Burn Out? Act Now Before its Too Late

A few months ago I noticed those all too familiar signs that I was starting to burnout.  Burnout can look different for all of us, but for me I notice increased stress and anxiety, impatience with loved ones, difficulty turning work off after hours, and difficulty sleeping.  I do my absolute best to prevent burnout from happening, but despite my good intentions, sometimes I forget to do the things I need to do.  The dangerous thing about burnout is that if we don’t do something about it, burnout can affect the care we offer our patients, and secondly affect our own wellbeing. 

The most effective way to prevent burnout is to have a well-rounded self-care regimen.  Self-care includes emotional, mental, physical and spiritual health.  The key is finding a way to address all of these areas.  It doesn’t have to be something ground breaking.  For example it can simply be saying the Serenity Prayer between each patient, or doing a deep breathing exercise on your lunch break.  The key is routine, intention, and longevity. 

When I noticed my own signs of burnout, I evaluated my self-care regimen and realized I needed to make some changes.  First, I needed to cut back on the number of patients I was seeing per week.  I also needed to make sure I was able to get to the gym 2-3 times during the week, which meant making sure I could leave work in enough time to get to the gym and pick up my daughter from preschool.  There were a few other things I decided to do as well.  I decided to cut my caffeine intake in half.  Caffeine is a stimulant and will increase anxiety, so I decided it would be worth a shot.  The final change I made was to increase the time I spent doing yoga and meditation each day.   My hope was that if I committed to practicing yoga and meditation each day for 15 minutes twice a day, I would see a faster reduction in my burnout symptoms. 

A month later, I’m feeling much better.  I’m feeling more rested, more relaxed, and I’ve created a much healthier work life balance.  To be honest, I felt better after just a couple of weeks.  I think all of the changes I’ve made have contributed to feeling better.  However, I feel that the increase in yoga and meditation and the reduction in caffeine helped the most. 

As therapists, it is our ethical responsibility to strive to be the healthiest person we can be.  This means continually evaluating our mental, emotional, physical, and spiritual health in order to best serve our patients. 

Therapists: Check Your Language When Discussing Addiction and Recovery

An area that I feel is extremely important when working with patients in early recovery from addiction is making sure we are using empowering language about addiction and recovery.  Language about addiction and recovery goes back decades.  However, some of this language was born out of the idea that addiction is a moral defect or weakness.  Consider the statement “clean and sober”.  How many times have we heard a patient say this?  Or a therapist say this?  When you consider what the opposite of “clean” is, being “dirty”, does that mean that someone who is not yet sober is dirty?  Absolutely not, which is why we have to change how we talk about addiction and recovery. 

We have to remember the amount of shame that some patients experience in early recovery.  Men and women can both experience shame.  Part of our job as a therapist is to help patients build back self-worth.  Using negative and shaming language with patients in early recovery can reinforce a cycle of messages that devalue self and increase feelings of shame. 

I like to compare addiction to other chronic diseases because it highlights how much we still hold addiction to moral standards versus medical standards, when compared to other chronic diseases.  Let’s consider cancer.  When someone is currently undergoing cancer treatment and has symptoms of the disease, then it is appropriate to say that they have cancer.  However, when someone is in remission from cancer, do they normally say that they still have cancer or are still sick?  Of course not.  Consider the emotional detriment that would cause if it was an accepted practice for people in remission from cancer to tell people they were still sick or still had cancer.  I would imagine this would impact emotional and mental health negatively.  I bring up this example of cancer to compare it with addiction recovery.  Many people feel they have to call themselves an alcoholic or addict even when they are in recovery.  For some, this may feel right for them.  However, for those with low self-worth or those with pervasive self-devaluing thinking, this could be very damaging.   I understand it is important for a patient to come to an acceptance that they have an addiction, however, we can help our patients come to this acceptance in ways other than reinforcing a label that results in feelings of shame for some patients. 

