Addiction

Aug 01 2020

Mindfulness in Treatment: Getting to Know Yourself

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

Mindfulness in Treatment: Getting to Know Yourself

The other area that’s important that’s come into the treatment field, when we’re looking at kind of how to recover and become whole and become healthy, is what I would say the Eastern practices and I’ll lose the categorize them as mindfulness and of yoga.

Mindfulness is around intention and attention.

If I meet somebody who’s suffering from addiction, demoralized, who’s ashamed, has some traumas in their background, often they’ll be sitting in my office, and you can kind of tell the level of trauma by body posture, and eye contact, and their ability to stay connected and intentional and paying attention in the interpersonal relationship.

The first thing that I have to do with this person is I’ve got to figure out how to help them feel safe.

That’s the beginning. You build on that a little at a time in relationship with them and groups and individual work in casual kind of covert, nurturing and caring in the hallway, this kind of thing.

Then eventually, when somebody is kind of here and they’re awake, that can take two, three months to blossom and start to change.

This is a great sign when their affect changes.

Then work on the directing people’s attention and having people being mindful of the things that they’re engaged in that’s right in front of them.

That goes to a very subtle level, eye contact, of focus, of being aware of what’s happening in my face and my shoulders, my neck and my back and that’s an endless route, both recovery and growth and wellness.

You can move deeper and deeper into the mindfulness attention and intention, by knowing what’s happening inside of your mind.

Not just of what’s happening outside of me, but what’s happening in the dark, creepy recesses of my unconscious mind. The whole thing about recovery to me is to help people to move deeper into a process and become deeper people.

Get addicted to getting to know myself and working on myself

Not just me, but working on myself in relationship to all the people that I care about, to understand myself in the context of my work.

That’s the “Wow. How can I be a better husband? How can I be a better father? How can I have a meaningful role in my work? How can I make a difference?”

That kind of thing and when you get a little bit obsessed and curious about that, then recovery is not that hard.

Then it’s this endless journey of getting to understand yourself, getting to understand the world, and interfacing with your reality in a way that’s meaningful, where you wake up and you look forward to it.

Those are like the deeper realms of recovery.

Getting to understand yourself schematically. How you process stress and all that stuff. And actually, it becomes fun. It doesn’t become this chore. Then it’s not about, you know, when can I leave treatment,. Then it’s about what are the other ways I can get to know myself and I can get to grow learn to change.

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Jul 15 2020

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The Spiritual Element of Recovery

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

The Spiritual Element of Recovery

In many programs, that you would go to, to engage in recovery from addiction, there’s a spiritual element to that program. So we have a spiritual program or something like this. And the most common spiritual traditions that they drawn are these Eastern traditions, Buddhism, the yoga, the mindfulness, meditation, these kinds of things. And honestly, I don’t think one can put into words the benefits of those practices.

Spiritual Psychology

There’s another spiritual tradition that’s more Western that I think is underutilized, which is spiritual psychology and it has to do with how the psyche works and it has to do with virtues. It’s sort of this mix of Greek thought, and philosophy and psychology.

That element is crucial because one of the things we’re addressing when we’re looking at recovery is who we are in the moral sphere. Because when you’re in your addiction, you feel demoralized and often ashamed of how you behave.

One of the things to try and figure out is how do I get in contact with my, let’s call it authentic self? And how can I be a better person? Which is a huge antidote against shame. If I feel like I’m being a good person over a period of time consistently, I usually don’t feel that a shame might take a while to get there. But we have to understand what it means to be a good person and that’s challenging. It’s a really complex philosophical issue and something that spiritual psychology looks at a lot.

The Ego- Self

In the moral sphere, the way that I think about that, is to think about a person as having a lower self, or you could call it -my great teacher, Dr. Rabbi Mordecai Finley calls it the ego-self- which is the, it’s a perfectly healthy part of the self for quick, unimportant decisions.

It’s the part of me that’s driving the car. That’s in chit chat on the elevator, that’s all ego-self. “Oh, would you like me to push this floor for you? Let me open the door.” You know, etiquette and basic memorized, mechanized ways of responding in the world. Ego self is great at that.

However, we needed to function. I don’t want to be looking at a doorknob thinking what do I do here? How do I go through this door? What does this mean, right? Ego-self is great with that kind of interaction that we have.

