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Karin* sits on her sofa, tearfully re-reading text messages and asking herself the same question… “why?”  She continues to end up in relationships where her partner is controlling, unappreciative, and disloyal. This is despite doing anything imaginable to make him happy. Her last boyfriend basically drained her savings while continually saying he was working on getting his car dent repair business going. She would go to work every day to earn the money to pay the bills while he worked from home “developing advertizing and networking plans”. Meanwhile, the only thing that seemed to improve was his video game skills.  How can people like Karin make different choices and find healthy relationships? These tips can help you improve the quality of various types of relationships, e.g. romantic and friendship.

First, one of the most important things is to have a good relationship with yourself. If you don’t truly value yourself, you may not recognize when you are being treated poorly or you may not know that you deserve better. Having a good relationship with yourself means that you take the time to take care of yourself (not just physically). Set aside time to do things for you, surround yourself with others who value you, and set appropriate boundaries with others. It also means living a life in harmony with your values.

Second, I always encourage those who struggle in this area to come up with a “deal-breakers” list. What are the things you are not willing to live with? What are the things that are traits, etc, that you require? Decide this before you get emotionally involved and your boundaries start to blur… “Well, it’s not that bad.” Yes it is! If you decided in your sane, uninfluenced mind that a certain behavior was unacceptable or a trait was necessary for your well-being, you should stick with it.  The less experience you have in life, the harder this list may be to develop. However, if you have had a history of “failed relationships,” you can probably recall things from that experience that will help you get started. Examples include: physical violence, spirituality, and desire to have children. Once you know what your deal-breakers are, use that information to choose who you spend your time with… and who you will be breaking up with.

Finally, pay attention to the evidence. I know my more romantic readers will find this part a little uncomfortable, but hear me out. Think about all of the times you have made a relationship choice (e.g. to become intimate with someone or trust someone with personal information) because it felt right. How many times has that feeling mislead you? This does NOT mean that feelings and attraction don’t matter. It means that you need to supplement them with evidence that the person is who you think they are. This often means moving more slowly in a relationship than you may have done in the past. Pay attention to what a person talks about. Are they telling you personal information about others? That may be a sign that they don’t respect a person’s privacy. Are they telling you deeply personal information right away? While this might seem romantic, it can be a sign that a person struggles with boundaries and jumps into (and out of) relationships quickly.

Karin, mentioned in the outset, called a friend for support and received empathy and encouragement. After having some time to grieve her loss, she sought help for developing relationship skills, and while she found it a challenge to change the way she handles relationships, she gained confidence, skills for setting boundaries, and freedom from unhealthy relationships, She now chooses to spend her time with people who treat her with respect and value her for the amazing person that she is. And, when someone doesn’t treat her the way she deserves to be treated; she kicks ’em to the curb!

*Karin is a fictitious character created to reflect the real life challenges faced by individuals who struggle with healthy relationship skills.

Lillian Hood, LPA, LCAS

Psychologist and Clinical Addictions Specialist

At the Chrysalis Center, I specialize in treating individuals who have trauma, depression, bipolar disorder, anxiety, eating disorders and addiction. I help those who are working on building self esteem and healthy relationship skills. I also perform psychological evaluations for those seeking to have bariatric surgery. I use evidence-based practices to assist patients in developing skills for successfully facing their unique challenges.

 

Reference:

National Association for Alcoholism and Drug Abuse Counselors www.naadac.org


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In a lamp lit room, a group of six casually dressed people sit in chairs which are arranged in a circle.  All, but one, seem to be engaged in two or three different conversations as a more formally dressed woman enters the room. She sits in one of the vacant seats of the circle as the people in the room gradually turn their eyes toward her. “Good morning,” she says, “you guys are a bubbly group this morning.” She smiles wryly as a tall gray-haired man in the group says, “Well, Amy started it.” He turns his gaze onto a thirty-year-old blonde woman sitting to his left who smiles as she begins to explain, “I picked up my six-month chip last night. It’s the longest I have been sober since I started drinking fifteen years ago.” Members of the group all offer her their congratulations in various ways. John, the quiet one, glances up quickly and says in a flat voice, “Keep up the good work, Amy.” “You don’t seem yourself today, John. What is going on with you,” asks the more formally dressed woman, a therapist facilitating this relapse prevention therapy group. Looking down at the floor, John reveals to the group that he used yesterday.