It is important for patients to know that they can choose to call their recovery whatever feels best for them.  Maybe this is “I am a person in recovery”, or a “person in long-term recovery”, or a “person in stable recovery”.  When someone in remission from cancer says “I have been in remission for this much time”, it instills a feeling of hope for the future.  Our patients in early and long term recovery deserve to experience this feeling of hope as well, just as much as a cancer patient.  Let’s help them feel that way. 

For more information on recovery messaging training please visit this website:

http://facesandvoicesofrecovery.org/what-we-do/training/recovery-messaging.html

Not All Addiction Treatment is Created Equal

Addiction is a chronic, neurological brain disease that requires on-going, individualized treatment.  One of the most important aspects of addiction treatment is helping the patient come to an acceptance of addiction as a chronic disease and providing them the tools to manage it long-term.  When the patient is able to understand that addiction is a chronic disease, then there is a higher probability that they will make choices in line with managing a chronic disease.  The treatment programs that have the most success in achieving low relapse rates are those that educate, prepare, and provide the patient with tools and knowledge to help keep the symptoms of addiction in remission, long-term.    In other words, acute intervention for a chronic disease does not work. 

Even though addiction is a chronic illness and can be compared to other chronic illnesses like hypertension and asthma, society still sees addiction as a moral defect, not a chronic disease.  Because of the stigma that exists, people who have a substance use disorder are held to moral standards, not medical standards.  However, when compared to relapse rates for hypertension and asthma, addiction relapse rates are fairly similar.  The National Institute on Drug Abuse states that relapse rates for addiction are 40-60%, whereas relapse rates for asthma and hypertension are 50-70%.  When diagnosed with something like asthma or hypertension, no one expects that 30 days of treatment will help them manage a lifelong condition, just the opposite, there is an understanding that the disease requires lifelong management.  Then why is there a belief that 30 days of substance abuse treatment is all that is needed to manage a lifelong neurological brain disease? 

When someone is diagnosed with a substance addiction, the treatment programs that are most successful are those whose philosophy and treatment protocols revolve around the idea that lifelong management is required to achieve long-term sobriety.  What this means is that 30 days of treatment is not enough.  The research shows that the longer someone is engaged in treatment, the better chance they have of maintaining long-term sobriety.  What this means is that the first 30 days of inpatient treatment is normally to simply detox and stabilize the patient.  All reputable residential treatment programs will recommend and set-up aftercare programs for their patients.  They may recommend an intensive outpatient program, sober living, an aftercare program, ongoing drug testing, self-help support groups, individual counseling, or a combination of all of these.  The patient’s ability to maintain long-term sobriety is directly connected to following through on their aftercare plans.   In other words, follow the recommendations of the residential facility. 

So if not all addiction treatment is created equal, how do you choose a treatment program?  That is the question.  Unfortunately addiction treatment has turned into a money making business and there are unethical treatment programs popping up on every corner.  If you work in the industry it’s easy to know who the good treatment programs are and who is not.  However, for the general public, it is very hard to navigate the waters of addiction treatment.  Especially when the not so good treatment programs have huge marketing budgets and are the ones that come up first on an internet search. 

If you or a loved one are looking for an addiction treatment program, I would recommend calling the impaired physicians organization in your state and ask for referrals.  Each state has an impaired physicians program that monitors physicians who have substance use disorders, and much more.  These organizations have strict guidelines about the addiction treatment programs they will refer to.  They also ascribe to the philosophy that addiction requires long-term, on-going care.  They will be able to point you in the direction of a reputable treatment program that they have found success with. 

Why Mindfulness?

Mindfulness is a buzz word that we all hear nowadays…however, mindfulness has been around forever, literally forever!  My mindfulness journey started 13 years ago when I was living in New York City, and could not afford to take yoga classes at a fancy studio.  So, I joined the gym I could afford, and that is where I had my first experience with yoga and meditation…attempting to sit in silence and focus on my breath while people in an aerobics class were jumping up and down and rattling metal lights right above my head.  Looking back, maybe this was the perfect place to learn.