The ego-self is terrible, a complex interpersonal reaction.

And any deep relational interaction is complex. It’s going to be reactive, impulsive.So, one of the core parts of spiritual psychology is this question of being able to identify when I’m in my ego self and when that’s appropriate. And when I’m in my higher self.

The really tricky part about addiction is that you become confused about the difference between those two ways of thinking and you use inconsistent rational thought to rationalize and justify ego desires, if that makes sense.

An ego thought does not stand up to scrutiny.

If you ask your ego deep questions, it cannot give you deep answer. It doesn’t have deep answers. To figure out how to respond in accordance with the situation so that you can continue to build on the most important thing.

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Mar 17 2020

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The Physical Aspects of Recovery

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

One of the things I don’t talk about as much–but it’s so important–is the physical aspects of treating addiction.

Now this doesn’t necessarily pertain to people who are already “fitness freaks”. There’s a whole group of people that come into treatment and their primary coping tool is the gym and eating well. For those people, they’re not gonna get the same kind of relief from the gym beyond what they’ve already got. They’ve already dealt with the nutritional and physical aspects of their neurophysiology.

But there’s another huge group of people who have never paid attention to their body. And sometimes it shows.

Huge Amounts of Information Are Stored in the Body

And we know that traumas are stored in the body. Memories are stored in the body. We know you can tell a lot about how a person is doing based on their body language, energy, posture, and eye contact.

In order to have a full recovery, you have to take care of the body. Meaning: you have to be mindful and intentional about what you’re bringing into your body, what you’re eating, and what you’re drinking.

And you have to be mindful and intentional of the physical activity you’re engaging in to help the body reach close to a peak performance.

Of Course, Exercise Is Healthy, But Did You Know…

There are meditative exercises that exist. I think particularly swimming, biking, and running. Real rhythmic, physical activities, that open up different emotional spaces. When we’re in a deep depression emotions get locked in.

I’ve told a story about when I picked up bike riding. On my first long bike ride, I just broke out in tears. There was so much emotion that was stored in my body. Until my body was moving in a rhythmic way, I couldn’t get to it.

One of the big ways to relieve that stress and anxiety is to start to take care of your body more. The way to do that well is to find an exercise routine that actually works for you. I do biking, it’s really hard for me to lift weights in the morning, and frankly I don’t enjoy it. And I don’t like gyms. I like to be outside. So, biking is great for me.

I wake up early in the morning and I jump on a bicycle. And it’s an automatic warm up; I kind of ease into that exercise. And, for me, it’s great because I’m kind of like, rusty in the morning. Biking, to me, brings this rhythmic, meditative thinking that just blows the thoughts and anxieties right out of my mind.

Of course, you have to find the exercise that’s right for you.

The physical components of recovery cannot be understated. It’s not my area of expertise. There are people who know much more about it than me, but it’s definitely worth talking about.

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Feb 21 2020

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The Desire to Move Forward

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

When I’m working as an addiction or spiritual counselor, clients want to climb the ladder of treatment. They want to move forward in their lives, which is understandable. We all want that direction.

And that idea of moving forward in treatment–that’s a therapeutic issue. I don’t mean that as an evasion. Our conception of what it means to move forward is a therapeutic issue.

How do I answer clients when they ask, “When is it time to go? When am I ready to leave?”

I used to say, “When you’re willing to stay.”

Considering Your Desire to Finish Treatment

My answer wasn’t cruel or a joke. I answered the question sincerely.

I wanted them to ponder:

What happens when you come into treatment?
What is this urge to move out?
What do you think is at the end of this journey?
Is there an illusion that when you leave treatment you get your freedom back?

Many expect leaving treatment restores the freedom to do, “What I want, when I want, and how I want.” That it’s some kind of promised land. That life is going to feel better–everything’s back to normal.

But your life wasn’t normal before you got there. You had an addiction problem and were suffering. And, in fact, when you leave treatment, life is more complex and difficult with less support.

So it’s actually harder.

I had a counselor that told me–when I was in treatment–the only thing that should change when you leave is your address. And what he meant by that was all of the tools and support that you’ve created while in addiction treatment–the kinds of choices you make and the things you have and haven’t been doing–all of that should stay the same.

