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The Physical Aspects of Recovery

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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The Desire to Move Forward

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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How Long Do I Need Addiction Treatment?

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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Are We Defining Treatment Success the Wrong Way?

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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The Reality of Treatment Success Rates

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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Dogma in AA: Trusting in the Spirit of Reality

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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AA tries NOT to be dogmatic

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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dual diagnosis treatment for mental health and addiction
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Dual Diagnosis vs Multidimensionality

Some time ago, I had the opportunity to work in the Skid Row area of downtown Los Angeles. In those days (the early ’90s) the residents of the area were divided between need “mental health services” or those needing “addiction services.”  This distinction was usually the result of some odd government funding rules or just the general ignorance of the time. It must have been extremely frustrating for clients to walk back and forth between programs as both programs had strict entrance criteria. Invariably, the client would give up and end up using and just sleeping on the streets. 

 

The Dual Diagnosis revolution came about as both traditional mental health, and substance abuse programs began to realize that clients didn’t fit into these neat boxes. In my mind, this was obvious. Any Introduction to Psychology course will instruct you on understanding the complexity of human behavior. More often than not, people need help in a variety of areas. 

 

Mental health disorders and substance abuse issues are only a small part of the recovery plan Click To Tweet

 

Services such as financial and legal planning, helping the family, and assisting clients in finding good-paying jobs and housing. More importantly, the staff needed to have a greater level of compassion and understanding as clients ranged in age, culture, and background. 

 

More recently, the Diagnostic Manual of Mental Disorders-V (DSM-V) (the psychiatric diagnostic manual) instituted new guidelines for diagnosis along a dynamic spectrum of issues (i.e., health, financial, relationship and emotional issues). This strategy of diagnosis avoided the stale one-word diagnosis (e.g. alcohol abuse) and painted instead of a richer and more clinically useful multidimensional picture.

 

The American Society of Addiction Medicine (ASAM, 2013) has developed a multidimensional assessment model that provides both clients and staff a client-friendly treatment model. The assessment model includes everything from treating withdrawal symptoms to assess the client’s risks of relapse. The ASAM Placement has also allowed a common means of communication between clinicians, recovery professionals, and third-party payors.

 

Unfortunately, rather than focus on treatment efficacy, many programs seem to offer a menu of attractive services, some of which have shown little value in establishing and maintaining the client’s sobriety. Click To Tweet

 

However, most programs use traditional treatment models. Unfortunately, most of these models of treatment reflect the treatment the staff received in their respective recovery programs.  Rather than focus on treatment efficacy, many programs seem to offer a menu of attractive services, some of which have shown little value in establishing and maintaining the client’s sobriety. It’s almost impossible to do a Google search on substance abuse issues without going through countless slick webpages offering expertise and a pleasant rehabilitation process. 

 

The relatively recent focus on Dual Diagnosis has opened the recovery community to an earnest attempt to provide a more simplistic but helpful understanding of clients who suffer from substance abuse and mental health issues. Although both issues are indeed mental disorders, the development of the Dual Diagnosis model has started a much-needed paradigm shift for both clients and treatment professionals. Although the multidimensional approach is growing in the recovery field, it is still challenging to have the staff and client to see just how complicated this perspective is.  Typically, a simple diagnosis like “he’s just an alcoholic” or “he’s a recently divorced drug addict” is used to describe a rather complex individual in a complicated situation. 

 

Along with this development, some insurance companies have become more “savvy” in how they evaluate treatment progress and thus pay for treatment. Some have demanded that the client be discharged to a lower level of care or burdening the client and the family with the additional costs of treatment. I have seen clients lose their treatment benefits and sadly return home only to repeat the cycle of addiction. Along with more effective treatment models, funding agencies need to support our client’s in their recovery as a medical necessity and not just auxiliary service. 

 

In my own recovery, the most helpful experiences were those in which compassionate staff helped me develop a sense of hope and regain a more balanced perspective on life in general. I learned to develop a greater acceptance of my higher power and trust in myself and my support system. These and other dynamics such as compassion, humor and the ability to have fun without drugs, remain outside traditional addiction medicine, but in many ways are just as important (or more). 

 

My own personal experiences at Recover Integrity have shown just how a program can be both a treatment program, providing complex dual diagnosis treatment, and a place of healing and renewal of hope Click To Tweet

 

My own personal experiences at  Recover Integrity have shown just how a program can be both a treatment program, providing complex dual diagnosis treatment,  and a place of healing and renewal of hope. This humanistic perspective perfectly emboldens my own work as a clinician and as an administrator of the program. [/vc_column_text][/vc_column][/vc_row]

If you think a loved one would benefit from a dual-diagnosis treatment plan, please reach out to us for a free 15-min consultation. We are here for you.