A bit about me first.  I’ve been a psychotherapist for almost a decade now, have been through years of psychotherapy myself, and am a trained yoga teacher.  I am in recovery from a severe anxiety disorder.  My desperation to find a holistic way of reducing my anxiety led me to this yoga class 13 years ago. 

The thing about mindfulness is that it is not new, it’s been around for thousands of years with its roots in Eastern traditions.  I sometimes wish we could call it something else, because I think just the name itself makes it sound impossible!  Who is mindful 100% of the time?  No one!  If it were called something else like “paying attention really well” that might not sound so daunting or impossible. 

But seriously, why mindfulness?  Because it works.  Many studies have emerged showing that mindfulness and meditation can improve symptoms of stress, anxiety and depression; and new research is coming out regularly about other areas in which mindfulness is helpful, such as addiction treatment. 

So, why don’t you give it a try?

How to Increase Recovery Rates for the General Population

The recovery rates for physicians, attorneys, nurses and pilots are significantly higher compared to the general recovering population.  Robert Dupont's longitudinal study of 16 physician’s health programs identified the common eight essential elements responsible for their significantly higher long-term recovery rates. The eight essential elements consist of: positive rewards and negative consequences, frequent random drug testing, 12-step programs and abstinence, recovery mentors, modified lifestyles, active and sustained monitoring, active management of relapse, and a continuing care approach.

How can we provide this type of service for the general population?

Recovery Transitions is a gender responsive, co-occurring disorder, Recovery Enhancement Program (REP) designed for adults leaving primary treatment. Recovery Transitions helps individuals transition back to their home or sober living environment by providing support and accountability in the form of group therapy, family support, and monitoring in order to increase the chances of sustained, long-term recovery.

The Recovery Enhancement Program (REP) was developed to fill a need in the addiction field for specialized treatment for those leaving primary treatment that is modeled partly after the physician health program model. The Recovery Enhancement Program is designed for those who have already obtained extensive education on addiction. It is composed of three, two hour group sessions per week that focus on Structured Family Recovery, Re-integration into daily life, and Mindfulness based Relapse Prevention. Additionally, treatment modalities focus on developmental recovery needs, accountability though monitoring and family recovery and mindfulness based relapse prevention skills. Following the twelve week Recovery Enhancement Program, a continuing care program is offered for continued group support and accountability.

For the Women’s Program please contact Kristin Dickie at 704-237-7037

For the Men’s Program please contact Steve Hanna at 704-517-0613

Helping Women in Early Recovery Build Self-worth

Women in our society are faced with glass ceilings, stigma, and closed doors every day of their lives. In the Western world we are light years ahead of other cultures, but these barriers still exist in our culture and are preventing women from feeling valuable.

When you think of what it means to be a woman in American culture, what messages come to mind?

We should be good wives and mothers….We shouldn’t be too outspoken or opinionated….We should look a certain way….We should dress a certain way….We should aim to please others….And the list goes on.

The problem is that these messages set women up to believe that their value is based on opinions of others and society, instead of placing value on their own dreams, goals, and needs which are consistently neglected. When our value as a person is based on the approval of others, we are constantly searching for ways to feel good about ourselves through other people. The problem with this situation is that self-worth is not conditional, it is something that every human has a right to feel, no exception.

For some, the pressure to obtain value from others is overwhelming. For some of these women the chronic shameful thoughts they experience have been present since childhood. Life has been a series of unsuccessful attempts to develop self-worth and value through other people and things. Some women turn to self-medication to escape feelings of not being good enough. Whether its alcohol, drugs, sex,shopping, work, or anything else used to escape, chronic feelings of shame are too much for anyone to bear.