Treatment is the First Step of Your Recovery

Don’t think because you move forward in treatment that it’s going to relieve your stress and anxiety. That, actually, may be what’s driving this idea of moving forward.

We all want to move forward in our lives, which is a complicated thing to even define. There’s a stress and anxiety that exists inside us all at times. If you’re active in addiction, stress and anxiety has a powerful pull. Yet we think, “If I can just get through these obstacles and move forward that will relieve the stress and anxiety.”

But actually what relieves the stress and anxiety is dealing with the underlying conditions of the emotions. What relieves the stress and anxiety in my interpersonal relationships is not getting away from them. Then I’m just guilty because I’m not around. Right?

I have to work through the emotions. And that’s what we’re actually doing in treatment. So it’s really a reframe. You’ve got to reframe your idea of moving forward. You’ve got to reframe your idea of stress and anxiety.

Another thing I used to say: that feeling you have–that restlessness and boredom–that’s your ism. That underlying cluster of feelings exists inside of you and drives you to use drugs and alcohol. So every time you have that feeling, it’s a signal for you something is up. That is the ism you have to address.

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Jan 21 2020

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How Long Do I Need Addiction Treatment?

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

One of the questions that people have when seeking treatment is how long do I need to do it?

I’m always trying to empower people by thinking deeply about their questions. If you put that question in perspective it’s more like: How long is it going to take for me to change? There isn’t an exact number of days that you can say.

Is 30 Days Enough?

There’s a model out there for 30-day treatment. What is that based on? Is that based on some science that people break addictions in 30 days? Absolutely not. It’s based on the way that insurance billing works. The 30-day treatment model may not provide the kind of change that people need.

The standard answer these days is recovery takes around 90 days. I think that has more to do with the amount of time that people can afford to spend away from the system of their lives. Most people can’t just drop out of their lives for six months or nine months unless they’re young and maybe have good insurance. Or have strong support from the family. Or possibly getting resources from the county or the city.

Our treatment program is 90 days. Still, the 90-day program is sort of a compromise. It’s trying to get people as much treatment as they can get realistically. In my mind, 30 days means maybe you’re starting to sleep good. Maybe you’re feeling safe. You’re beginning to approach recovery, but you’re nowhere near where you need to be to move on. By 90 days, you should have built a decent foundation…not a solid foundation, but a decent foundation.

The Goal of Effective Treatment

A lot of TV programs, they portray good treatment. But the goal of treatment is not to do treatment well. The goal of treatment is to engage people in recovery so they can do their lives well. That’s the real trick.

The immersive experience is upfront: experience with the recovery culture, knowledge and tools, understanding therapy, psychiatry, all the things you need. And then you really want to kind of move that person into life to build those peer and family support structures outside that they have forever. So that they can keep recovery sustainable.

Ninety days in relatively contained care, as I see it: first 30 days real contained, second 30 days less contained, and much more freedom in the third 30 days. Then you’re back in your life but with a lot of support and resources to help you along the way..

That’s really good treatment and it works phenomenally well when the circumstances lineup to be able to do that.

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Adam Mindel Interventionist with patient

Jan 17 2020

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Interventions and Recovery: a Process

Adam Mindel

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

As I look back over the last several months of working with individuals and families towards recovery, I promise I am terribly understating when I describe interventions as a process versus an event. All interventions are a process, I promise you, and I promise you so is recovery. Firsthand, I reflect on my nearly 17-year journey of recovery and recognize the years I spent in my addiction leading up to my current sobriety as all part of the process that produced the recovery that I have today.

Research shows that individuals must often go through a process of preparation before they are ready for permanent sobriety. The Transtheoretical Mode of Change by Prochaska & DiClemente is a model which describes sobriety as a movement from Denial to Contemplation to Preparation and ultimately Action and Maintenance.

Two Predominant Methods to Move Individuals from Denial to Motivated States of Change

If the above is true, then realistically how do I utilize interventions to move individuals from states of denial to more motivated states of change? I suggest there are two predominant ways:

1. Utilizing leverage to engage individuals in treatment, with ultimately, treatment itself as the vehicle which provides the process of resolving ambiguity and resistance to change
2. Meeting individuals “where they are at”, by finding levels of care that can begin to engage individuals in a process of change.

