing who and what we are, but knowing that we know. Self-awareness gives us the capacity to grow beyond the limitations of genetic programing.

This capacity for self-awareness is called the higher self, or the observing self, or the silent witness. This capacity to detach, observe ourselves, and make decisions to change gives us the capacity to grow beyond our previous programing and our previous limitations. It does not happen on its own. We must make the choice and take the steps to make it happen.

The way we anticipate what tomorrow may bring, sets the power of our mind-brain to work. Tomorrow always comes, bringing with it both new promise and new challenges. The way we practice anticipating tomorrow trains the brain to respond as if it were so. In this way, we condition the brain to create, again within limits unknown, the tomorrow we anticipate and mentally prepare for, rather than the tomorrow we desire.

There is always something to be grateful for. gratitude focuses the mind on the positive experiences of the past, and by doing so, trains the mind in the present, to reproduce the object of gratitude in the future.

A Gratitude List, therefore,  Is a powerful tool for focusing the mind on what really counts. As we focus our mind, the brain will slowly follow. As the brain follows, the body heals. Like a boat well made, the mind and body are self-righting mechanisms designed to stay afloat during storms, and even if turn over, to right themselves. The ability rebalance is built into the design. This is why I believe that the mind is a powerful thing! 

Read: Straight Talk About Addiction
by Terence T. (Terry) Gorski
http://www.relapse.org – www.cenaps.com


Cognitive Impairment and Recovery From Alcoholism

April 30, 2012

Introduction by Terence T. (Terry Gorski)

I first introduced the concept of Post Acute Withdrawal (PAW) in training programs that I presented starting in 1976 and the concept was originally published in the first edition of book Learning To Living Again – A Guide for Recovery From Alcoholism 

The concept of PAW was based upon a combination of clinical experience with relapse-prone alcoholics and a small but growing literature published by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) which was suggesting long-term neuropsychological impairment in recovering alcoholics. These impairments made it difficult for alcoholics to respond to traditional addiction counseling, even when advances in the cognitive therapy field were specifically adapted to alcoholism treatment.

(http://www.cenaps.com/The_Cenaps_Corporation/Learn_to_Live_Again.html ).

The use of harsh confrontation, which was common in the treatment of alcoholics and drug addicts in the 1970’s, actually increased client denial and defensiveness, decreased the ability of recovering people to hear understand and integrate new information. The client got stuck in recovery was unable to progress in recovery, and became increasing frustrated. Symptoms if increased stress were obvious, but clients were unable to respond to the relaxation and stress management training which was just starting come of age. I coined the word stuck point to describe this inability to progress in recovery in spite of attempts to do so.

Once the client got stuck their stress increased and a predictable pattern of early warning signs became apparent. In a future article I will present the independent research which resulted in the AWARE Questionnaire, which confirmed and refined the ability to recognize the early warning signs of relapse.

The stuck point led to increased stress. The high stress, in turn, increased frustration and a morbid fear of inevitable failure. Since alcohol and drug use had be so destructive in the past, the fear of relapse activated a survival threat seemed to decrease the ability to think clearly and learn new information and skills. The relapsing people usually failed to understand what was happening and judged themselves as dumb, stupid, and unable to recover. Therapist often failed to recognize the neuropsychological basis of the symptoms, mislabeled it as denial and resistance and proceed to confront the client. The confrontation just made things worse. Other therapists decided the neurocognitive impairment was caused by unresolved family of origin problems and used deep relaxation and guided imagery to resolve trauma from previous physical or sexual abuse. This of course, was the hallmark of the codependency era.

The use of confrontation, regressive hypnosis, and catharsis techniques all increased the stress of clients, lowered their self-esteem by making them feel crazy, and decreased their self-confidence. This lack of self-confidence or absence of the positive belief in their ability to successfully recover was later dubbed low efficacy by cognitive therapists such as Alan Marlatt, Dennis Donovan, and Dennis Miller.

Convincing evidence began to develop that low efficacy was directly related with an increase in early relapse warning signs and the eventual failure to maintain recovery. The final trigger event was a high risk situation which activated craving in an environment that reinforced alcohol use while removing support for ongoing recovery.