Like everyone else in this therapy group, John is an addict. Most of the people in the room have at least 90 days clean and are now working on relapse prevention skills. If they are not actively using drugs or alcohol, why are they still in treatment? What are relapse prevention skills? And, what is a “relapse”?

One reason to remain in treatment after discontinuing the use of substances is because the physiological addiction is only part of the challenge. Long after the individual has ceased substance use, the psychological and behavioral elements of addiction remain. Many addicts struggle with how to cope with stress, celebrate, socialize, or even go to sleep without relying on a substance.    These elements of addiction need to be addressed or most addicts slip right back into substance use.

Another aspect to consider is that “withdrawal symptoms” can actually last for up to two years after cessation of use. While the acute symptoms may alleviate within a few weeks, there are “post acute” withdrawal symptoms that follow. During this time, changes that occur in the brain, as the brain is adjusting to no longer having the effects of the substance use, can trigger a person to want to use. It can even cause them to have very vivid dreams of using that are so real, the individual may have trouble telling the difference between the dream and reality.

This is what happened to John mentioned earlier. He awoke one morning having had a “using dream.” It felt real, as if he had used his drug of choice and actually felt high. Realizing this was a dream, he tried to put it out of his mind, but he just kept thinking about it. He didn’t share his struggles with anyone, feeling like a dream was a silly thing with which to trouble his sponsor and other friends. Later that day, he received a call from an old using buddy whose car had broken down and who needed a ride. John picked up his friend, and when he dropped that friend off, the friend repaid him for his help with his drug of choice. John tried to decline, but his friend left the drugs on the seat of the car and waved goodbye. John returned home to an empty apartment and used.

The bottom line is, getting sober is different from staying sober. To recover from substance addiction requires learning a new lifestyle, developing a support system that will help you maintain that lifestyle, and learning how to cope with life on life’s terms… without using. The relapse prevention phase of treatment focuses on achieving these goals. While someone, like John, might slip up and use while in the process of learning such skills, they can remain connected with support and treatment, using the experience as a learning tool, and preventing a complete return to his/her former way of life.

After John shared with the group, they offered him support. Amy said, “John, I know how hard it was to come in here and say that. I know I’d be worried that people would judge me, so thank you for sharing and showing us that it is safe to do so.” Others chimed in and echoed Amy’s commendation. One group member shared, “When I feel like I  want to use, I call someone from our group and call my sponsor. I keep calling numbers until I get someone on the phone.” Another said, “When I am craving, I get out of wherever I am and go somewhere safe. I like to walk on the beach. It clears my mind and calms me down.” Then, the therapist facilitated a discussion around the various elements of John’s story and the skills that any group member could use should any of them face similar things in the future.

  • I am a Psychologist and Clinical Addictions Specialist at the Chrysalis Center. I have successfully treated individuals who struggle with addiction for eight years. I also treat individuals with binge eating, anxiety, depression, and trauma challenges. To schedule an appointment to see me, please call the Chrysalis Center at 910.790.9500. ~Lillian Hood, LPA, LCAS

*John and Amy are fictional characters used to demonstrate the real experience that individuals under these circumstances tend to face.



On a cloudy, cold and rainy day in November, Tom walks out of his front door at 6:00 AM. He doesn’t have to be at work until 7:30, but as usual, he has a stop to make before work. He pulls into the parking lot of “the clinic” around 6:30 and parks close to the building. There aren’t many people here yet. As he walks in the front door, a middle-aged African American woman greets him, “Hey Tom!” “Good mornin’ Ms. Janey, He responds as he beams at her. They exchange a few quips as she flips through a stack of tickets. She pulls out one and stamps it twice; once with a number indicating his place in line and once with an mark indicating he is required to leave a drug screen today. He looks down at the ticket, and says, “Have a good day, Ms. Janey,” as he takes a seat in the waiting room. The ticket he holds in his hand has his name, the afore mentioned stamps, and a check mark next to something that says, Methadone Dosing. Tom, is a heroin addict and has been for 12 years now. He is being treated for his addiction at a clinic that provides medication-assisted treatment for opiate addiction.