Two important qualities required for an intervention

First, let’s cover the basics in all models of interventions, most interventionist asses for two important qualities required for an intervention

A. Influence – The capacity to have an effect on the character, development, or behavior of someone.

B. Leverage – The power to create consequences, or require behavioral change by an individual that is addicted.

I additionally assess for Attachment, which -is a deep and enduring emotional bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969). Put simply, I like to know how much individuals care for and are connected to the friends and family that love them. Realistically individuals with high levels of sociopathy do not generally enter treatment without being compelled by the fear of consequences. At the same time, addiction and neurochemical changes will often resemble anti-social behavior.

Realistically individuals with high levels of sociopathy do not generally enter treatment without being compelled by the fear of consequences. Click To Tweet

Individuals often enter treatment due to tensions in interpersonal relationships.

With over 15 years of experience working with families and individual in treatment, I can unequivocally inform you that individuals with deep attachments to friends and family have better outcomes from interventions and addiction treatment.

Having experience and understanding the quality of influence and leverage is vital to producing positive outcomes and creating the correct type of intervention. Quite frankly it is always easiest to intervene on loving individuals that care for their friends and family, and due to interdependent relationships, there are real consequences if the loved one does not enter treatment. For example, I recently intervened on a college student that had very close relationships with his parents and extended family. From the beginning, the initial assessment it was clear that this dutiful son would be entering treatment. In addition, he was dependent upon his parents to return to college. The intervention became high-level consultation, psychoeducation, and changing family dynamics while creating an accountable path back to university with the parent’s support post-treatment.

Unfortunately, not all interventions are high in relational influence or attachment, and not all interventions have real leverage. Click To Tweet

I describe “real leverage” as actual consequence that an individual would experience if they choose to not enter treatment. These consequences may include the removal of financial support, parental or marital consequences.

“Adaptive models of interventions find ways to engage with individuals realistically in different stages of change” – Adam Mindel

Adaptive models of interventions find ways to engage with individuals realistically in different stages of change, different level of care, and often must create processes that allow individual to fail or provide them the dignity to try things “their way”, before accepting recommended courses of action.

For example, I recently Intervened on a successful businessman that was abusing both opiates and amphetamines. Though he loved his family, no individual in his family had any type of leverage, he was well able to finance/self-enable his own addiction. In addition, as a result of chronic amphetamine abuse, the client was dysregulated and unable to acquiesce to residential treatment, and insisted upon beginning outpatient treatment. An agreement was made between the client and his friends and family that included scheduled follow up meetings to track his progress in outpatient. Ultimately due to repeated relapses while attending outpatient treatment, the client became more intrinsically accepting in of entering residential treatment of his own accord versus external coercion.

After the Intervention

Once in treatment a further process was created moving client through different levels of care which included residential treatment, sober living coupled with day treatment, intensive outpatient treatment, and ongoing continuing care which included week individual therapy for 6 months, psychiatric care, continued urine analysis monitoring, and of course the client’s agreement to attend self-help group throughout the recovery process. The client to this day continues in his own process of recovery and growth…the process continues.

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Jan 04 2020

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Are We Defining Treatment Success the Wrong Way?

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

Let’s face it, the media has an impact on our opinions and how we view the world. Unfortunately, seeing the world through the eyes of the media isn’t always…well, reality.

Take substance abuse treatment. Popular culture believes a person successfully completing treatment will stay away from drugs or alcohol for the rest of his or her life. As a result, life gets better. Sure this idea of success is ideal, but…

It’s not always that black and white.

Let’s say someone completes treatment and slips up some. Maybe they go out for a couple of drinks or have a weak moment with their drug of choice. But then they used what they learned in treatment to get back on track and not fall into the cycle of addiction.

Is this a success or failure?

Sure, there was relapse. But there was also a personal recovery taking place afterward. Ultimately, their quality of life did not suffer.

So treatment success may not fit into a neat little box of assumptions. Every individual comes to treatment with a unique set of circumstances. Is measuring success in a standard “popular” way counterproductive or even setting one up for failure?

Sometimes the right environment for the right amount of time can be the difference between success stories and failures. Recovery Integrity offers a long-term, all male program in Los Angeles. With a success rate of around 45%–much higher than the industry standard.

