Therapy

Oct 13 2020

The Role of People-Pleasing and Codependency in Addiction

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

The Role of People-Pleasing and Codependency in Addiction

When you’re working with people that are in early recovery, they suffer from the same kind of orientations and disorders that exist in the culture at large, just usually in a more extreme way.

Over accommodation or people-pleasing

So one of the things that come across a lot is what we call over accommodation or people-pleasing, and it means sort of overextending the boundaries of myself in a way that causes me a deficit for the sake of the other, you know, psychologically call that kind of co-dependence, it’s on that spectrum. And it’s a really big deal.

“A lot of people that you find coming into recovery have felt that they’ve been living for the world and they don’t really get theirs. And so there’s becomes using drug and alcohol.”

Straightening out what your boundaries are

You know, the metaphor for me is like, okay, I do everything I’m supposed to do. I mean, the world asks of me during the day and at night, I hide in the closet and drink vodka and smoke meth, you know, or whatever it is, that’s for me, the rest of its for the world because the world’s been demanding on me since I was born. You can think about that dynamic. And so one of the things that needs to happen in treatment is you have to straighten that out.

You have to help people become more assertive.

Assertive is a tricky word. I don’t mean asserting your will on others. But I mean, being clear about what your boundaries are, and being clear about how to draw those boundaries in a way that’s effective in your life. So if you’ve been people-pleasing for a long time, you have to get clear about how to assert boundaries. And you have to be clear about what your rights are and asserting those boundaries. So where people are confused, is they’re confused about where their rights stop and start in the interpersonal reactions. I’ll give interactions.

When I was working in treatment

I remember I walked into a lobby, and there was a woman who I liked quite a bit, who was working there. And she said, “Hey, I sent you a Facebook friend request. Did you get it?” And I said, “Yeah, I got it. I saw that friend request.” And she said, “Well, are you going to friend me?” And I said, “No, I’m not going to accept your friend request.” And she gives me this look like you know, she’s offended. And she says, “Why not?” And I said, “Well, I don’t, you know, I don’t want to.” And she said, “Well, my roommate, who you know, she sent you a Facebook friend request, and you accepted that friend request.” And I said, “Yes, I did.” And what did she say? She said, “Why didn’t you accept my Facebook request?”

And you should know this a teaching from my mentor. When somebody says “why” to you and interpersonal reaction. They don’t really mean it. They don’t want to understand it. It’s really a complaint. Right? And so you go, is that a question or a complaint that “why”. I need to clarify that. But in that circumstance, I said, “Can I ask you a question?” She said, “Yeah.” And I said, “Do I have the right to decide who my Facebook friends are?” She said, “Yes.” I said, “Okay, good. We’re clear.”

Let me ask you another question. “Were you ever married?” She said, “Yes”. I said “Did you have a wedding?” She said “Yes.” I said, “Did you invite some people to your wedding?” She said, “Yes.” I said, “Were there other people you didn’t invite?” “So the other people I didn’t invite?”. “And did you ever have somebody who didn’t invite to your wedding come up to you after the wedding?” And say, “Why didn’t you invite me to your wedding?” And she said, “In fact, I did.” And I said “What did that feel like?” She said, “It didn’t feel good.” I said, “Great. Now you understand this interaction. Right?”

And now I’m being a little bit you know, humorous or whatever. But it’s an example of how we get confused in our boundaries of what we’re obligated to do. Where do my obligations stop and start? If I’m in a relationship with somebody, and I don’t want to be with them anymore, which is usually why people break up out of relationships, right?

Usually people don’t want to be in a relationship because they don’t want to be with that person anymore.

The question that the party asks that is being broken up with is usually “why”, but they don’t mean it. Because nine times out of ten there’s only one answer, “Because I don’t want to be with you anymore.” Obviously, on the other end, that’s hard for you to understand because human beings are naturally kind of narcissistic. And so somebody breaks up with me and I love them and they don’t love me that I don’t understand. But I do understand because there are people who have loved me who I didn’t love in the same way.

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Sep 19 2020

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The Moral Aspects of Treatment

Yeshaia Blakeney

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

Remove the Moral Aspects of Addiction Treatment?

I talk a lot about the moral aspects of treatment and I am very resistant to removing morality from the conversation about addiction and recovery. I understand why people want to do that. It’s to bring down the stigma to address the confusion around the free will issues, for it to be covered by insurance, I agree with all that. I agree with the reasons. My hesitation is that there is a huge moral component to addiction and recovery, and let’s talk about what that looks like in recovery.