Opiates include drugs like heroin, morphine, and codeine as well as synthetic drugs like oxycodon and hydrocodone. When individuals use large enough amounts of such substances, frequently, over a long enough period of time, their brains become physiologically dependent on (or addicted to) that substance. The chemistry in their brains acclimates to the presence of the substance, and when that substance is no longer present, it takes a while for the brain to reacclimatize to functioning without that substance. The result is withdrawal. Withdrawal from opiates can include a variety of symptoms, including anxiety, insomnia, sweats, vomiting, diarrhea and muscle pain. Many who decide they want to stop using opiates find that they continue to use simply to prevent the severe withdrawal symptoms. Those who share needles to inject the substance also put themselves at risk for contracting infections like hepatitis C.  Finally, in order to afford to continue using, some find themselves engaging in other risky and illegal activities.

One way to break this cycle is “medication-assisted treatment.” This means that an individual is prescribed a medication by a physician in an amount that will stop withdrawal symptoms and will decrease or eliminate cravings to use. This allows a person to discontinue use of the substance, without going through withdrawals, while they are making lifestyle changes, developing a support system, and learning skills for coping. It also promotes discontinuation of illegal and/or risky activities.

The National Institute on Drug Abuse indicates that research has shown participation in a medication-assisted treatment program using methadone is most effective when the individual remains engaged for a minimum of one year. Some individuals remain on medication-assisted treatment for many years because they are unable to maintain abstinence any other way. Others use this treatment for a period of time and then eventually taper off of the medication, i.e. they are prescribed smaller and smaller doses over time until they are no longer in need of the prescription. This slow taper allows a person to discontinue the need for the prescription without triggering an onset of severe withdrawal symptoms.  According to the Substance Abuse and Mental Health Services Administration, “For optimal results, patients should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support.”

Tom, mentioned at the outset, looks down at his ticket, “Drug screen,” he mutters to himself. He is a little annoyed thinking about the extra time it is going to take and how that means he won’t be able to get out of the clinic before the heavy traffic kicks in. On the other hand, he is looking forward to it. The person who was in line in front of him comes back down the hall. He gets up and walks down the hall and around the corner to the window where a nurse is waiting. “Morning Judy! He says with a light-hearted grin. “Looks like you’ve got a drug screen today, Tom” “Yes ma’am.” As his grin widens, Judy raises her eye brows. “This will be my first clean drug screen!” She smiles back. “Keep up the good work, Tom,” she says as she watches him drink today’s dose of liquid methadone. As he walks away from the window, he smiles again to himself, “I’m clean.” A reminder pops up on his cell phone, “Therapy appointment at 6:00 PM.” “That’s right,” he says to himself, “and I have my home group NA (narcotics anonymous) meeting after that.

*I am a Psychologist and Clinical Addictions Specialist at the Chrysalis Center. I specialize in working with individuals with addiction challenges as well as those with binge eating, anxiety, trauma, depression and other mental health challenges. Feel free to call to schedule an appointment. –Lillian Hood, LPA, LCAS

References:

Substance Abuse and Mental Health Services Administration

https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone

National Institute on Drug Abu7se

https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment



Michael*, a 52-year-old man who has recently reconciled with his wife, walks in his front door shortly after 9:00pm on a Monday evening. His wife is sitting on the sofa watching Law & Order on Netflix. She looks over at him suspiciously, “Did you work late today?” “No,” he says,” I went to a meeting.” “You go to your meetings on Tuesdays and Thursdays…” she says with a “gotcha” tone.  Michael, fighting becoming exasperated, looks her in the eye and says, “I’m going to have to work late tomorrow and I’ll end up missing that meeting, so I went today to keep up my routine of two meetings a week.”  Michael’s wife still looks discontented. Looking away, she says, “Fine.” Then she mutters, “Are you going to go to two of those meetings a week for the rest of your life? And, aren’t you still doing therapy too? I thought we’d eventually get our life back.”

Michael is an alcoholic and has been attending AA meetings for about nine months now, and has been in therapy for just as long. Why does he do both? How long will this go on?  First, AA or Alcoholics Anonymous is a self help group, and it’s not the only self help group out there for individuals struggling with an addiction. Let’s start by looking at what self help groups are and then we can look at what role therapy plays in a person’s recovery.