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Dec 15 2019

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The Reality of Treatment Success Rates

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

Coming to treatment has always been a hard threshold to cross – but more so now… Working in treatment for a long time, I’ve experienced greater consumer wariness.

People are more hesitant to send their loved ones to treatment and people who are looking for treatment are more hesitant to come. I think one of the reasons is the discourse about addiction, treatment and recovery has hit the mainstream, and one of the things that has come out is that the success rate of treatment is like, 15%.

But why are success rates so low? Several reasons:

– Poor treatment. Treatment that’s not set up well & doesn’t understand the various personalities of the population they’re working with and their underlying conditions and problems. Like a bad mechanic.

– Shady treatment that just isn’t trustworthy. Meaning their intention wasn’t to figure out how to help people recover. Their intention was to make money. That type of intention can be disasterous.

– The nature of addiction and recovery. The nature of addiction is… it’s chronic. It is not a problem that can be solved with an event. It’s something that has to be worked with over time.

A good analogy to understand why treatment success rates are low is to think about something like the gym. My guess is you’re going to see like ten, fifteen percent success on those goals of fitness of people who signed up for memberships. Right?

Recovery is the same way. Recovery is similar to a muscle you have to exercise consistently. Lots of people will sign up for something that they won’t follow through with. It’s the really hard part of treatment and recovery.

It’s this mysterious question of the will, why some people have the will to change certain parts of their lives and other people don’t, and honestly it’s not a place where we have good answers.

Many times we just wait for people to be ready to change, but if you have a loved one or a spouse, or kid who is – shooting heroin – you really don’t feel like you have the luxury to wait around for them to change.

So people intervene, and people are in different stages of readiness for change, and there’s not an easy solution for that.

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Nov 26 2019

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Dogma in AA: Trusting in the Spirit of Reality

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

Dogma is not actually something I would want to get rid of within Alcoholics Anonymous.

I would also say dogma is not something that I want to get rid of in alcoholics anonymous. On some level, what it means to be a person in recovery, who’s engaged in traditional 12 steps is to have some sense of acceptance, that you are not in charge of the world.

And it’s sort of like trusting the spirit of reality and they call it God’s will, right. It’s a little bit more loaded of a term, I’ll just call it the spirit of reality. Meaning, I have to accept what is. Right?

I could fight it, but I’m going to lose, because – what is. And so if what is, is there are dogmatic personalities in alcoholics anonymous, who am I to fight that?

Am I in charge of how people should be in meetings? And the answer is no, I’d be a hypocrite. Right? Am I dogmatically against people who are dogmatic? Well, no.

There’s another reason why I wouldn’t get rid of dogma in alcoholics anonymous. It’s helped a lot of people. There’s a, sort of a spectrum of meetings, there are meetings, a late-night Hollywood meeting, it’s like a comedy show fiasco. It’s totally insane and foul and people yelling. A bunch of jesters all in one space acting out. There’s no order. It’s total chaos. Great Energy. I thought I sober was gonna be boring, this meeting is wild!

And then you have very rigid (you have to wear a tie) and other groups that have developed their own culture which is much stricter, much more dogmatic, much more rule-bound, and all are helpful for a lot of people.

That kind of container and that rule of structure and not having to question everything, and just being able to take direction feels really safe, and it feels good and it helps them build lives.

So there is dogma in the personalities in alcoholics anonymous. It’s not a bad thing, and if the traditional 12-step is something that’s going to help you, there are ways for you to belong that work for you.

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Nov 10 2019

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AA tries NOT to be dogmatic

Yeshaia Blakeney

Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment, Therapy, Video, Yeshaia Blakeney

Alcoholics Anonymous

Although somewhat known for dogma – actually has gone out of the way to NOT be dogmatic.

Everything is languaged from a place of suggestion as opposed to declarative statements for how you are supposed to be.

When you see it in the literature of Alcoholics Anonymous, you notice that these were people who were not only NOT particularly dogmatic, but they were also sensitive to the fact that people would be sensitive to dogma.

I am half African-American, and when I read the core text, the Big Book of Alcoholics Anonymous, I’m shocked that the word “negro” isn’t in there.

It’s 1936, pre-civil-rights-movement. It says nothing about who can come and who can’t…

So there is dogma in the 12-steps, it’s not my cup of tea, but it largely has to do with the personalities that exist in certain meetings within the fellowship.

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