Alan Marlatt observed the same thing. He originally described the phenomenon of apparently irrelevant decisions, which, in essence, described the same phenomena that I described as early relapse warning signs.

Both concepts were pointing at the same thing – symptoms caused progressive neuropsychology or neurocognitive dysfunction related to the stress of feeling stuck in a dysfunctional state and slowly becoming so dysfunctional and having no effective way to manage the growing inability to function. This produced a survival threat. We now know that high levels of stress activates the amygdala in the brain. The amygdala would shift behavioral control from slow-moving conscious decision-making to automatic use of emergency survival skills.

I labeled this progressive stress-induced dysfunction as the relapse syndrome.

The relapse syndrome was a progression of early warning signs of relapse  that ended in a high risk situation which activated craving, drug-seeking behavior, exposure to high risk situations, and the return to using alcohol and or other drugs.

The bottom line is this. In 2008 a compelling body of evidence exists that there is progressive brain dysfunction in alcoholic clients. This brain dysfunction is measureable and supported in the scientific literature. What follows is the research verification for the Post Acute Withdrawal Syndrome (PAW) Syndrome. This evidence is summarized in the following Alcohol Alert.

National Institute on Alcohol Abuse and Alcoholism

Alcohol Alert, No. 53 – July 2001

http://pubs.niaaa.nih.gov/publications/aa53.htm

 Brain damage is a common and potentially severe consequence of long-term, heavy alcohol consumption. Even mild-to-moderate drinking can adversely affect cognitive functioning (i.e., mental activities that involve acquiring, storing, retrieving, and using information) (1). Persistent cognitive impairment can contribute to poor job performance in adult alcoholics, and can interfere with learning and academic achievement in adolescents with an established pattern of chronic heavy drinking (2). A small but significant proportion of the heaviest drinkers may develop devastating, irreversible brain-damage syndromes, such as Wernicke-Korsakoff syndrome, a disorder in which the patient is incapable of remembering new information for more than a few seconds (3).

It stands to reason that cognitive impairment also may impede recovery from alcoholism, although evidence has not conclusively shown this to be the case.  For example, Morgenstern and Bates (4) studied whether deficits in a patient’s learning and planning abilities-core aspects of many treatment strategies-affected recovery from alcoholism. They found that impairment was not a significant predictor of poor treatment response. On the other hand, evidence does support the possibility that brain damage, whether resulting from or predating alcohol use, may contribute to the development and progression of alcoholism (5).

Designing practical strategies to cope with the complex combination of alcoholism and cognitive impairment requires an understanding of the nature of cognitive functions and their interactions with structural and functional brain abnormalities. This issue of Alcohol Alert describes the nature and consequences of common alcohol-associated cognitive defects, explores the extent to which some cognitive abilities recover with abstinence, and summarizes recent research on the effects of cognitive deficits on alcoholism treatment outcome.

Cognition and Alcohol

Most alcoholics exhibit mild-to-moderate deficiencies in intellectual functioning (6), along with diminished brain size and regional changes in brain-cell activity. The most prevalent alcohol-associated brain impairments affect visuospatial abilities and higher cognitive functioning (7). Visuospatial abilities include perceiving and remembering the relative locations of objects in 2- and 3-dimensional space. Examples include driving a car or assembling a piece of furniture based on instructions contained in a line drawing. Higher cognitive functioning includes the abstract-thinking capabilities needed to organize a plan, set it in motion, and change it as needed (2).

Most alcoholics entering treatment perform as well as nonalcoholics on tests of overall intelligence. However, alcoholics perform poorly on neuropsychological tests that measure specific cognitive abilities (8). For example, an alcoholic who has remained abstinent after treatment may have no apparent difficulty filing office documents correctly, a task that engages multiple brain regions. However, that same person might be unable to devise a completely different filing system, a task closely associated with higher cognitive functioning.

How Much Is Too Much?