Here, in the Wilmington, NC area, we have a few different self-help/self-empowerment groups for those seeking self help for addiction. I’m going to talk about AA (Alcoholics Anonymous), NA (Narcotics Anonymous), CR (Celebrate Recovery), and SMART Recovery (Self Management And Recovery Training).  Most people have at least heard of AA and NA. These two groups are aimed at helping people in similar ways. The major difference is that AA is specifically geared toward alcoholics and NA is open to a variety of chemical dependency addictions. These two groups provide a support network and guidance for individuals who have a desire to live a clean and sober lifestyle. Individuals are encouraged to get a sponsor, someone who has experience in recovery and the AA/NA “program,” otherwise known as the 12-step program.  A sponsor guides the addict through working the steps and provides support for recovery and a lifestyle free of addictive behaviors. This program asks members to acknowledge a “higher power” to whom they will give over their will and in whom they trust to help them with their addiction. Although this program originally began based on biblical principles and Christianity, currently the wording is changed to include all forms of belief in a power greater than yourself.

Celebrate Recovery, on the other hand, is strictly a Christian self help group. This group covers all addictions, habits, and hang-ups that a person wants to change and can include everything from alcohol to sex, co-dependency and gambling. This program is similar to AA/NA in many other ways including a 12-step program and sponsorship.

SMART Recovery is not based in any form of spiritual belief system. It is specifically based on scientific research and the principles of cognitive-behavioral therapy. They teach the “4-Points” which include working on motivation, learning how to deal with urges, managing thoughts, feelings and behaviors, and living a balanced life. In SMART Recovery, there are usually fewer meetings offered in a community, and there is not as broad of a community of support as tends to be available through AA/NA and CR. Which one should you choose? Anecdotally, I know of success stories from individuals who have used each of these programs. I’m a firm believer in doing what works for you!

Why should a person do therapy and engage in self help? Self-help groups offer a level of support that is just not available through meeting with a therapist. However, a trained professional is able to identify and treat problematic behaviors and mental health issues. This is not something that self help groups are truly able to do. For example, individuals who have survived a trauma are especially vulnerable in a way that is best addressed by someone who is trained to do so. I have seen many trauma survivors relapse because someone well meaning addressed the individual’s trauma in a way that triggered nightmares or flashbacks that the trauma survivor was not skilled enough to handle yet. Issues related to mental health and trauma frequently rise to the surface once the addiction isn’t masking them. This is why many of the individuals who are successful at managing an addiction often attend therapy in addition to participating in self-help groups. It allows an individual to benefit from the strengths of both methods and increase the likelihood of success in reaching recovery goals.

Michael, mentioned in the outset, is a trauma survivor. He attends AA meetings to address his addiction, develop a new lifestyle, and gain support from those who understand his journey. He participates in therapy for all of those reasons and also to address his trauma and develop the skills he needs to deal with trauma symptoms without drinking. He will attend some kind of 12-step meeting for the rest of his life as part of his program of recovery. When his sponsor agrees that he is ready, he will sponsor those who need help and request his guidance. He will provide support for other members of AA and for “new comers” for years to come. Michael attended 90 meetings in the first 90 days of his sobriety, as suggested by his sponsor, and has now reduced down to twice per week. His personal goal is to always attend at least one meeting per week. However, if he finds himself struggling for whatever reason, he will attend as many meetings as he can, and he will call members of his support system for help. As far as therapy goes, when he started nine months ago, he attended intensive outpatient therapy for the first 90 days of his sobriety. This means that he attended nine hours of group therapy and one session of individual therapy per week. Upon completion of intensive outpatient therapy, he began attending two individual therapy sessions per week and is still doing so six months later. As he accomplishes therapy goals related to addiction and trauma, he will reduce down to attending one session per week, then one session every other week, then once per month, and then at some point, he will no longer need to participate in therapy. In the mean time, he also faces the challenge of helping his loved ones understand what he needs to do to be a healthy person. He will probably discuss this with his therapist and his sponsor before addressing the issue with family members who are struggling to understand how he spends his time and what it takes for him to stay in recovery. With support and the application of what he learns through AA and therapy, he has a good chance of succeeding!

*Michael is a fictional character used to demonstrate the real experience that individuals under these circumstances tend to face.

Lillian Hood, LPA, LCAS
Psychologist and Clinical Addictions Specialist
At the Chrysalis Center, I specialize in treating individuals with co-occurring disorders. This includes working with individuals who have trauma, depression, bipolar, anxiety, and/or eating disorders along with an addiction. I use evidence-based practices to help patients develop skills for successfully facing this unique challenge.