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    The Rebel Side of Alcoholics Anonymous

    What to expect in this episode:

     

    1. People suffering from addiction often feel very rebellious inside
    2. The most radical thing about AA is that it’s completely detached from the market
    3. Alcoholics Anonymous is rebellious, it rejects traditional hierarchy & is free

    Alcoholics Anonymous is for Rebels 

     

    The other thing about Alcoholics Anonymous; addicts and alcoholics often feel rebellious inside.

     

    There’s a rebel piece that grows inside of us during the teenage years and sometimes we have a hard time growing out of.

     

    (…Maybe we shouldn’t grow out of it.)

     

    I would say Alcoholics Anonymous is very rebellious.

    Alcoholics Anonymous is completely disconnected from the market place

     

    When I say its free, that’s a big deal, it also is completely disconnected from the market place. Its not only that it doesn’t cost any money to go there. There are non profits that you can go to that don’t cost money; but it actually has little to no relationship to the market place at all other than people putting a dollar in a basket to pay some cheap rent at a particular building. 

     

    SO it is totally disconnected from our economic system, and I would invite anybody to name any other institution that’s completely disconnected from our market economy. I think that’s important. 

     

    There are no commercials or advertising for it, somehow it’s just its own temple, or sacred space. It hasn’t been invaded by a lot of economic forces that we are all at the whim of. So I think there is something special about that. 

    Alcoholics Anonymous Hierarchy

     

    The other thing about AA is that it’s not hierarchical, not that there is no hierarchy, it just a very flat hierarchy.

     

    There’s nobody in charge; when you go to a meeting, there is someone leading the meeting, that rotates every 6 months based on a democratic process usually, that people vote on. 

     

    You might ask, “Who is in charge of these millions of people in Alcoholics Anonymous?” nobody knows, no one is in charge. It is people coming together to help each other in a way that has now worked for 80 years. It’s incredible to have that kind of flat hierarchy and it’s worked now through 3-4 generations of people.

     

    That’s deep, religion is not like that, corporations are not like that, and my family is not even like that… well sometimes it’s like that… 

     

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    The Controversial Nature of Alcoholics Anonymous

    What to expect in this episode:

     

    1. Where, specifically, is your resistance coming from?
    2. CBT & DBT are nice , but they are cost prohibitive
    3. The most radical thing about AA is that it’s FREE

     

    The Controversial Nature of Alcoholics Anonymous

     

    The resistance that people have to the 12 steps can be overcome.

     

    What it takes is a person understanding specifically where your resistance is and walking you through it; allowing you to see it and understand it in a way that’s palatable for you. Showing you that in the beginning you can tolerate it and in time come to enjoy. 

     

    I’m not into force or coercion, so a person has to say, “I am open to learning about this”. For a lot of people 12 step recovery is the biggest resource they’re going to have. There are quite a few things about 12 step that are really incredible and are not replicated anywhere else as of now, in terms of support for addicts and alcoholics. 

     

    The first thing I would say that is really radical about the 12 step program is that it’s FREE. I hear a lot of critique from psychologists and psychiatrists, and honestly I don’t like it, about the 12 step program. That it’s not sophisticated enough, it’s a religion; the same critique that clients have, they parrot those (opinions) back in NPR.So I will ask, “What is your solution then, for addicts and alcoholics”? They will say CBT, which is particular therapeutic modality or DBT (another therapeutic modality), or psychiatry, etc. 

     

    That’s great, but what about the hundred million people who can’t afford to go see a therapist 3 times a week, at $120-$180 per hour in LA. What about the million people who can’t afford $400 per hour to see a psychiatrist monthly? What about those folks? What is going to be their consistent support? SO they critique it, but they don’t have another good solution in the end. If you were to ask me, “How many people do you know in recovery”? I’d say, “I know about 2500 people in recovery”. If they said, “how many of those people had a 12 step experience as a foundation for their recovery”? I’d say, “Probably about 2475”. 

     

    Now that’s not evidence that this is the only way to do it, or the only way that works, it’s the most available way to do it, so that makes sense. However, if you were to say, “Yeshaia, how many times have you seen people use an alternate route to recover successfully”? My answer would be 330-40, or something like that.

     

     

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