The link between duration and lifetime quantity of drinking and the development of cognitive problems is unclear. Some investigators have proposed that cognitive performance worsens in direct proportion to the severity and duration of alcoholism (6,9). Studies suggest that social drinkers who consume more than 21 drinks per week also fit into this category (6). Other investigators have suggested that cognitive deficits may be detectable only in those alcoholics who have been drinking regularly for 10 years or more (8,10). Long-term, light-to-moderate social drinkers have been found to fall into this category as well, showing cognitive deficits equivalent to those found in detoxified alcoholics (8). Although further research is needed to determine how a person’s pattern of drinking is related to cognitive impairment, some deficits are possible even in people who are not heavy drinkers.

Tracking Structural and Functional Brain Abnormalities

Structural and functional brain abnormalities generally are measured by noninvasive imaging techniques that provide a picture of the living brain with minimal risk to the individual. Structural imaging techniques, such as computed tomography and magnetic resonance imaging, are used to generate computerized pictures of living tissue. Functional imaging techniques, such as positron emission tomography and magnetic resonance spectroscopy, permit scientists to study cell activity by tracking blood flow and energy metabolism. For more information about imaging, see Alcohol Alert No. 47, “Imaging and Alcoholism: A Window on the Brain.”

Structural imaging consistently reveals that compared with nonalcoholics, most alcoholics’ brains are smaller and less dense (11,12). Loss of brain volume is most noticeable in two areas: the outer layer (i.e., the cortex) of the frontal lobe, which is considered a major center of higher mental functions (7,12,13); and the cerebellum, which is responsible largely for gait and balance as well as certain aspects of learning (14). Support for these results is provided by functional imaging studies, which reveal altered brain activity throughout the cortex and cerebellum of heavy drinkers (15). In addition, functional imaging often is sufficiently sensitive to detect these irregularities before they can be observed by structural imaging techniques, and even before major cognitive problems themselves become manifest. This suggests that functional imaging may be particularly useful for detecting the early stages of cognitive decline (15).

Understanding the Basis of Cognitive Impairment

Accurate measurement of cognitive abilities is challenging, and relating those abilities to a specific brain irregularity simply may not be possible with the current technology (16). Discrepancies among research findings have led scientists to develop improved cognitive-measuring techniques. Using a battery of tests, Beatty and colleagues (9) have suggested that widespread (i.e., diffuse) cognitive impairment could arise from damage to multiple brain areas, each of which regulates distinct but related abilities. Likewise, damaging the network of brain cells that synchronizes the overall activity of those multiple areas may produce the same cognitive impairments previously attributed to localized damage (9).

Is Impairment Reversible?

Certain alcohol-related cognitive impairment is reversible with abstinence (17). Newly detoxified adult alcoholics often exhibit mild yet significant deficits in some cognitive abilities, especially problem-solving, short-term memory, and visuospatial abilities (18). By remaining abstinent, however, the recovering alcoholic will continue to recover brain function over a period of several months to 1 year (19)-with improvements in working memory, visuospatial functioning, and attention-accompanied by significant increases in brain volume, compared with treated alcoholics who have subsequently relapsed to drinking (18).

Rewiring Brain Networks

Reversibility of alcohol-related cognitive function also may be the result of a reorganization of key brain-cell networks. Some researchers have proposed that such reorganization may contribute to the success of alcoholism treatment. Using advanced imaging techniques, Pfefferbaum and colleagues (20) examined the brain activity of cognitively impaired alcoholic participants during a series of tests designed to assess cognitive function. They found that although the alcoholic subjects had abnormal patterns of brain activation, compared with control subjects, they were able to complete the tasks equally well, suggesting that the brain systems in alcoholics can be functionally reorganized so that tasks formerly performed by alcohol-damaged brain systems are shunted to alternative brain systems.  This finding-that cognitively impaired alcoholic patients use different brain pathways than unimpaired patients to achieve equivalent outcome-also was suggested in a study of patients in 12-step treatment programs (4). Functional brain reorganization may be particularly advantageous for adolescent alcohol abusers in treatment, because their developing brains are still in the process of establishing nerve-cell networks (21).