For women in early recovery from alcohol and drug addiction, shame can be a constant state of being. Shame exists from not only chronic feelings of not being good enough, but also feeling as though they have failed as wives and mothers. And now that they are in recovery, some also experience shame for having an addiction. Shame is a feeling that can trigger relapse. It is important to distinguish shame from guilt. Guilt is a normal human emotion that we experience when our behavior has led to a consequence that we feel bad about, such as hurting someone’s feelings. Shame, however, is a much deeper, more pervasive feeling. Shame is a feeling we experience when we feel that not only is our behavior bad, but we are bad.

Helping women develop healthy self-worth in early recovery is one of the most important aspects of relapse prevention for women. Women have to feel as though they are valuable and that their feelings and needs are important. All women need to be treated with respect and dignity by family members and treatment providers. These women will need help determining which relationships in their life are healthy, and which are unhealthy, and assisting them to set boundaries or end unhealthy relationships. It is especially important for facilities and counselors to provide treatment and assistance to these women in a way that helps to empower them, not hinder their development of self-worth.

All women deserve to feel they are valuable. If you are a woman in early recovery struggling with low self-worth, it is important to know that you deserve compassionate and respectful treatment from professionals that will empower you and help build you up, not break you down.

Sitting with uncomfortable feelings

Sitting with uncomfortable feelings is hard for all of us, this is why they are called “uncomfortable feelings"... they’re not comfortable. Western society views these uncomfortable feelings as “bad”, yet, these “bad” feelings are completely normal. Some of us go to great lengths to escape these feelings, whether they are resentment, anger, rage, sadness, grief, depression, jealousy, anxiety, fear, etc.

However it is these feelings that make us human.

A common reason for some people to turn to substances is to escape these uncomfortable feelings. Maybe some feel as though they are weak, or bad, or wrong for having these feelings, and so to escape them they use drugs and alcohol. Overtime the use of substances to escape feelings can turn into addiction.

A major part of the recovery process and learning how to live sober is learning how to sit with uncomfortable feelings. Feelings are temporary, and feelings carry no judgment. Yet some fear that a feeling will never end, or that something awful will happen if they feel the feeling. Sitting with uncomfortable feelings means to invite them in and experience them. 

Sitting with uncomfortable feelings means to accept that you are human. 

Sitting with uncomfortable feelings means to understand feelings are temporary, and they will pass. Sitting with uncomfortable feelings means to face the feeling and walk through it. Sitting with uncomfortable feelings means you are growing and maturing emotionally. Sometimes sitting with uncomfortable feelings means facing a truth you have been avoiding. Sitting with uncomfortable feelings is being honest with yourself.

The next time you experience an uncomfortable feeling, instead of trying to escape it, invite it in, know it will pass and embrace the knowledge you can gain from it.

Thoughts on Addiction from Silver Lining Counseling

DO I REALLY HAVE A PROBLEM?

In the early stages of identifying if you have a drug or alcohol problem, there is a constant debate in the mind; rationalizing, justifying, and then doubting yourself and your justifications. 

Some questions to ask yourself:

1.    Do you feel guilty about your drug or alcohol use?

2.    Have you ever thought you should cut down your drug or alcohol use?

3.    Have you ever felt annoyed when people have commented on your use?

4.    Have you ever used to avoid withdrawal symptoms or to avoid feeling low after using? 

WHAT DOES AN ALCOHOLIC OR ADDICT LOOK LIKE?

An alcoholic or addict looks like everyone.  They look like me and you.  They look like your next story neighbor.  They look like your doctor or dentist.  Addiction does not discriminate and affects everyone and anyone regardless of race, culture, socioeconomic status, gender, education, profession, sexual orientation, etc.

THE REALITY

The reality is that people are dying from this disease every day.  According to NIDA, more than 1700 young adults died in 2014 alone due to prescription drug overdoses, that’s 5 deaths per day.  Like other chronic diseases, addiction is fatal if left untreated.  The good news is that addiction is very treatable.       

THE PROBLEM

The problem is that not enough people are getting treatment.  Stigma is still a huge problem in our culture when it comes to addiction and prevents people from wanting to come forward and admit they have a problem.  Addiction is NOT a moral defect.  Addiction is NOT a defect in willpower.  Addiction is a chronic brain disease. 