References:

Alcoholics Anonymous  www.aa.org

Celebrate Recovery       www.cr-inside.com

Narcotics Anonymous   www.na.org

SMART Recovery  http://www.smartrecovery.org



Lisa*, a 41-year-old woman, wakes up at 5:45am to the screeching sound of an alarm clock. She rolls over and slaps it furiously to silence the brain piercing sound. She sighs and says in a determined whisper, “Thirty-six days.” As she begins her daily routine, worries swirl around her mind…”Did I forget to wash my coffee cup before I went to bed last night? If I left it out again, I will get fined by the recovery house manager. What if the bus is running late this morning… they’ll fire me if I’m late again. How am I going to make it to my therapy appointment today? I think my roommate hates me. She’s always so mad that I have to be up before she wants to get up when I work a morning shift. Am I going to have enough money to pay my rent?” Her chest feels tight, and she is filled with dread before the day even begins. Lisa lives in a recovery house. A recovery house is a place where addicts live with other addicts who are working on recovery from addiction. The recovery house provides structure, accountability, and support to those who are willing to comply with the rules of that recovery house’s program and who are actively pursuing recovery. Lisa shares a room with another woman who is in recovery from heroin. She has been sober from heroin for 31 days, and Lisa has been sober from alcohol for 36 days. However, Lisa faces a challenge in her recovery that her roommate does not. Lisa has Generalized Anxiety Disorder in addition to her addiction.

The National Institute on Drug Abuse (NIDA) states that individuals diagnosed with a substance use disorder are twice as likely as a member of the general population to be diagnosed with a co-occurring mental health disorder. In addiction, when an individual stops using a substance such as alcohol or another drug, the body goes through a period of time, called withdrawal, where it is adjusting to the absence of the substance. During this time, it is particularly difficult for an individual to refrain from using since using is the easiest way to stop withdrawal symptoms. These symptoms vary depending on the substance(s) used by the individual and can include extraordinary pain, depression, sweats, goose flesh, vomiting, diarrhea, and seizures. This is considered “acute” withdrawal. Depending on the amount and duration of substance use, this can last for a few weeks. After these symptoms subside, a person will go through “post acute withdrawals” which can include forgetfulness, inability to focus, confusion, emotional disregulation, sleep disturbance, emotional numbness, depression, anxiety and more. This can last up to two years after completely ceasing use and generally lessens over time. During post acute withdrawal, the extreme experience of emotions, depression, anxiety, and feelings of boredom are major triggers to use.

So, as you think about Lisa’s story, imagine what it is like to have used alcohol to cope with anxiety, only to have become addicted to alcohol. Having realized that her life had become unmanageable, she sought help at a recovery house and at a clinic where they treat people who have co-occurring mental health and substance use disorders. She is motivated to “get her life back” and tries hard to follow the advice given by those who know more than she knows about the road to recovery, but she still struggles daily with overwhelming feelings of anxiety, all the while her brain is begging her to fix it the old way… with alcohol. She is also not immune to the emotional effects of post acute withdrawal symptoms that are common at this point in her recovery, and her anxiety can be exacerbated by these symptoms. She can seek medical attention for her anxiety but is afraid of becoming reliant on a pill to cope with anxiety. She only considers this as an option because the symptoms of her generalized anxiety are so severe that she is afraid she will relapse on alcohol if she doesn’t stabilize her mental health.

Individuals who suffer from co-occurring mental health and substance use disorders face the challenge of staying sober while not being able to lean on the substance that they have used for so long to medicate their mental health disorder. They also face the challenge of coping with mental health symptoms complicated by post acute withdrawal symptoms. Structure, accountability and support is often not enough to help them overcome this special challenge. Frequently, medication and psychotherapy are necessary to stabilize their mental health disorder symptoms while they build the skills for living a sober lifestyle. Programs that include this combination offer hope to those who are determined to make a change and willing to work hard to begin a new life.

*Lisa is a fictional character created to represent real circumstances and challenges faced by those who suffer from co-occurring mental health and substance use disorders.

Lillian Hood, LPA, LCAS
Psychologist and Clinical Addictions Specialist
At the Chrysalis Center, I specialize in treating individuals with co-occurring disorders. This includes working with individuals who have trauma, depression, bipolar, anxiety, and/or eating disorders along with an addiction. I use evidence-based practices to help patients develop skills for successfully facing this unique challenge.

Reference:
National Institute on Drug Abuse www.drugabuse.gov
National Association for Alcoholism and Drug Abuse Counselors www.naadac.org


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At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More

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