Cognitive Function and Alcoholism Treatment

The exact role that cognitive function has in alcoholism treatment success is unclear. Structural and functional imaging, as well as more specific cognitive tests, may provide scientists with the tools needed to reveal subtle relationships between alcohol-related cognitive impairment and recovery. Meanwhile, certain conclusions can be drawn from existing research that help to explain how cognitive function may influence alcoholism treatment:

Cognitive deficits have been hypothesized to affect the efficacy of alcoholism treatment, although a clear association has not been established. One view finds that cognitively impaired patients may not be able to comprehend the information imparted during therapy and, thus, may not make full use of the strategies presented, thereby hampering recovery. Another view is that cognitive functioning may not directly influence treatment outcome, but may impact other factors that, in turn, contribute to treatment success (22). Focusing on those factors-such as improved nutrition, opportunities for exercise, careful evaluation of comorbid mental or medical disorders, and/or treatment strategies aimed at enticing the patient out of long-standing social isolation-ultimately may be more beneficial than focusing exclusively on recovery from alcoholism.

Other types of non-alcohol-related brain damage also can produce symptoms resembling those associated with chronic alcoholism. Clinicians must be aware that no matter the cause of the impairment, it may have an impact on the patient’s ability to benefit fully from alcohol-treatment strategies. Cognitive impairment is usually most severe during the first weeks of abstinence, perhaps making it difficult for some alcoholics to benefit from educational and skill-development sessions, which are important components of many treatment programs (22,23). For example, one study found that alcoholics tested soon after entering treatment were unable to recall treatment-related information presented in a film they had just been shown (4). As time goes by and cognitive function improves, however, patients may make better use of information presented to them in individual and group therapy, educational programs, and 12-step programs.

Cognitive Impairment and Recovery From Alcoholism-
A Commentary by NIAAA Director Enoch Gordis, M.D.

The new noninvasive imaging techniques that allow us to “see” how the brain operates have been a boon to the study of cognition. Through this medium, we now know that the brain is capable of “rewiring” itself. In doing so, the brain can regain some of the cognitive abilities previously diminished as a result of damage from alcohol or other diseases. The brain’s remarkable ability to recover is important for at least two reasons. First, alcohol use over a period of time, even at low levels of drinking, can produce varying degrees of cognitive damage, a problem that is of particular concern because alcohol use is so widespread. Thus, the brain’s self-repairing ability may help defer or reduce alcohol-induced cognitive problems among a large portion of the population. Second, the brain’s ability to rewire itself may have implications in terms of adolescent drinking. Recent evidence suggests that the adolescent brain, which is still forming important cellular connections, is more vulnerable than the adult brain to alcohol-induced damage. This is particularly troubling, given the problems associated with chronic binge drinking, which is all too common among young people. The brain’s ability to rewire important neurological systems might help mitigate a lifetime of cognitive difficulties resulting from chronic drinking during adolescence, but we do not yet know if this is true. Future research will help clarify this and other important questions about alcohol’s effect on cognition.