In recovery, the moments where we gain the most growth are the same moments where we gain the most growth in life.

One of the most pivotal moments of growth in my life, there are moments when I’m in a moral conflict and I’m not sure what to do. What is the right thing to do in this moment? If I’m in a marriage and I don’t know if this marriage is working and I have kids and I’m trying to figure out– I’m- some of them in this world conflict, what is the right thing for me to do? If I’m tempted to go into a career largely for money, but it’s not my passion, I’m in a moral conflict what is the right thing for me to do.

The most serious conflicts in our life are these moral conflicts with competing claims on each end.

The reason why I’m hesitant to remove that from the conversation is, it is the moral conflicts that induce inhuman beings the most important parts of ourselves. In order for me to wrestle with a moral conflict, I have to draw on all of these different parts of who I am and my personality. Right?

So a common conflict and treatment that happens is, my roommate snuck out and got drunk and I know. My roommate comes back and says, “Don’t tell anybody,” and suddenly there’s a couple of things happening.

One, I am asked to keep a secret. And in general, secrets, those kinds of secrets are not the healthiest things to keep inside of us.

Number two, I’m in this interesting quandary around loyalty to my friend, but on the other end I’m in an interesting quandary about being honest with the people that are helping me: counselors, therapists, the community at large and treatments. I have these competing claims. I also have me. I don’t want to be walking around with lies in myself. I don’t want my friend to get in trouble, which is a normal thing, but I don’t wanna be dishonest, and suddenly I’m in the midst of a moral conflict.

What somebody does in a predicament can be the make or break moment in somebody’s treatment experience.

When somebody can say, “Hey, you put me in a really bad position by asking me to keep your secret because you act it out and I’m not willing to co-sign that with you, and it wasn’t okay, and you need to go work this out because you’ve put me in a bad situation. You’ve put you in a bad situation. You’re an alcoholic who allegedly is here to get sober. I get that you don’t do this thing perfectly but you need to straighten this out,” right? That’s a high level response. That’s not the government’s fault, but imagine if somebody is used to cosigning everybody’s everything all the time in life, they’ve engaged in a program of recovery. They strike them, they built what we call a moral core, some center about what the right thing to do is. They’re challenged, they’re in the middle. They’re stuck there in the hallway. They don’t know whether to go left, whether to go right. Right? Suddenly it’s like, okay, and they have that conversation. You know what that does for me. That’s everything. That’s the turning point for people’s recovery.

The moment when you have the difficult conversation with your parents or your loved one that you’ve never had, we build that moral core.

Begin to put yourself in the equation. That’s where we get the most growth. Not only do we get that growth morally, we also get it psychologically. We are moral psychological beings that come hand-in-hand. Right? To be– if you meet somebody who’s evil, which is a moral term whether you believe in evil or not, but behaves in evil ways depending on their level of narcissism and the way in which they act out, you would have a difficult time saying, “Well, that person is mentally healthy. They’re just evil.” Right? In general, those things come together. Right?

So, you know, to use the extreme example. Adolf Hitler was not only evil. There’s such a thing exists. He was also mentally ill and a methamphetamine addict. Those things come together. So our moral behavior in our psychological wellness, they’re integrated with each other. We have to understand that. So we cannot remove morality from the equation of recovery addiction. We have to figure out how we incorporate that in the conversation about well-being, psychological well-being, spiritual well-being, etc.

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Aug 21 2020

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Do You Need to Dumb it Down in Treatment?

Yeshaia Blakeney

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

Do You Need to Dumb it Down in Treatment?

One of the things that’s common in some therapeutic communities, when it comes to recovery is telling people to dump it down. And I understand what they mean, but I don’t like it. Because I like to think.

If you learn to reason well, which is not about coming to the conclusion that I had before I started reasoning, that you’re actually trying to figure out the truth of the situation. That has been an incredible asset.

Recovery is cognitive

In my recovery, in many ways, a lot of my recovery was cognitive. It was an intellectual endeavor. I was trying to reason whether or not this made sense to do. Now reason alone won’t do it.

I have to have some foundation, some axiom there. And my axioms are to live is better than to die and to be healthy is better than to be sick. I don’t know why that is. I can’t tell you why that is. It’s a choice that I make. It’s the foundation for the rest of my reasoning.

Once I start there I could build up reasons to get clean, that makes sense to me, reasons to do things I don’t want to do, reasons that I can transcend my ego desires.

A part of what I do when I work with people, is I try to harness that.

If you ask questions, and you’d like to learn, instead of telling people like, “Hey, dump it down. Don’t think. Just show up.”