THE SOLUTION

If you feel that you may have a problem, or simply want to talk to a professional about your drug or alcohol use, pick up the phone and ask for help.  Fortunately there are many licensed professionals that specialize in addiction treatment that will help you develop a treatment plan for achieving sobriety.  A good place to start is the SAMHSA treatment locater:  https://findtreatment.samhsa.gov/

Another place to start is with your health insurance company.  Call the member phone number and ask for a referral to an addiction specialist.  If you live in the greater Charlotte area, Silver Lining Counseling can help.  Call 704-237-7037 for a free consultation and to schedule an appointment.  Visit www.silverliningcharlotte.com

Many people are nervous about meeting with a professional to discuss their drug or alcohol use.  Those of us who are licensed as addiction specialists understand that addiction is a chronic medical disease and that those struggling with the disease deserve to be treated with compassion, professionalism, and respect.  In your first meeting with an addiction specialist, the professional should inform you upfront of their business practices, typically done through their intake paperwork.   A thorough assessment follows which includes substance use and mental health history, medical and family history, relationship history, work and education history, legal history, and then the goals and needs of the client.  Following the assessment, the professional should be able to make a recommendation for the best treatment plan to help you achieve sobriety. 

Remember, addiction is a treatable disease.  All you have to do is ask for help. 

Sources

National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

Is being connected really connecting?

I was up with my daughter this morning at 6am.  We were sitting on the floor in front of the fireplace playing with one of those wooden puzzles.  She was sitting in my lap, and I was helping her put the letters in the right place.  However, I noticed that I was constantly having to check my phone or look at my tablet.  There was this consistent urge that was pulling me back to my electronics, interfering with my ability to stay present and fully connected to my daughter.  Finally, with intention, I put the gadgets down and turned my attention to my daughter.  Almost instantly I noticed a shift in my state of mind.  When truly connecting with my daughter I felt more alive and present.  I've realized that I need to be intentional with my use of electronics, and to make sure I'm not using them as a distraction.  There is a difference between accomplishing a specific task using electronics and using them as a way of distraction or escaping. 

An Attitude of Gratitude

Thanksgiving is a time we give thanks for the blessings in our life. 

Every day is Thanksgiving.  Every day I am reminded of how grateful I am in so many ways.  I am so grateful to live in a country where my family and I are physically safe.  I am so grateful to have been provided the opportunities to pursue the career that I have always wanted.  I am so grateful to be part of the lives, struggles and healing process of my clients.  I am so grateful for my family and friends who support me.  I am so grateful for my husband, my daughter, and my dog.  And, I am so grateful for my own mental health struggles that have allowed me to heal and grow in ways I never dreamed of.  

Every day I am grateful.

Dogs Do The Darndest Things

I walked into the living room this morning, and my standard poodle Oscar had eaten, literally EATEN, eight of my daughter's crayons.  What is tasty about CRAYONS?  They certainly don't taste like chicken.  There were little multi colored bits all over my ivory shag rug...

Oscar has been misbehaving since my daughter was born a year and a half ago.  I know it's because we are not giving him the attention he needs.  One of the things I am constantly working on, is remembering that he needs attention too and making time to do that.  Practicing mindfulness and intention helps me to remember about the important things in life, like spending time with Oscar. 

Beginnings

“And suddenly you know…It’s time to start something new and trust the magic of beginnings”    -Unknown

As I enter into my third week of starting my new private practice, Silver Lining Counseling, I am grateful for the kind community of mental health professionals that Charlotte has.  Before my practice opened I was anxious and fearful of the unknown.  I had a constant feeling of discomfort in my stomach for weeks.  However times of discomfort bring opportunities for growth and experience.  The Charlotte community has welcomed Silver Lining Counseling with open arms, and I will always be grateful. 

Thank you Charlotte….