References

(1) Evert, D.L., and Oscar-Berman, M. Alcohol-related cognitive impairments: An overview of how alcoholism may affect the workings of the brain. Alcohol Health Res World 19(2):89-96, 1995. (2) Giancola, P.R., and Moss, H.B. Executive cognitive functioning in alcohol use disorders. In: Galanter, M., ed. Recent Developments in Alcoholism: Volume 14. The Consequences of Alcoholism.New York: Plenum Press, 1998. pp. 227-251. (3) Oscar-Berman, M. Severe brain dysfunction: Alcoholic Korsakoff’s syndrome. Alcohol Health Res World 14(2):120-129, 1990. (4) Morgenstern, J., and Bates, M.E. Effects of executive function impairment on change processes and substance use outcomes in 12-step treatment. J Stud Alcohol 60(6)846-855, 1999. (5) Bowden, S.C.; Crews, F.T.; Bates, M.E.; et al. Neurotoxicity and neurocognitive impairments with alcohol and drug-use disorders: Potential roles in addiction and recovery. Alcohol Clin Exp Res 25(2):317-321, 2001. (6) Parsons, O.A. Neurocognitive deficits in alcoholics and social drinkers: A continuum? Alcohol Clin Exp Res 22(4):954-961, 1998. (7) Oscar-Berman, M.; Shagrin, B.; Evert, D.L.; and Epstein, C. Impairments of brain and behavior: The neurological effects of alcohol. Alcohol Health Res World 21(1):65-75, 1997. (8) Parsons, O.A., and Nixon, S.J. Cognitive functioning in sober social drinkers: A review of the research since 1986. J Stud Alcohol 59(2):180-190, 1998. (9) Beatty, W.W.; Tivis, R.; Stott, H.D; Nixon, S.J.; and Parsons, O.A. Neuropsychological deficits in sober alcoholics: Influences of chronicity and recent alcohol consumption. Alcohol Clin Exp Res 24(2):149-154, 2000. (10) Eckardt, M.J.; File, S.E.; Gessa, G.L.; et al. Effects of moderate alcohol consumption on the central nervous system. Alcohol Clin Exp Res 22(5):998-1040, 1998. (11) Pfefferbaum, A.; Rosenbloom, M.; Crusan, K.; and Jernigan, T.L. Brain CT changes in alcoholics: Effects of age and alcohol consumption. Alcohol Clin Exp Res 12(1):81-87, 1988. (12) Pfefferbaum, A.; Lim, K.O.; Zipursky, R.B.; et al. Brain gray and white matter volume loss accelerates with aging in chronic alcoholics: A quantitative MRI study. Alcohol Clin Exp Res 16(6):1078-1089, 1992. (13) Lyvers, M. “Loss of control” in alcoholism and drug addiction: A neuroscientific interpretation. Exp Clin Psychopharmacol8(2):225-249, 2000. (14) Sullivan, E.V.; Rosenbloom, M.J.; Deshmukh, A.; et al. Alcohol and the cerebellum: Effects on balance, motor coordination, and cognition. Alcohol Health Res World 19(2):138-141, 1995. (15) Eberling, J.L., and Jagust, W.J. Imaging studies of aging, neurodegenerative disease, and alcoholism. Alcohol Health Res World 19(4):279-286, 1995. (16) Parsons, O.A. Determinants of cognitive deficits in alcoholics: The search continues. Clin Neuropsychologist 8(1):39-58, 1994. (17) Volkow, N.; Wang, G.J.; and Doria, J.J. Monitoring the brain’s response to alcohol with positron emission tomography. Alcohol Health Res World 19(4):296-299, 1995. (18) Sullivan, E.V.; Rosenbloom, M.J.; Lim, K.O.; and Pfefferbaum, A. Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: Relationships to changes in brain structure. Neuropsychology 14(2):178-188, 2000a. (19) Sullivan, E.V.; Rosenbloom, M.J.; and Pfefferbaum, A. Pattern of motor and cognitive deficits in detoxified alcoholic men. Alcohol Clin Exp Res 24(5):611-621, 2000 b. (20) Pfefferbaum, A.; Desmond, J.E.; Galloway, C.; et al. Reorganization of frontal systems used by alcoholics for spatial working memory: An fMRI study. NeuroImage 13:1-14, 2001. (21) Spear, L. Modeling adolescent development and alcohol use in animals. Alcohol Res Health 24(2):115-123, 2000. (22) Allen, D.N.; Goldstein, G.; and Seaton, B.E. Cognitive rehabilitation of chronic alcohol abusers. Neuropsych Review 7(1):21-39, 1997. (23) McCrady, B.S., and Smith, D.E. Implications of cognitive impairment for the treatment of alcoholism. Alcohol Clin Exp Res 10(2):145-149, 1986.


Helping Characteristics

April 29, 2012
By Terence T. Gorski

www.relapse.org –  www.relapse.com

Effective helpers have integrated eight basic helping characteristics into their personalities.  The effectiveness of the therapists will improve as they consistently demonstrate a broader balance of these characteristics.

