Download Bare Essentials

Two Pillars – A Metaphor
for the Bare Essentials of
Early Recovery
Geoff Kane, MD, MPH
Brattleboro, VT
February 12, 2013
“…people will forget what
you said, people will forget
what you did, but people
will never forget how you
made them feel.”
- Maya Angelou
Overview
• Laws of nature and personal
responsibility
• Neurobiology
Behavior
Addiction
Powerlessness
Recovery
• The Two Pillars of Recovery
• People matter most
“Addiction is like gravity; it
is governed by the laws of
nature and never takes
time off.”
Addictive chemical
substances change the
brain and change behavior.
“…the essence of addiction:
uncontrollable, compulsive
drug seeking and use, even in
the face of negative health and
social consequences.”
- Alan Leshner, PhD
Addiction
• Subjective: Powerlessness (loss
of control)
• Objective: Persistent use
despite adverse consequences
neurobiology of behavior
plus
neurobiology of addiction
equals
neurobiology of powerlessness
There is more to who we
are and more to why we
do the things we do than
what meets our own
minds.
Lower centers of the
Central Nervous System
can act independently of
higher centers.
“New research shows that emotions
have a separate system of nerve
pathways, through the limbic
system to the cortex, allowing
emotional signals to avoid
conscious control.”
-Robert Ornstein, 1991
“…unconscious decisions for action
go on constantly inside the head.”
-Robert Ornstein
“We’re worse off than Freud thought,
because many actions proceed
without our knowing anything about them.”
-Robert Ornstein
“Our limbic system sets the mind’s
emotional tone and stores our
highly charged emotional memories.”
- Tian Dayton, PhD
Addictive chemical
substances change the
brain and change behavior.
“I have a passion for
alcohol.”
- 25 year old female
“Any addict knows, you’ll do
anything to get it.”
- 23 year old male
Are they really hooked?
•Violate their own rules for behavior/values
when under the influence?
• Break promises to themselves about use?
• Pay an emotional price for using (shame,
guilt, fear, remorse, anger at self)?
• See a different version of their own
drinking/drugging than other witnesses?
• Would become defensive or lie if asked these
questions?
- John and Pat O’Neill
in Help to Get Help
RELAPSE RATE OVER
TIME
Abstainers (%)
100
90
Heroin
80
Smoking
70
Alcohol
60
50
40
30
20
10
0
0
1
2
3
4
5
6
7
Time (Months)
2 Weeks
8
9
10
11
12
Two Pillars of Addiction
Recovery
• Keep your distance!
• Ask for help!
“The treatment of
addiction is [still]
people.”
Suggestions Made in Addiction
Treatment
•
•
•
•
90 meetings in 90 days
Obtain and use sponsor
Do some Step work
Participate in an aftercare
group
• Participate in counseling/
psychotherapy
Counseling Tips
•
•
•
•
Be Empathic, Nonconfrontational
Offer Choices
Emphasize Patient’s Responsibility
Convey Confidence In Patient’s
Ability To Change
Determinants of Client “Change”
•
•
•
•
Client factors
Relationship factors
Expectancy & Hope
Model/technique
40%
30%
15%
15%
- Michael Clark, MSW
Positive interpersonal
relationships change the
brain and change behavior.
“Neural repatterning comes
as we enter into and sustain
new types of relationships
that allow us to reregulate
our sense impressions
slowly and over time.”
- Tian Dayton, PhD
“Interpersonal experience shapes the
mind as it continues to develop
throughout the lifespan…
Interactions with the environment,
especially relationships with other
people, directly shape the development
of the brain’s structure and function.”
- Daniel J. Siegel, MD
“ …the amygdala, along with related
areas…, plays a crucial role in
coordinating perceptions with memory
and behavior. These regions are
especially sensitive to social interactions.”
- Daniel J. Siegel, MD
Abstinence results from
Skill Power
not Will Power
Some Recovery Skills/Tips
• Be honest
• Embrace your pain
• Mistrust yourself
• Keep your distance
• Seek people, not
chemicals
• Pay attention!
ADDICTION
CRAVING
HABIT
COPING
Docherty’s Craving Triangle
Spirituality
Involves Relationships With:
•
•
•
•
Self
Other Human Beings
Nature
Creator, God, Higher Power
Patients help ensure recovery
success when they embrace:
•
•
•
•
Abstinence
Mental and emotional changes
Spiritual changes
Daily spiritual practice
Providers help ensure recovery
success when they promote
continuity of:
• Healthcare
• Caring
• Accountability
Treatment/Recovery Essentials
Patient
• Understand &
accept “laws”
• Avoid or manage
“triggers”
• Use supports, human
& spiritual
• Avoid abusive
relationships
• Take meds when
appropriate
Community
• Understand “laws”
• Reduce drug availability
• Make professional and
other positive
relationships available
continuously
• Protect people from
abusive relationships
• Make appropriate meds
available
A Model for Recovery
• Emotional Arousal
• Sense of Hope
• Sense of Mastery
• Love and Humor
- Modified from Jerome Frank, MD