You can actually harness that asset that people have and use it.

Now, the reason why people don’t like it is because people have the capacity to reason their way into what they want. But just means you’re not reasoning, good enough, well enough. It doesn’t mean don’t use your reason. It means use your reason better. Right? And that’s a huge part of recovery.

If you know, I need to make reasonable decisions to have a healthy life and if I don’t know how to think well, I can’t do it and there are techniques and ways to think well.

They don’t teach you that in school. You memorize a lot of facts in order to figure out how am I supposed to be in my relationship with this person when I’m in a moral conflict between using drugs and my parents, you know, coming into town next weekend. How do I weigh those competing claims and come to a decision, you know. We don’t teach people how to do that, but we can.

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Aug 16 2020

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“When I’m High, I Really Want to Be Sober”

Yeshaia Blakeney

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

Addiction hijacks- let’s call it semi-rational thought, as a way to justify ego desires.

The simplest way to put this is to tell a story.

I remember working with a client, and he was about a week sober, had gotten out of detox from opioids. He was a week sober and he was still in some obsession to use heroin. And he very earnestly approached me as a counselor at the time. That’s probably 10 years ago.

He said, “Can I talk to you for a little bit?” I said, “Sure.” We went back in my office, and he said, “I’m craving. I really want to use heroin, you know, will you help me?”

I said, “Well, tell me what your plan is. How are you– let’s lay it out. How are you going to go use heroin?”

He said, “Well, I go to Inglewood. I’m going to get some heroin.” I said, “Slow down. Do you have any money on you right now?” He said, “Yeah, I got 10 bucks.” “Well, first of all, give me that 10 bucks.” I took that 10 bucks.

Then I said, “So, how are you going to get ahold of your dealer?” And he said, “I’m going to call him.” I said, “Do you have a cell phone?” He said, “No. You like picked up on my game, right?” And I said, “Okay, well now, if you don’t have a cell phone, how are you going to call dealer?”

He said, “We go to the gas station, and I’m going to call him.” I said, “But you don’t have any money.” He said, “Well, panhandle and then I’ll call my drug dealer.”

I said, “Okay. So, we’re going to walk to the gas station on the corner over there. You’re going to call your drug dealer. He’s going to come drop it off.”

He said, “No. My dealer doesn’t deliver. I got to go to Inglewood. I got to get there. So, I’m going to take the bus.”

I said, “Okay. So, you’re going to take the bus to Inglewood and you’re going to meet your dealer. Where?” “There’s Burger King in Inglewood.” I said, “Okay. And then what?” “So, I’m going to use.” “So, where are young going to use?”

He said, “I’m going to use in the Burger King bathroom.” I said, “With what?” He said, “With foil and a straw.”

I said, “Okay. So, using in a Burger King bathroom.” I said, “And then what are you going to do.” He said, “I’m going to be high.” I said, “Okay. And then what?” And then he said, “I’m going to come home.”

I said, “Yeah. You’re going to go back to your mom and dad’s?” And he said, “No. They kicked me out and I’m going to come back here.” “Okay, so you’re going to go use at the Burger King. You’re going to get high in the bathroom. You are going to catch the bus back after you’re high. You’re going to come back to this treatment program.” So, yeah. I said, “And then what are you going to do?”He said, “Then I’m going to get sober.”

And I, of course, you know, I said, “But you’re sober now. You’re already there. You don’t have to do the loop de loop.”

And he looked at me and he said, “Yeah, but when I’m high, I really want to be sober.”

And I said, “Okay, so what I hear you saying is that in order for you to get and stay sober, you have to get high again.” He said, “Yeah.”

The ego self had basically taken the rational ability and created a little narrative and story, that makes semi sense.

But obviously, if you use that rationale in your life, you’d never get sober, right? Because every time I try to get sober, I have to get high and be motivated to get sober again. You just do that rinse and repeat, over and over. It’s actually what a lot of people do.

The ego self can hijack the rationale in order to create justifications

It’s a reality. And with this particular person, he actually did it. He didn’t do it that night. But a couple of days later, he left and incredibly he was right. He got high at the Burger King. We ended up referring him to a program out of town. And he’s, I think, sober eight, nine years now. So, he happened to be right. But it’s not a good equation as to how to get clean. As an example of how the ego self can hijack the rationale in order to create justifications to continue to enable addiction.

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Aug 01 2020

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Mindfulness in Treatment: Getting to Know Yourself

Yeshaia Blakeney

Addiction, 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, 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, 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, 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, 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, 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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