In the GORSKI-CENAPS® model, these helping characteristics are also applied in Group therapy.  Since an important role of group members is to help one another solve problems, it seems reasonable that the higher the level of helping characteristics demonstrated by group members during sessions, the more effective the groups will be.  This establishes a primary goal of the group leader to encourage the development of helping characteristics in all group members by role modeling them.

1.         Empathy:  Empathy is the ability to understand how another person perceives or experiences a situation or event.  It is the ability to enter the context, mind-set, or frame of reference of another person and to perceive the world from his or her point of view.  It is also the ability to communicate your perception of how the other person is perceiving the experience.

2.         Genuineness:  Genuineness is the ability to be fully yourself and to express your unique individual style and personality to another.  It is an absence of phoniness, role-playing, and defensiveness.  In a genuine person the outer behavior (the public self) matches the inner thoughts and feelings (the private self).

3.         Respect (Positive Regard):  Respect is the ability to communicate to another person, both verbally and non-verbally, the belief that he or she has the inner strength and capacity to make it in life, has the right to make his or her own decisions, and has the capacity to learn from the consequences of those decisions.

4.         Self-Disclosure:  Self-disclosure is the ability to communicate personal thoughts, feelings, attitudes, and beliefs to another person in a context appropriate manner when it is in the benefit of the other person for you to do so.

5.         Warmth:  Warmth is a non-verbal behavior that demonstrates positive regard and makes another person psychologically visible in a positive way.  Examples of behavior that communicate warmth would be touching, smiling, making eye contact, talking in a soft gentle tone of voice, etc..

6.         Immediacy:  Immediacy is the ability to focus upon the “here and now” interaction between yourself and other people.  The use of “I” statements followed by statements of personal reaction typically express immediacy.  Examples would be:  “Right now I am feeling ________.  When you said that, I began to think __________.  Right now I feel like _________.  As you were speaking, I began to sense that you were experiencing ___________.”

7.         Concreteness:  Concreteness is the ability to identify and clarify specific problems or issues.  It also includes the ability to design an action plan that describes the concrete steps that need to be solved in order to correct or resolve the problem.  Concreteness involves the ability to keep focused upon a specific problem and the action plan designed to resolve it.  It includes making clear and concrete expectations of others and inspecting the outcomes of those expectations.

8.         Confrontation:  Confrontation is the act of honestly communicating to another person your perception of reality which includes:  Your honest perception of the person’s strengths and weaknesses.  What you believe the person is thinking and feeling; How you observe the person to be acting; and What you believe are the logical consequences of those actions.  Effective confrontation communicates your view of reality to the other person in a way that supports the person while pointing out self-defeating thinking, emotional responses, behavior, and situational involvement.

Confrontation, Self-Exploration, and Helping Characteristics

Susan Anderson (Anderson, 1968) did a study that shows the relationship between the use of confrontation,  other helping characteristics (which she called facilitating conditions), and the movement of patients from confrontation to self-exploration. This article demonstrates the importance of having clear operation definitions of basic counseling procedures.

Anderson looked at the relationship between SUPPORTIVE/RATIONAL CONFRONTATION (which she simply called confrontation), the use of HELPING CHARACTERISTICS (which she called facilitating factors),  and the ability of the patient to move from Confrontation to SELF-EXPLORATION (Confrontation –> Self Exploration).

SUPPORTIVE-RATIONAL CONFRONTATION is defined as pointing out problems, self-defeating behaviors, or inconsistencies in a way that supports the person and points out the problem behavior. Anderson’s study did not allow therapists to use HARSH PSYCHO-NOXIOUS CONFRONTATION which involves angry/hostile attacks, arguing, fighting, or challenging a patient to look at problems from the therapist’s point-of-view with the intent to prove that the therapist is right or and the patient is wrong. From this point on, when I use the term confrontation, I use it to mean rational-supportive confrontation as defined above. When I use the term HELPING CHARACTERISTICS is will be used to mean the same as Anderson’s facilitating conditions.

THE RELATIONSHIP BETWEEN CONFRONTATION, HELPING CHARACTERISTICS, AND MOVEMENT FROM TO SELF-EXPLORATION

METHOD: Tape recordings were made of 40 initial therapy interviews. A review panel of judges were trained to accurately identify the therapist’s use of CONFRONTATION and the Helping Characteristics (Five facilitating Conditions) and the patients movement from the confrontation to self exploration.

CONFRONTATION was operationally defined as “the therapist initiating interactions in which the therapist pointed out to the patient a discrepancy between his own and the client’s way of viewing a situation.” This is essentially the same as the definition of confrontation used in the first part of this article).

The HELPING CHARACTERISTICS, described as Five facilitating Conditions, were defined as: the therapist’s observable use by the judges of   the therapist’s use of: (1) Empathy,  (2) Genuineness, (3) Respect (Positive Regard), (4) Self-Disclosure, and (5) Concreteness. The characteristic warmth (part of the description of genuineness) and immediacy were not evaluated as separate categories).

SELF EXPLORATION was defined as the client’s ability to hear the therapists feedback (the content of the confrontation) accurately and discuss what aspects of the information presented in the confrontation fit or did not fit the situation being discussed.

Anderson’s study looked at the relationship between:

(1) Th number of times the therapists used CONFRONTATION

(2) The number of time the therapist used  HELPING CHARACTERISTICS, and

(3) And how frequently the use CONFRONTATION led into patient initiated SELF-EXPLORATION

HYPOTHESIS: The hypothesis was that:

(1) Confrontation would be positively related to high levels patient self-exploration, when accompanied by high levels of the helping characteristics, and

(2) Confrontation would be related to low levels of movement into self-exploration when accompanied by low levels of helping characteristics. these conditions, confrontation was never followed by increased self-exploration.

THE RESULTS WERE:

1. Patients had a high level of movement INTO self-exploration when the therapist used high levels of HELPING CHARACTERISTICS,
2. Patient’s NO NON-EXISTENT) movement from confrontation to self-exploration.  In other words, the patient NEVER moved from confrontation to self-exploration) when the therapist used low levels of HELPING CHARACTERISTICS.
3. As the use of HELPING CHARACTERISTICS increased there was an increase in the patient’s level of movement from confrontation to self-exploration.
4. There appears to be a minimal level at which the use of helping characteristics need to be used before any change in the movement from confrontation to self-exploration occurred.
5. This could be because a level of trust (defined as a consistent use helping characteristics used to support self-exploration ) requires at least a moderate use of the helping characteristics.

REFERENCES:
Anderson, Susan C., THE EFFECTS OF CONFRONTATION BY HIGH AND LOW-FUNCTIONING THERAPISTS., Journal of Counseling Psychology, Vol 15(5, Pt.1), Sep 1968, 411-416.

Carkhuff, Robert R. and Anthony, William A., The Skills of Helping, Human Resource Development Press, Amherst, Massachusetts, 1979.

Carkhuff, Robert R. and Berenson, Bernard G., Beyond Counseling and Therapy – Second Edition, Holt Rinehart, and Winston, Amherst, Massachusetts, 1977

Gorski, Terence T., The Gorski-CENAPS Model for Recovery and Relapse Prevention, Independence, Missouri: Herald House/Independence Press, 2007.

Rogers, Carl R. “The characteristics of a helping relationship.” The planning of change (1969): 153-166.


Brain Disease – Expanding Into A Unified Model

April 29, 2012

By Terence T. (Terry) Gorski

The “Brain Disease Model” of addiction is useful but limited. I believe the best model is a bio-psycho-social-spiritual model that is described in detail in my new book Straight Talk About Addiction (Check out :http://www.cenaps.com/The_Cenaps_Corporation/Home.html and www.relapse.org )

The bio component involves “the addictive brain response” which occurs when the drug of choice activates a flood of pleasure chemicals in the brain while slowing down the production of stress other warning chemicals that give us the gift of fear which warns us of danger.

The Psycho component involves the addictive thoughts, feelings, urges and actions that drive chemical and process addictions.

The social dimension involves personal relationships, attachment to social groups for the purpose of business and recreation, and culture. It is within this social dimension where we confront the difficult issue of the group mind or group consciousness

This addictive brain response causes changes in thinking, feelings, motivations, and actions. When the addictive brain response is activated, intuition and conscience are both affected. Intuition and conscience activate automatic signals generated by brain chemistry which come from both innate characteristics (we are programmed to know right and wrong, safety from danger, what is good for me and what is bad for me on primitive felt-sense level; our conscience or moral compass) and learned moral behavior (our sense of right and wrong is refined and developed through learning and life experience. The addictive brain response distorts or shuts down both intuition and conscience.

The addictive brain response also diminishes or eliminates anxiety and fear, which are natural warning signals that we may be in danger. The addictive brain response also causes the unconscious signaling system designed to support our family of origin program, as expressed in our personality, to diminish or disappear entirely. As a result people can overcome the unhealthy inhibitions programmed into their brain chemistry responses as children. Unfortunately, when sober these old responses return.

This unique feeling of euphoria can free people from inhibitions and allows them to feel free to be who they want to be and to do what they choose to do. As the addictive disease progresses, it takes higher doses of alcohol or other drugs of choice to get the euphoric feelings. In terms of process addictions, it takes greater and greater levels of stimulation over longer periods of time to get the euphoric effect. People drink and use drugs more often and more heavily. Their lives become focused around alcohol and other drug use. They develop an addiction-centered social life, and chasing the euphoria becomes the primary concern. This is where the “social” part of biopsychosocial enters the picture.

With sobriety, the brain heals. Brain research also provides compelling evidence for brain plasticity – the term used to describe the idea that the brain grows in response to experience throughout the course of the life span. As a result specific cognitive and behavioral therapies can systematically cause the building of new neurocircuits   that support recovery and responsibility through systematical practice of specific ways of thinking and acting when under stress. As recovering people stop using addictive thoughts, behaviors, and chemicals, the addictive  that support drug-seeking behavior become weaker . The circuits that support sober and responsible behavior get stronger.  Good news, but it takes knowledge, skill, practice, and determination over a long period of time to activity neuroplastic brain growth.

Spirituality provides a critical connection with a source of courage, strength, and hope allows people to keep moving ahead in their recovery even when they don’t feel like it. It allows them to overcome cravings, face and manage fear, and find a way to stay calm in the face of the frustrations of life and living.  This is a life-long recovery process. Life is hard. Human beings die and we know that we will do so. Living in the shadow of the inevitable deaths of ourselves and our loved ones produces a background feeling of fear and pain which has been described as angst. We need courage, strength and hope that something good will come of our recovery. This sense of hope keeps on going during hard times. To keep hope alive in the face of fear and discouragement requires courage.

The Brain Disease Model of Addiction provides useful information and helpful ideas about approaching recovery. Unfortunately, fails to take into account some critical biopsychosocial aspects of recovery encompassed in nonphysical or spiritual ideas like Higher Power, group conscience, courage, strength and hope. These nonphysical dimensions of humanity is what gives people their greatest sense of meaning and purpose. We can’t yet take brain scans that show pretty pictures of these things in the brain.  Perhaps we never will! This, however, does not mean they do not exist. The spiritual aspects of recovery may not be tangible or physical. There may very well be a nonphysical mind that inhabits and takes control of the physical brain. These nonphysical aspects of humanity provide powerful experiences that often defy description. Yet these power spiritual experiences often mark critical turning points or milestones in recovery. The importance of these of building upon these nonphysical or spiritual aspects of recovery are critical to recovery. Recovery is possible.

~ Terry Gorski  via http://www.facebook.com/GorskiRecovery

Gorski Home Studies for CEUs: http://www.cenaps.com/The_Cenaps_Corporation/Home_Study.html

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

Straight Talk About Suicide by Terry Gorski:
     http://www.relapse.org/custom/cart/edit.asp?p=129702

Call Tresa at 352-279-3068 for information
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